Information

  • Conducted on

  • CitiPower/Powercor Contract Responsible Officer

  • Resource Partner (Contract Company)

  • Does the Inspection Project Site involve construction work with a value >$250,000

C6 - Construction Projects >$250,000

  • Has site induction been performed and documented onsite?

  • Has a site H&S Co-ordination Plan been developed, available for inspection and communicated to all employees onsite?

  • 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)

  • Contract No / PM Order No

  • Location
  • Inspection No

  • Brief Description of Job

  • Prepared by

C - CUSTOMER SERVICE

C1 - Identification

  • Do ALL personnel on job site have CitiPower/Powercor IDs available?

  • Employee
  • Name & ID No. required

C2 - Passports & Authorities

  • Do ALL personnel have ESI Skills Passports and/or relevant Authorities/Licences present?

  • Are personnel undertaking duties that align with their job role displayed on their photo ID?

  • Where applicable has site specific induction been performed?

Passport/Licence Authority Matrix

  • List the names of all Traffic Controllers (Ensure ESI Skills Passport is available and listed Training is up to date)

  • Employee
  • Name

  • ESI Skills Passport on site and signed

  • Lineworker Registration Card (Record Number)

  • VEDN U/G Accreditation (minimum 1 person onsite)

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

  • WorkSafe High Risk License (e.g. WP,DG)

  • Apply ESI safety rules (Initial Only)

  • CPR and First (ESI Environment) (yearly)

  • EWP Rescue & EWP Controlled Descent Escape (yearly)

  • Testing of Connections (Servicing Procedures) (yearly)

  • VESI Safety Framework (3 yearly)

  • VESI Environmental Framework (3 yearly)

  • Glove & Barrier - Live Line (yearly)

  • Live LV Work (e.g. O/H, Cable Jointing - 3 yearly)

  • Safe Approach Distances (yearly - if applicable)

  • Safe to Approach SWER (3 yearly)

  • Traffic Management (3 yearly - if applicable)

  • Entry to Enclosures (3 yearly - if applicable)

  • Other?

C3 - Vehicle Signage

  • Do the vehicles have CP/PAL signage correctly displayed?

  • 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?

C5 - Safety Observer

  • Does the work being performed require a dedicated Safety Observer?

  • Name Required:

  • 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

  • Are completed risk assessments available onsite?

  • JSA / Toolbox?

  • Traffic and/or Environmental Plan?

  • CSCC and/or Fault Log Sheet?

  • Apprentice JSA (if appliacble)

  • Safe Work Method Statement? (Mandatory for Construction Projects >$250,000)

  • 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)

  • 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)

  • Is the latest copy of the Field Traffic Management Guidelines available? (i.e. When Traffic Control performed by work crew)

Q2 - Job File Documentation

  • 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)

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

Q3 - Vehicle Log Book

  • Does the vehicle have a CP/PAL daily/weekly/ drivers Log Book or equivalent available onsite?

  • Is it being filled out correctly and is vehicle washing being recorded?

Q4 - Procedures

  • Is the work being undertaken covered by appropriate permits or HV suppressions?

  • Note Feeder suppressed:

  • Is a signed Vicinity Access Authority onsite where required?

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 PPE in good condition and worn appropriately? (e.g. coveralls, dust coat)

  • 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 Respiratory Protection required and/or worn? (Drilling of CCA Poles, Dusty conditions)

  • Is Sun Cream available and/or supplied?

H2 - Electrical & Permit Procedures

  • Is the most current Green Book available onsite?

  • Is the work being performed in accordance with Green Book, CP/PAL Technical Standards, Acts, Regulations & Code of Practices, etc?

  • Where Connection work is being performed are the following documents available & current?

  • Connection Worker Manual?

  • VESI Procedures?

  • Construction Manuals?

  • Is an Electrical Access Permit (EAP) required and appropriate for the work?

  • EAP Number:

  • Do the recipients understand the permit (EAP) requirements?

  • Are ALL persons signed onto the Permit (EAP)?

  • Are isolations as per the Permit (EAP)?

  • Is Earthing as per the Permit (EAP)?

  • Is a work site earth/bonder applied/required?

  • Are the Crane Operator/Dogman and/or Resource Partner signed onto a Vicinity Authority? (Mandatory when working within close proximity of LIVE conductors)

  • Have Confined Spaces been identified?

  • Have Confined Space Entry Procedures been implemented prior to entry? (if applicable)

  • Is air monitoring device within test period?

