Queensland Urban Utilities- Safety Conversation Record

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety Conversation

• Safety Share/ Discussion (Details)

Personnel Details

• Work Group?

  Select Governance Legal & Risk People & Safety Information Services Customer & Community Commercial Customer Service Delivery Operations Infrastructure Maintenance Service & Reliability

  • Governance
  • Legal & Risk
  • People & Safety
  • Information Services
  • Customer & Community
  • Commercial Customer
  • Service Delivery
  • Operations
  • Infrastructure Maintenance Service & Reliability

• PICOW Details

• QUU Worker(s) Details

• Contractor PCBU Name

• Contractor(s) Details

Work Risk Assessment Process (WRAP)

• WRAP Notebook Required? (for low risk activities)

  Yes

  No

  N/A

• WRAP Sheet Required? (for high risk activities)

  Yes

  No

  N/A

• Are any High Risk Activities Being Undertaken?

  Select Confined Space Entry Excavation & Trenching Electrical Hazardous Chemicals Working At Height Manual Handling Plant & Equipment Working Adjacent to Roadway Energy Lock Out Tag Out Lifting & Pulling Activities Working Adjacent to Water Lone Worker Demolition Works Scaffolding Asbestos High Pressure Equipment Diving Work Use of Explosives

  • Confined Space Entry
  • Excavation & Trenching
  • Electrical
  • Hazardous Chemicals
  • Working At Height
  • Manual Handling
  • Plant & Equipment
  • Working Adjacent to Roadway
  • Energy Lock Out Tag Out
  • Lifting & Pulling Activities
  • Working Adjacent to Water
  • Lone Worker
  • Demolition Works
  • Scaffolding
  • Asbestos
  • High Pressure Equipment
  • Diving Work
  • Use of Explosives

• Discussion Points:

Photos

• Add media

  Media

Management Representative Completing Safety Conversation (Details)

• Name & Signature

  Sign