Information
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Project Name
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Project Number
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Assessment No.
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Date of Assessment
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WE* assessor
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WE* representative
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Service Provider
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Works Address
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Site photo
Site Security/Condition
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Is the site appropriately secure (fences, gates, signs, etc)?
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Is pedestrian public being managed safely and efficiently?<br>
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Is the approved Corridor Access Request (CAR) on site?<br>
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Is Traffic Management set up correctly with TMP on site?<br>
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Are Trucks/EWP’s chocked and earthed?<br>
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Are relevant plans available (including any required mark outs)?
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Are all excavations being completed following MOBIE requirements?
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Has the appropriate permit been issued for the work task?<br>
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Is the general site housekeeping of an acceptable standard?
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Have affected stakeholders, landowners or users been notified of the site works?
Site Personel
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Are site personnel wearing appropriate PPE and safety gear including harness?
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Where personnel are required to hold a WTC, are those certificates appropriate and currently valid?
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Are individuals WTC cards available?
Risk Management/Assessment
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Has a hazard assessment been suitably completed by workers prior to commencement of work?
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Have the identified risk mitigation control measures been implemented?
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Are environmental spill kits available on site?
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Do all electrical tools and equipment have current inspected tags?
General observations
Project Description / Work Activity
Other Findings
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Observations and BP
Observations and Best Practice
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P1 non conformance
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P2 non conformance
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