Information
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Conducted on
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Resource Partner (Contract Company)
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CitiPower / Powercor Contract Responsible Officer
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Does the Inspection Project Site involve construction work with a value >$250,000
C6 - Construction Projects >$250,000
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Has site induction been performed and documented onsite?
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Has a site H&S Co-ordination Plan been developed, available for inspection and communicated to all employees onsite?
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Is Principal Contractor signage detailing company name and contract information displayed at worksite? (If project is for a short duration, signage on vehicles displaying the Company name will suffice)
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Contract No / PM Order No
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Location
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Inspection No
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Brief Description of Job
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Prepared by
C - CUSTOMER SERVICE
C1 - Identification
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Do ALL personnel on job site have CitiPower/Powercor IDs available?
Employee
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Name & ID No. required
C2 - Passports & Authorities
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Do ALL personnel have ESI Skills Passports and/or relevant Authorities/Licences present?
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Are personnel undertaking duties that align with their job role displayed on their photo ID?
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Where applicable has site specific induction been performed?
Passport/Licence Authority Matrix
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List the names of all Traffic Controllers (Ensure ESI Skills Passport is available and listed Training is up to date)
Employee
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Name
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ESI Skills Passport on site and signed
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Lineworker Registration Card (Record Number)
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CP/PAL Authority label/s in passport (if applicable)
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Construction Industry Induction Card (e.g. White/Red Card)
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WorkSafe High Risk License (e.g. WP,DG)
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Apply ESI safety rules (Initial Only)
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CPR and First (ESI Environment) (yearly)
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EWP Rescue & EWP Controlled Descent Escape (yearly)
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Live LV Work (e.g. O/H, Cable Jointing - 3 yearly)
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Testing of Connections (Servicing Procedures) (yearly)
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VESI Safety Framework (3 yearly)
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VESI Environmental Framework (3 yearly)
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Safe Approach Distances (yearly - if applicable)
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Safe to Approach SWER (3 yearly)
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Traffic Management (3 yearly - if applicable)
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Other?
C3 - Vehicle Signage
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Do the vehicles have CP/PAL signage correctly displayed?
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List All Vehicles & Plant
Vehicles / Plant
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Registration No. & Vehicle Type
C4 - Company Logo
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Are the contract company employees wearing attire with their company logo clearly displayed?
C5 - Safety Observer
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Does the work being performed require a dedicated Safety Observer?
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Name Required:
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If a Safety Observer has been nominated for HV Live Line works, are they wearing a dedicated "Safety Observer" vest or equivalent?
Q - QUALITY
Q1 - JSA Related Documentation
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Are completed risk assessments available onsite?
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JSA / Toolbox?
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Traffic and/or Environmental Plan?
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CSCC and/or Fault Log Sheet?
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Apprentice JSA (if appliacble)
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Safe Work Method Statement? (Mandatory for Construction Projects >$250,000)
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Do the risk assessments reflect ALL hazards of the job and have the appropriate control measures been documented? (e.g Exposure to potential LIVE Electrical sources, SWER earth exposure, asbestos removal, etc)
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Does the risk assessment reflect all the Environmental aspects of the job and have the appropriate control measures been documented? (e.g. Cartage delivery & removal of soils, concrete, bitumen etc)
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Is the latest copy of the Field Traffic Management Guidelines available? (i.e. When Traffic Control performed by work crew)
Q2 - Job File Documentation
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Does Job File contain adequate information? (e.g. "Dial Before You Dig", Civil MOC's (from Shire and/or Vic Roads), work instruction, applications, permits, switching instructions, plans, maps)
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Is the job being performed in accordance with the Work Request?
Q3 - Vehicle Log Book
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Does the vehicle have a CP/PAL daily/weekly/ drivers Log Book or equivalent available onsite?
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Is it being filled out correctly and is vehicle washing being recorded?
H - HEALTH & SAFETY
H1 - Personal Protective Equipment
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Are Hardhats being worn/available and within safety period? (Two (2) years from issue date)
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Are Safety Boots being worn and in good condition?
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Is PPE in good condition and worn appropriately? (e.g. coveralls, dust coat)
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Is High Visibility clothing/vest being worn?
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Are Working Gloves required and/or worn?
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Is Eye Protection required and/or worn?
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Is Hearing Protection required and/or worn?
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Is Respiratory Protection required and/or worn? (Drilling of CCA Poles, Dusty conditions)
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Is Sun Cream available and/or supplied?
