Rabbit Warren Fumigation - Daily Inspection Sheet

• Date & time

  Date

• Person conducting inspection

• Site

  Select

• Client Name

  Select

• Please specify

• Site Name

• Site Address
  Address

• Is there emergency / SOS mobile phone coverage?

  Yes

  No

• 2-way radio may be required or identify nearest coverage point.

• Have you notified the client that you are on site?

  Yes

  No

• Please select method of communication

  Emailed BEFORE

  Text upon arrival

  Phone call

  Email AFTER works conducted

  Sign into site

• Yes

  No

• Emergency Acess Location (Nearest cross roads including suburb)

• Emergency Muster Area

  Ute

  Site Entrance

  Other

• Please specify

• Nearest Public Hospital with Casualty. If unsure you can check http://www.health.vic.gov.au/maps/

  Select

• Please specify hospital

Safety, Quality & Environment Checklist

• Do you have a copy of the Safe Working Method Statement (SWMS) forfumigation. This isrequired for high risk activity, such as fumigation and WILL NEED TO BE HAVE BEEN COMPLETED BEFORE PROCEEDING - Please take a photo of the SWMS SIGNED PAGE

  Yes

  No

• Have everyone in the crew been made aware of site risks and had the tasks for the day explained?

  Yes

  No

• All crew must be induction into site and have today's task explained. Have you now taken a moment to do this?

  Yes

  No

• Have all members of the crew completed a chemical safety course (e.g. ChemCert Course) within the last 5 years,?

  Yes

  No

• Does the crew leader (at an minimum) have a current ACUP license with endorsement suitable for the chemicals being used?

  Yes

  No

• Are all chemicals stored in a lockable box that is labelled " Poison"

  Yes

  No

• Does the crew have access to a spill kit?

  Yes

  No

• Has at least two members of the crew completed first aid level 2 within the last 4 years?

  Yes

  No

• Does the crew have access to a first aid kit (including snake bite first aid supplies) that has been serviced and re-stocked within the last 6 months within 20m of where they are working at all times?

  Yes

  No

• Do all vehicles have a fire extinguisher that has be tested within the last 6 months?

  Yes

  No

• Does the crew have access to 20L of clean water?

  Yes

  No

• Does the crew have access to in field hand washing facilities?

  Yes

  No

• Do all crew members have their own full face respirator with a with organic gas/inorganic gas/acid gas/ammonia filter class ABEK1?

  Yes

  No

• Do all crew members have access to a pair of chemical gloves?

  Yes

  No

• Is the crew wearing correct PPE? Long sleeve hi-vis shirt, long pants steel capped boots etc?

  Yes

  No

• Do all crew members have drinking water?

  Yes

  No

• Do all crew members have access to sun protection? Sunscreen, hats, glasses etc?

  Yes

  No

• Is the site accessible by vehicle in current conditions?

  Yes

  No

• Call client to discuss options

• Slopes - are there slopes present

  Yes

  No

• Is there a danger of a vertical fall over 2m on this site?

  Yes

  No

• Fall protection must be used - either prevent access by webbing or other means or use ropes - SWMS must be developed!

• Yes

  No

• Is there potential for staff to spread pathogens & weed propagules?

  Yes

  No

• Please specify type of pathogen/propagules e.g. Phytophthora or Noxious Seed (Refer to Hygiene HSEP)

  Select Phytophthora Noxious Weed Seed Myrtle Rust Blue-green Algae Other

  • Phytophthora
  • Noxious Weed Seed
  • Myrtle Rust
  • Blue-green Algae
  • Other

• If yes - check and clean entire vehicle, boots and clothing for seeds / propagules.

• Is pedestrian and public access management required?

  Yes

  No

• Do not proceed without appropriate barriers and signage.

• Is there a traffic management risk? (i.e. working within 2m of roadside - if unsure check with your manager or client.

  Yes

  No

Site Specific Hazard Identification and Controls

• The following is to be signed to confirm that the job and risk controls have been agreed to, and everyone working on site has had the opportunity to contribute to the contents of the Site Specific Hazard Identification and Controls:
  
  Note: Do not sign if you’re unclear about the risk controls listed in this document (including any risk controls listed in a HSEP or other documents referenced). Ask for clarification from the client or your manager

Crew Sign Off

• Supervisor's Name & Signature

  Sign