  • Test Due Date:

H3 - Traffic Management

  • Is Traffic Control for the job site under the direct of CP/PAL/Resource Partner or Traffic Company?

  • Note Traffic Company:

  • 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)

  • Note Traffic WSL Name & Authroities

  • Name
  • WSL Name

  • RIIOHS205A

  • RIIOHS302A

  • Other

  • Has the Traffic Control WSL signed onto the CP/PAL/Resource Partner JSA?

  • 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?

  • 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?

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

  • How does the Traffic Controller manage it?

  • 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)

  • 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)

  • Fire Extinguishers over 1.5kg require testing to comply with A & NZ Safety Standards - yearly

  • Is the correct fire control equipment available? (Declared Bush Fire period - 9L knapsack, shovel, rake, drinking water - Powercor area)

  • Have the requirements for working on a day of Total Fire Ban been considered? (if applicable)

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:

  • Is the First Aid Kit stocked as per content list?

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

H6 - Fall Prevention

  • Has fall prevention been considered in JSA?

  • Has the highest practicable fall prevention control been considered and employed on the work site?

  • Are Safety Harnesses & Lanyards required and/or worn within Test Period? (Required when bottom of feet are 2m above the ground)

  • Test Due Date:

  • Are the appropriate ladders being used? (non conductive)

  • Is the Anchor Strap required, attached and utilised? (Mandatory for live ladder works)

  • Is the condition of ladders sound? (e.g. stiles, rungs, head and extension ropes)

  • Is the ladder secured to the pole correctly? (head rope - 12mm min)

  • Is a dedicated Pole Top Rescue Kit (LIVE ladder work) or Pit Rescue Kit available and within test period?

  • Test Due Date:

  • Is the Pole Top Rescue Kit location identified by signage?

H7 - LV Equipment

  • Are working Voltage, Neon & Phase Sequence Testers available?

  • Is a working Insulation Resistance and Continuity Tester available and within test period? (e.g. Meggar)

  • To establish Neutral Integrity Test Point (NITP) Test Due Date:

  • Is a working NST Tester available and within test period?

  • Test Due Date:

  • Is an Independent Earth Reel available?

  • Is Voltmeter available and within test period?

  • Test Due Date:

  • Is the Height / Telescopic Stick available, in good condition and within test period?

  • Test Due Date:

  • Is the Meter Tester (Hair Dryer) available and in good condition?

  • Are LV Gloves available, in good condition and used correctly? (i.e. "work glove outers")

  • Was an Integrity Test of LV gloves performed by a "Roll Test" to confirm serviceability?

  • Are LV Matts/Hoses available and in good condition?

  • Are LV Hoppers and Bonders available and in good condition?

  • Is a Fuse Stick and adapter available and in good condition?

H8 - HV Equipment

  • Are ALL Operating Sticks and Live Line Equipment within test period and in good condition?

  • Test Due Date:

  • Are HV Mats/Covers available, within test period and in good condition?

  • Test Due Date:

  • Are HV Operating Gloves and Sleeves available, within test period and in good condition? (yearly)

  • Test Due Date:

  • Are personal HV Gauntlets/Sleeves available, within test period and in good condition? (G&B - 6 monthly)

  • Test Due Date:

  • Is the Modiewark within test period and in operable condition? (yearly)

  • Test Due Date:

  • Are High Current (16Ka) and/or Trifurcating Earths available and used where required? (Operational / SWER and 3/12 Conductors)

H9 - Plant & Equipment

  • Note type of Equipment and Plant being used:

  • Equipment / Plant
  • Type of Equipment / Plant:

  • Is the Plant & Equipment being used in accordance with relevant safe work practices?

  • If NOT, is the appropriate Plant & Equipment available?

  • Is Mobile Plant (EWP/Crane etc) connected to earth via a permanent earth or driven stake? (if applicable)

  • Note type of Earth connection:

Elevating Work Platform (EWP)

  • Is the EWP logbook available and completed? (Mandatory - WorkSafe requirement)

  • Is the EWP in a clean and serviceable condition?

  • Is the EWP correctly positioned and earth chain utilised? (Mandatory when working within close proximity of LIVE Conductors - WorkSafe requirement)

  • Are the chocks and stabilisers correctly used? (chocks behind front wheels & pads beneath stabilisers)

  • Is the EWP inspection & service sticker on top RHS of windscreen? (scheduled 3 monthly)

  • Is the EWP within its electrical test period & is sticker on top RHS of windscreen? (electrical test 6 monthly - insulated EWP)

  • Electrical Test Due Date:

  • Is the EWP within its mechanical/load weight test period & is sticker on top RHS of windscreen? (scheduled 12 monthly)

  • Note type of Earth connection:

Mobile Cranes (If applicable)

  • Is the Crane Operator Certificate of Competency available?

