Information

  • Conducted on

  • CitiPower/Powercor Contract Responsible Officer

  • Resource Partner (Contract Company)

  • Contract No / PM Order No

  • Location
  • Inspection No

  • Brief Description of Job

  • Prepared by

C - CUSTOMER SERVICE

C1 - Identification

  • List the names of all Traffic Controllers

  • Employee
  • Name

C2 - Passports & Authorities

  • Do ALL personnel have their relevant Authorities/Licences present?

  • Where applicable has site specific induction been performed?

Passport/Licence Authority Matrix

  • List the names of all Traffic Controllers

  • Employee
  • Name

  • Construction Industry Induction Card (e.g. White/Red Card)?

  • Traffic Management (3 yearly)?

  • Other?

C3 - Vehicle Signage

  • Do the vehicles have CP/PAL signage correctly displayed? (Only when working on CitiPower/Powercor related jobs)

  • List All Vehicles & Plant

  • Vehicles / Plant
  • Registration No. & Vehicle Type

C4 - Company Logo

  • Are the contract company employees wearing attire with their company logo clearly displayed? (Recommendation Only)

Q - QUALITY

Q1 - JSA Related Documentation

  • Are completed risk assessments available onsite?

  • JSA / Toolbox?

  • Traffic Plan?

  • Safe Work Method Statement?

  • Do the risk assessments reflect ALL hazards of the job and have the appropriate control measures been documented? (List additional risks as appropriate)

  • Does the work site reflect ALL the documented control measures?

  • Has the Traffic Control WSL signed onto the CitiPower/Powercor/Resource Partner JSA?

Q2 - Job File Documentation

  • Is sufficient information available to safely undertake the work? (e.g. Job file, location references, road speeds etc)

  • Is the job being performed in accordance with the Work Request?

H - HEALTH & SAFETY

H1 - Personal Protective Equipment

  • Are Hardhats being worn/available and within safety period? (Two (2) years from issue date)

  • Are Safety Boots being worn and in good condition?

  • Is High Visibility clothing/vest being worn?

  • Are Working Gloves required and/or worn?

  • Is Eye Protection required and/or worn?

  • Is Hearing Protection required and/or worn?

  • Is Sun Cream available and/or supplied?

H3 - Traffic Management

  • For which CitiPower/Powercor/Resource Partner is Traffic Control required?

  • In your opinion doe the Traffic Management Plan meet the requirements of Australian Standards & Vic Roads Code of Practice?

  • Is the Traffic Plan relevant for the work site and available?

  • Is the Traffic Plan a separate document or a linked Plan reference to the JSA?

  • 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)

  • Are the appropriate traffic management signs & devices being used? (Class 1 Retro Reflective)

  • Advanced warning signs?

  • Worksite signs? (Symbolic Worker - Bright Orange)

  • Speed Indicator signs / Speed Advisory signs?

  • Traffic cones/bollards/barriers? (With Retro Reflective bands)

  • Detour signs / Road Closure signs?

  • Divergence signs?

  • Pedestrian signs?

  • Pedestrian Barriers? (e.g. Mesh fence)

  • Onsite traffic lights?

  • Electronic indicators/arrows?

  • Stop/Slow battens? (Identify signage used)

  • Is there a copy of the Traffic Memorandum of Authority ("Permission for works on the road") available and on site? (ALL Victorian Roads)

  • Is the Traffic signage monitored during the course of the work and has it been documented on the Traffic Plan and/or SWMS?

  • Has possible traffic congestion been considered and are sufficient measures in place to avoid it?

  • How does the Traffic Controller manage it?

  • Have the speed limits been determined correctly through the worksite?

  • Are worksite signs reflecting the actual job and used in conjunction with other traffic signs as required?

  • Are the worksite and vehicles adequately protected and clearances maintained between workers/vehicles and adjacent traffic?

  • Is the 600mm clearance being maintained between the extended EWP boom elbow and/or crane counter weight and cones/barriers/bollards?

  • Is the method of traffic/plant/pedestrian management on site suitable and effective?

  • Have two flags been placed in the initial approach & speed indicator signs? (Flags are only required in Multi Message signs)

  • Are signs in pairs where needed? (if required)

  • Have signs been placed on ALL approach roads? (if required)

  • Are ALL spaces in multi-message signs filled? (with reflective yellow black minimum)

  • Is the signage level & at least 200mm off the ground?

  • Is the signage in a reasonable condition and of the correct size?

  • Is the signage legible, safely placed and clear of obstructions?

  • Have rotation & rest periods of Traffic Controllers been considered? (Break every 2 hours)

H4 - Vehilces

  • Are the vehicle(s), (including trailers) in a clean and serviceable condition?

  • Is the vehicle presented in an appropriate & road worthy manner? (i.e. Visually check for broken tail lights / windscreen etc)

  • Is the vehicle cabin, load area clean & tidy?

  • Can equipment be securely restrained when in transit? (including trailers)

  • Are safety pins on trailers fitted and being used? (If applicable)

  • 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

  • Is the First Aid Kit available and located by signage?

  • Is the First Aid Kit clean and tidy?

  • Are both content and audit checklists included in the First Aid Kit?

  • Has the First Aid Kit been audited & signed off by an appropriate person? (Once yearly - minimum)

  • Date First Aid Kit last checked:

  • Does the First Aid Kit contain the mandatory CPR Mask, Emergency Blanket and Disposal Gloves?

H10 - Work Practices

  • Were any unsafe work practices observed at the time of inspection?

E - ENVIRONMENTAL

E1 - Site Management

  • Are there any restrictions placed on entry to the property and/or roadway?

E3 - Vehicle Washing

  • Are vehicles clean? (e.g. No obvious mud or vegetation present on vehicles)

OVERALL INSPECTION COMMENTS:

  • Comments

COMMENTS REGARDING PREVIOUS NON-CONFORMANCES (if applicable):

  • Comments

NON-CONFORMANCE / OBSERVATION Raised

  • Non-Conformance

  • NC
  • Section

  • Identified Non-Conformance (Agree Corrective Action)

  • Responsible Person(s)

  • Date for Completion

  • Has a CARE been raised?

  • CARE Number:

  • Observation

  • OBs
  • Section

  • Identified Observation (Agree Corrective Action)

  • Responsible Person(s)

  • Date for Completion

  • Has a CARE been raised?

  • CARE Number:

Inspected Party Representative - CP/PAL Inspector - Observer (if appliacble)

  • Representative

  • Name
  • Name

  • Company / Position

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.