H2 - Electrical & Permit Procedures
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Is the most current Green Book available onsite?
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Is the work being performed in accordance with Green Book, CP/PAL Technical Standards, Acts, Regulations & Code of Practices, etc?
H3 - Traffic Management
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Is Traffic Control for the job site under the direct of CP/PAL/Resource Partner or Traffic Company?
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Note Traffic Company:
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In your opinion doe the Traffic Management Plan meet the requirements of Australian Standards & Vic Roads Code of Practice?
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Is the Traffic Plan relevant for the work site and available?
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Is the Traffic Plan a separate document or a linked Plan reference to the JSA?
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Is the Traffic WSL qualified to draw a plan? (Traffic T/L must have RIIOHS205A Control traffic with a stop/slow bat & RIIOHS302A Implement traffic management plan or equivlent)
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Note Traffic WSL Name & Authroities
Name
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Name
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RIIOHS205A
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Date of Issue
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RIIOHS302A
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Date of Issue
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Construction Induction
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Other
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Has the Traffic Control WSL signed onto the CP/PAL/Resource Partner JSA?
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Are the appropriate traffic management signs & devices being used? (Class 1 Retro Reflective)
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Advanced warning signs?
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Worksite signs? (Symbolic Worker - Bright Orange)
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Speed Indicator signs / Speed Advisory signs?
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Traffic cones/bollards/barriers? (With Retro Reflective bands)
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Detour signs / Road Closure signs?
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Divergence signs?
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Pedestrian signs?
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Pedestrian Barriers? (e.g. Mesh fence)
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Onsite traffic lights?
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Electronic indicators/arrows?
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Stop/Slow battens? (Identify signage used)
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Is there a copy of the Traffic Memorandum of Authority ("Permission for works on the road") available and on site? (ALL Victorian Roads)
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Is the Traffic signage monitored during the course of the work and has it been documented on the Traffic Plan and/or SWMS?
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Have the speed limits been determined correctly through the worksite?
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Are worksite signs reflecting the actual job and used in conjunction with other traffic signs as required?
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Are the worksite and vehicles adequately protected and clearances maintained between workers/vehicles and adjacent traffic?
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Is the 600mm clearance being maintained between the extended EWP boom elbow and/or crane counter weight and cones/barriers/bollards?
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Is the method of traffic/plant/pedestrian management on site suitable and effective?
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Has possible traffic congestion been considered and are sufficient measures in place to avoid it?
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How does the Traffic Controller manage it?
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Have two flags been placed in the initial approach & speed indicator signs? (Flags are only required in Multi Message signs)
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Are signs in pairs where needed? (if required)
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Have signs been placed on ALL approach roads? (if required)
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Are ALL spaces in multi-message signs filled? (with reflective yellow black minimum)
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Is the signage level & at least 200mm off the ground?
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Is the signage in a reasonable condition and of the correct size?
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Is the signage legible, safely placed and clear of obstructions?
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Have rotation & rest periods of Traffic Controllers been considered? (Break every 2 hours)
H4 - Vehilces
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Are the vehicle(s), (including trailers) in a clean and serviceable condition?
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Is the vehicle presented in an appropriate & road worthy manner? (i.e. Visually check for broken tail lights / windscreen etc)
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Is the vehicle cabin, load area clean & tidy?
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Can equipment be securely restrained when in transit? (including trailers)
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Are safety pins on trailers fitted and being used? (If applicable)
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Are ALL vehicle warning lights/arrows operable and being used appropriately? (Flashing Lights need to be operating when in a designated work zone unless on Private Property or over 3 metres from edge of the road)
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Is an appropriate Fire Extinguisher available for ALL hydraulic plant and/or vehicles carrying a gas bottle or fuel container and where entry into enclosures is required? (minimum 1L pressurised)
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Fire Extinguishers over 1.5kg require testing to comply with A & NZ Safety Standards - yearly
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Is the correct fire control equipment available? (Declared Bush Fire period - 9L knapsack, shovel, rake, drinking water - Powercor area)
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Have the requirements for working on a day of Total Fire Ban been considered? (if applicable)
H5 - First Aid Kit
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Is the First Aid Kit available and located by signage?
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Is the First Aid Kit clean and tidy?
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Are both content and audit checklists included in the First Aid Kit?
