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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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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List the names of all Traffic Controllers
Employee
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Name
C2 - Passports & Authorities
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Do ALL personnel have their relevant Authorities/Licences present?
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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
Employee
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Name
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Construction Industry Induction Card (e.g. White/Red Card)?
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Traffic Management (3 yearly)?
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Other?
C3 - Vehicle Signage
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Do the vehicles have CP/PAL signage correctly displayed? (Only when working on CitiPower/Powercor related jobs)
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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? (Recommendation Only)
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 Plan?
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Safe Work Method Statement?
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Do the risk assessments reflect ALL hazards of the job and have the appropriate control measures been documented? (List additional risks as appropriate)
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Does the work site reflect ALL the documented control measures?
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Has the Traffic Control WSL signed onto the CitiPower/Powercor/Resource Partner JSA?
Q2 - Job File Documentation
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Is sufficient information available to safely undertake the work? (e.g. Job file, location references, road speeds etc)
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Is the job being performed in accordance with the Work Request?
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 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 Sun Cream available and/or supplied?
H3 - Traffic Management
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For which CitiPower/Powercor/Resource Partner is Traffic Control required?
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Note 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 & Authorities
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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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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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 the speed limits been determined correctly through the worksite?
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Note speed/s:
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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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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 - Vehicles
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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)
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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Does the First Aid Kit contain the mandatory CPR Mask, Emergency Blanket and Disposal Gloves?
H10 - Work Practices
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Were any unsafe work practices observed at the time of inspection?
E - ENVIRONMENTAL
E1 - Site Management
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Are there any restrictions placed on entry to the property and/or roadway?
E3 - Vehicle Washing
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Are vehicles clean? (e.g. No obvious mud or vegetation present on vehicles)
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