Project Name
Project Number
Assessment No.
Date of Assessment
Date
WE* assessor
Peter Cooper
Chris Hancock
Edwin Leong
WE* representative
Peter Cooper
Chris Hancock
Edwin Leong
Service Provider
Connetics
Northpower
Treescape
Other
Works Address
Address
Site photo
Media
Progress % complete
Site Security/Condition
Is the site appropriately secure (fences, gates, signs, etc)?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Is pedestrian public being managed safely and efficiently?<br>
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Is the approved Corridor Access Request (CAR) on site?<br>
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Is Traffic Management set up correctly with TMP on site?<br>
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Are Trucks/EWP’s chocked and earthed?<br>
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Are relevant plans available (including any required mark outs)?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Are all excavations being completed following MOBIE requirements?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Has the appropriate permit been issued for the work task?<br>
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Is the general site housekeeping of an acceptable standard?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Have affected stakeholders, landowners or users been notified of the site works?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Site Personel
Are site personnel wearing appropriate PPE and safety gear including harness?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Where personnel are required to hold a WTC, are those certificates appropriate and currently valid?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Are individuals WTC cards available?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Risk Management/Assessment
Has a hazard assessment been suitably completed by workers prior to commencement of work?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Have the identified risk mitigation control measures been implemented?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Are environmental spill kits available on site?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Do all electrical tools and equipment have current inspected tags?
observation/BP
compliant
P1 non conformance
P2 non conformance
non applicable
Project Description / Work Activity Other Findings
link copied
Anonymous
QSE Assessment Report
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