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Has the First Aid Kit been audited & signed off by an appropriate person? (Once yearly - minimum)
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Date First Aid Kit last checked:
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Is the First Aid Kit stocked as per content list?
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Does the First Aid Kit contain the mandatory CPR Mask, Emergency Blanket and Disposal Gloves?
H6 - Fall Prevention
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Has fall prevention been considered in JSA?
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Has the highest practicable fall prevention control been considered and employed on the work site?
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Are Safety Harnesses & Lanyards required and/or worn within Test Period? (Required when bottom of feet are 2m above the ground)
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Test Due Date:
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Are the appropriate ladders being used? (non conductive)
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Are safety Harnesses & Lanyards required and/or worn and with Test Period? (Required when bottom of feet are above 2m above the ground)
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Is the Anchor Strap required, attached and utilised? (Mandatory for live ladder works)
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Is the condition of ladders sound? (e.g. stiles, rungs, head and extension ropes)
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Is the ladder secured to the pole correctly? (head rope - 12mm min)
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Is a dedicated Pole Top Rescue Kit (LIVE ladder work) or Pit Rescue Kit available and within test period?
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Test Due Date:
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Is the Pole Top Rescue Kit location identified by signage?
H7 - LV Equipment
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Are working Voltage, Neon & Phase Sequence Testers available?
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Is a working Insulation Resistance and Continuity Tester available and within test period? (e.g. Meggar)
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To establish Neutral Integrity Test Point (NITP) Test Due Date:
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Is a working NST Tester available and within test period?
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Test Due Date:
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Is an Independent Earth Reel available?
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Are LV Gloves available, in good condition and used correctly? (i.e. "work glove outers")
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Was an Integrity Test of LV gloves performed by a "Roll Test" to confirm serviceability?
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Are LV Matts/Hoses available and in good condition?
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Are LV Hoppers and Bonders available and in good condition?
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Is a Fuse Stick and adapter available and in good condition?
H8 - HV Equipment
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Are ALL Operating Sticks and Live Line Equipment within test period and in good condition?
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Test Due Date:
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Are HV Operating Gloves and Sleeves available, within test period and in good condition? (yearly)
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Test Due Date:
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Is the Modiewark within test period and in operable condition? (yearly)
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Test Due Date:
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Are High Current (16Ka) and/or Trifurcating Earths available and used where required? (Operational / SWER and 3/12 Conductors)
H9 - Plant & Equipment
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Note type of Equipment and Plant being used:
Equipment / Plant
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Type of Equipment / Plant:
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Is the Plant & Equipment being used in accordance with relevant safe work practices?
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If NOT, is the appropriate Plant & Equipment available?
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Are portable Electric Tools and Leads within test period?
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Test Due Date:
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Generators (Minimum 12 monthly)
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Service Due Date:
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Earth Meggar
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Test Due Date:
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Other
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Test Due Date:
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Are Gas Bottles securely and safely stored adequately in a ventilated area?
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Does the vented cupboard have a "L.P.Gas Storage" sticker displayed?
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Are hoses and fittings in good condition?
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Is the Gas Bottle within 10 years of manufacture or test period?
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Are all Fuel and/or Chemical containers labelled correctly?
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Are Fuel and/or Chemical containers stored adequately in vented area?
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Is portable straining and lifting equipment within inspection period?
Elevating Work Platform (EWP)
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Is the EWP logbook available and completed? (Mandatory - WorkSafe requirement)
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Is the EWP in a clean and serviceable condition?
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Is the EWP correctly positioned and earth chain utilised? (Mandatory when working within close proximity of LIVE Conductors - WorkSafe requirement)
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Are the chocks and stabilisers correctly used? (chocks behind front wheels & pads beneath stabilisers)
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Is the EWP inspection & service sticker on top RHS of windscreen? (scheduled 3 monthly)
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Is the EWP within its electrical test period & is sticker on top RHS of windscreen? (electrical test 6 monthly - insulated EWP)
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Electrical Test Due Date:
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Is the EWP within its mechanical/load weight test period & is sticker on top RHS of windscreen? (scheduled 12 monthly)
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Note type of Earth connection:
Stabilisers/Outriggers and Level Indicators
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Are Stabilisers/Outriggers deployed correctly?
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Were the Stabilisers pads/chocks correctly used?
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Can the Stabilisers be stowed correctly
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What is the condition of the Stabilisers/Outriggers?
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Are Level Indicators fitted?
