Work Details

  • Coordinator

  • Contractor or Worker

  • Task

  • Guidance: Review the JSA or SOP before having the conversation, Comment on good QSE performance, Follow up major concerns with coordinator, Stop dangerous work practices immediately, Avoid blame (look at systems of work), Offer advise to resolve QSE issues you understand, Ask the coordinator to join you, Ask the workers what the JSA or SOP says to do and for their suggestions, Point out any areas needing improvement.

Personal Protection Equipment

  • Is a Hard Hat Required and if so are they wearing it?

  • Is Hearing Protection Required and if so are they wearing it?

  • Are Steel Cap Boots Required and if so are they wearing it?

  • Is Fall Prevention Equipment Required and if so are they wearing it? (Harness required in a boom lift)

  • Is Eye or Face Protection Required and if so are they wearing it?

  • Are Gloves Required and if so are they wearing it?

  • Is a High Visibility Vest Required and if so are they wearing it?

  • Is breathing Protection Required and if so are they wearing it?

Procedures and Actions

  • Is a JSA, SOP or MSDS available and are they following it?

  • Is an EWP being used is the worker using the right equipment and is it safe?

  • Is Mobile Plant being used around people and if so is there separation of people and plant?

  • Is Bending or Lifting required and if so is it being done Safely?

  • A Signs or Barriers required and if so are they being used?

  • Is Plant and Equipment in use and if so is it Maintained (Pre-start checks completed)?

  • Are Environmental Protection Controls required (to protect stormwater, etc.) and if so are they being used?

  • Is Housekeeping being kept up to date (a tidy site is a safe site)?

  • Any further comments?

  • Follow up: On completion the form should be emailed to the QSE Manager, he will record it in the database,file it in the IMS and emailed to the Coordinator for review at the next meeting.

Signatures

  • Manager

  • Coordinator

  • Revision 1 16/02/2013

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.