Information
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Project/Job #
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Conducted on
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Prepared by
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Personnel
Basic Information
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A. Health and Safety Documentation (incident alerts, investigations etc) completed in a timely fashion?
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B. New Risks identified on site, recorded and forwarded onto RAL promptly?
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C. All personnel inducted onto site?
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D. All personnel signed into site?
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E. Notifiable Work reported appropriately to RAL and WorksafeNZ?
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Any Notifiable Events since last audit?
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F. Have Notifiable Events been reported appropriately?
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G. Corrective actions following Notifiable Event completed in a timely fashion?
General
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A. Is there a relevant JSA/SOP/SWMS (Safe Work Method Statement) for the task(s) being undertaken currently?
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B. Has it been signed by all personnel involved?
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C. Does the JSA/SOP/SWMS cover each phase of project?
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D. Is the JSA/SOP/SWMS on site?
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Take photo of current JSA/SOP/SWMS
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E. Is there a daily site (tool box) meeting to ensure all new hazards / risks have been identified and controlled?
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Take photo of meeting notes.
WORK AREAS
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Site sign-age and fencing appropriate and in good condition?<br>
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General Housekeeping
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Walking - trip hazards managed?
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Unprotected Sides or Holes
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Impalement Hazards
HEALTH/FIRST AID
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A. Trained and current 1st Aid (16 hour course) personnel available at all times?
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B. First Aid Kit (No Expired Items) on site.
PERSONAL PROTECTIVE EQUIPMENT
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A. Hard Hats
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B. Safety Glasses with Side Shields
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C. Face Shield / Goggles (If Required)
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D. Respiratory Protection (If Required)
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E. Hearing Protection (If required)
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F. Clothing (hi vis, fire resistant etc..)
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H. Gloves
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I. Foot Protection
Work at Height
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Is there any work at height?
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A. Trained personnel - (US 15757 fall-arrest or US 23229 basic work at heights) or equivalent.
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B. Equipment inspected within last 6 months?
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C. Equipment (PPE, harnesses etc) worn properly?<br>
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D. Suitable anchors / system set-up?
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E. Emergency rescue system in place? (including trained and competent rescuers)
LADDERS
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A. Base/Footing/Set Up
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B. Inspections/Color Coded
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C. Proper Type for Task
TOOLS AND EQUIPMENT
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A. In Good Condition
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B. Inspected/Color Coded
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C. Whip-Checks
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D. Other:
CONFINED SPACE
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Are there any confined spaces identified on site?
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A. Trained Personnel (Competent Person)
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B. Attendant Trained
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C. Entrants Trained
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D. Attendant Wearing
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E. Attendant Sign In Sheet
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F. Permit Required
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G. Permit Followed
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H. Air Monitoring
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I. Emergency Rescue Plan
ELECTRICAL
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B. Extension Cords (tested and tagged)
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C. Power Tools (tested and tagged)
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D. Lock Out SOP
FIRE SAFETY
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Any hot work being undertaken as part of this project?
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A. Hot Work Permit (if required)
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C. Fire Extinguisher/Inspected
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D. Combustibles removed/isolated
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E. Hot Work Barricade (if required)
EQUIPMENT
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Heavy equipment (excavators, loaders, dumpers etc) being used as part of this project?
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A. Heavy Equipment Inspections completed daily when in use?
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Have vehicles got appropriate ROPS (roll over protective structure), FOPs (falling object protection), COPs (cabin operator protective structure) etc..?
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Take photo of certificate plate.
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B. Operator Qualified and Certified
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C. Operator Manual
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E. Proper setup and use
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F. Lifting equipment and or rigging in service and current.
Hazardous Substances
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Are there any Hazardous Substances located on site?
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Hazardous Substances register on site and up to date?
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A. SDS on Site
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B. Approved Handlers on site if required?
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C. Proper Storage of Chemicals
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D. Proper PPE for Handling Chemicals
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Is explosive blasting being undertaken as part of this project?
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Has this been notified to WorksafeNZ
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Approved Handler with current CSL in charge?
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Appropriate compliant explosives storage provision for site?
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Has an adequate blast plan been developed that covers record keeping, public exclusion, fly rock risks etc?
Environmental Risk Management
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Any affected plants removed carefully and stored for future replanting?
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Have boundaries of work for this project been identified by DOC/RAL/RDC etc?
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Has work remained inside defined boundaries?
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Are vehicles (including concrete trucks etc) being washed down in designated areas only (no run off into any water courses etc)?
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Are fuels (petrol, diesel) being stored on site?
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Is appropriate secondary containment in place? (bunds, tarps, containers)
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Are all personnel trained in refuelling SOPs?
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Are appropriate spill kits on site in close proximity to fuel storage point?
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Are daily checks being done on fuel storage systems on site?
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Appropriate sediment control (silt traps) measures in place where required as per project CMP (construction management plan)?
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Any excess spoil from excavations is being contained and reused for restoration purposes?
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Rubbish or waste materials contained (sawdust, paint flakes, nails wood etc) removed from site - at least weekly.
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Any environmental related incidents reported since last inspection?
Comments/Recommendations
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Enter any corrective actions that will be undertaken
Sign Off
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Safety & Environmental Risk
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Project Manager (RAL)
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Site Supervisor (contractor or RAL)