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What is the condition of the Level Indicators?
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What is the condition of the Hydraulic Controls?
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Are Spring Lock-outs functional? (if applicable)
Condition of EWP Boom
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Are there any visible oil leaks?
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Are the Boom Hoses in good condition?
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Are there cracks visible in the Top Boom?
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Are the EWP Booms clean?
Elevating Work Platform Basket
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Is the Controlled Decent Device (CDD) in good condition?
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What is the condition of the Protective Strip?
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Is the SWL marked on the Basket?
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Is the Basket clean and tidy?
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Are the Controls clearly marked?
Hydraulic Controls
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What is the condition of the EWP Basket Controls?
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What is the condition of the Stabiliser Controls?
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Are the Control Markings in the Basket legible?
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What is the condition of the EWP Base Controls?
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Are the Base Control Markings legible?
H10 - Work Practices
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Were any unsafe work practices observed at the time of inspection?
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Are mandatory test procedures being undertaken? (as required)
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Polarity/NST/Check Testing
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Safe to Climb
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Safe to Approach SWER
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Are the correct work practices being undertaken? (as required)
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Safety Observer
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Sufficient Covering / Matting
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Ladder Secured
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Are appropriate manual handling aids available and/or in use on site?
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Is a handline required and/or in place?
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Are insulated tools being used where appropriate?
Tasks completed as per Technical Specifications (Bulk Change)
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Was lantern cleaned, including around PE Cell Housing?
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Was lamp replaced with correct type of lamp?
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Are PE Cells marked with installation month and year?
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Was PE Cell replaced?
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Was diffuser retaining screws greased?
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Was diffuser thoroughly cleaned?
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Was damaged diffuser replaced?
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Was loose public lighting hardware tightened?
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Was lanterns marked to indicate completion of Bulk Change?
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Were faulty 99, 00 2A PE Cells kept for warranty?
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Were stray light shields removed?
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Was damaged lantern replaced with correct rated latern?
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Was obsolete control/contractor box removed?
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Was gear cassette replaced on roadster lantern and line replaced under year? (e.g. 99 00)
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Was public lighting stay wire replaced and/or reported?
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Were vegetation problems reported? (e.g. Vemco and/or controller)
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Was priority 1 maintenance reported to Outage Co-ordinator?
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Were public lighting faults reported?
E - ENVIRONMENTAL
E1 - Site Management
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Has an Environmental Management Plan been developed for the job site and available?
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Is it a separate plan or linked to JSA and/or SWMS?
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Does the Environmental Management Plan include adequate transportation for removal of waste?
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Are the wastes appropriately stored during transport?
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Are there any restrictions placed on entry to the property and/or roadway?
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Are any waste going off site? (e.g. Soil, Concrete, Bitumen etc)
Material
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After completion of work is all debris on the site being picked up?
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Are there any restrictions placed on entry to the property and/or roadway?
E2 - Incident Response
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Does the Work Site Leader know the appropriate emergency contact phone numbers in the event of an incident?
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Is there a minimum of one spill kit contents available on the job site for any vehicle with hydraulics or jobs involving oil filled equipment?
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Are the spill kit contents sufficient to initially contain a spill situation for the job being performed?
E3 - Vehicle Washing
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Is there Powercor Weeds and Seeds Guide available? (if applicable)
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Are vehicles clean? (e.g. No obvious mud or vegetation present on vehicles)
E4 - Housekeeping
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If the job has been completed, was the work site left orderly, neat and debris free?
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Was suitable storage of materials on EWP/support vehicle retained for the correct disposal of lamps and PE Cells?
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Are hazardous areas protected?
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Are hazardous goods clearly labelled and being stored appropriately?
OVERALL INSPECTION COMMENTS:
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Comments
COMMENTS REGARDING PREVIOUS NON-CONFORMANCES (if applicable):
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Comments
NON-CONFORMANCE / OBSERVATION Raised
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Non-Conformance
NC
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Section
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Identified Non-Conformance (Agree Corrective Action)
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Responsible Person(s)
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Date for Completion
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Has a CARE been raised?
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CARE Number:
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Observation
OBs
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Section
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Identified Observation (Agree Corrective Action)
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Responsible Person(s)
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Date for Completion
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Has a CARE been raised?
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CARE Number:
Inspected Party Representative - CP/PAL Inspector - Observer (if appliacble)
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Representative
Name
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Name
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Company / Position
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Signature