QSE Executive Walk Record

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

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?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

Procedures and Actions

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 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

  Sign

• Coordinator

  Sign

• Revision 1 16/02/2013