Queensland Urban Utilities WRAP Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Job Details

• 1.1 Have all relevant job details been documented on the WRAP Sheet?

  Yes

  No

  N/A

2. Site Conditions

• 2.1 Have all relevant site conditions been documented on the WRAP Sheet?

  Yes

  No

  N/A

3. General Hazards

• 3.1 Have all relevant General Hazards been documented on the WRAP Sheet?

  Yes

  No

  N/A

4. High Risk Activities

• 4.1 Have all relevant High Risk Activities been documented on the WRAP Sheet?

  Yes

  No

  N/A

5. Emergency Rescue Planning

• 5.1 Have all relevant Emergency Rescue Plans been documented the WRAP Sheet, and been completed correctly?

  Yes

  No

  N/A

6. Equipment & Tools

• 6.1 Have all relevant Equipment and Tools been documented on the WRAP Sheet?

  Yes

  No

  N/A

7. Permits/ Records Required on The Job

• 7.1 Have all relevant Permits/ Records Required on The Job been documented on the WRAP Sheet and been completed correctly?

  Yes

  No

  N/A

8. Licences & Competancies

• 8.1 Have all relevant Licences & Competencies been documented on the WRAP Sheet?

  Yes

  No

  N/A

9. Personal Protective Equipment

• 9.1 Has all relevant PPE required for the job been used and recorded on the WRAP sheet?

  Yes

  No

  N/A

10. General Public Safety

• 10.1 Have all relevant Public Safety risks and controls been documented on the WRAP Sheet?

  Yes

  No

  N/A

11. Task Risk Assessment

• 11.1 Have all Risks & Controls relevant to the activities been implemented and documented on the WRAP Sheet?

  Yes

  No

  N/A

12. Work Team Hazard Control Acknowledgement- Sign-on Record

• 12.1 Have all personnel involved with the activities signed onto the WRAP Sheet?

  Yes

  No

  N/A

13. Ongoing Monitoring

• 13.1 Have all relevant changes been considered and recorded on the WRAP Sheet?

  Yes

  No

  N/A

14. PICOW Handover Meetings

• 14.1 Has there been a PICOW handover as required? (answer yes if there has not been a handover)

  Yes

  No

  N/A

15. Further Reccomendations or Actions

16. Internal/ External Audits

• PICOW Consulted During Inspection- Name & Position:

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• Person Conducting Inspection- Name & Position:

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