  • Does the crane have WorkSafe registration or interstate equivalent?

  • Note Number (if appliacble)

  • Is there a copy of the Operators Manual available in the cabin? (Cranes over 10 tonne)

  • Is the Crane Log Book available onsite?

  • Are pre-start checks and daily inspections being performed and recorded?

  • Are pre-start checks and daily inspections being performed and recorded?

  • What is the SWL/WWL of the crane?

  • Are BOTH a minimum 10mm 1 metre chain (Vicinity of LIVE conductors) and E & SC (Live Line work) being used as per WorkSafe requirements?

  • Is there a DANGER notice displayed in the cabin relating to electrical hazards? (e.g. DANGER - Watch Out for Overhead Powerlines)

  • Is there a DANGER notice displayed near the outrigger controls? (e.g. DANGER - Watch Out for Crush Zone)

Plant & Equipment cont.

  • Are portable Electric Tools and Leads within test period?

  • Test Due Date:

  • Generators (Minimum 12 monthly)

  • Service Due Date:

  • Earth Meggar

  • Test Due Date:

  • Other

  • Test Due Date:

  • Is lifting tackle including chains, slings, etc within inspection period and tagged or painted appropriately? (Current colours: 2011/2015 Bronze, 2012/2016 Blue, 2013/2017 White, 2014/2018 Green)

  • Are Gas Bottles securely and safely stored adequately in a ventilated area?

  • Does the vented cupboard have a "L.P.Gas Storage" sticker displayed?

  • Are hoses and fittings in good condition?

  • Is the Gas Bottle within 10 years of manufacture or test period?

  • Are all Fuel and/or Chemical containers labelled correctly?

  • Are Fuel and/or Chemical containers stored adequately in vented area?

H10 - Work Practices

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

  • Were LV Gloves being worn when working within 1 metre of LIVE overhead electricity?

  • Are appropriate manual handling aids available and/or in use on site?

  • Is a handline required and/or in place?

  • Are the correct work practices being undertaken? (as required)

  • Safety Observer

  • Sufficient Covering / Matting

  • Ladder Secured

  • Are mandatory test procedures being undertaken? (as required)

  • Polarity/NST/Check Testing

  • Safe to Climb

  • Safe to Approach SWER

  • Entry to Enclosures

  • Are insulated tools being used where appropriate?

  • Are correct clearances being maintained during Live Line and/or G&B work?

  • Are Ampac Tools and Cartridges stored appropriately and are cleaning tools available?

  • Is the location of the Cartridges identified by an "Explosive Sticker"?

H11 - Metering & Servicing Work Practices

  • Has the CP/PAL Connection Standards Compliance Certification been completed?

  • Were correct Polarity, NST, Phase Sequence & Voltage tests performed as per VESI Guidelines?

  • Are ALL tags/plates in place where required?

  • If asbestos (Zelemite) panels are being drilled or screwed, are appropriate control measures being implemented? (e.g. One hole drilled: plastic drop sheets and silicon required - multiple holes drilled: disposable coveralls required etc)

  • Are appropriate insulating mats being used when connecting/disconnecting UG supply? (e.g. pit end)

  • Were mats/hoses/gloves inspected for damage prior to use?

  • Has Hazard/Installation Under Test signage been appropriately displayed?

H12 - Civil Works Installation (Earths/Cables etc)

  • Is there a copy of the Pole to Pit Guidelines and/or appropriate Construction Manuals available onsite?

  • Are installed earths being testing if required?

  • Are newly installed earths being tested prior to backfilling?

  • Is the appropriate permanent earth being installed? (e.g. HV & LV, common, SWER, pad mount etc)

  • State type

  • Have ALL existing underground services been located?

  • Is the trench adequately protected for live work, exposure of HV/LV for service joints?

  • Are ALL workers adequately protected from trench collapse?

  • Is there safe access to the trench and/or shaft?

  • Is the public adequately protected from ALL stock piles, hazards and the trench etc, with installed barriers?

  • Are ALL workers in the excavation wearing Safety Helmets?

  • Are Coverguards been installed at the correct height? (2.4m above ground)

  • Is conduit installed at the correct depth?

  • Are conduits being clued where appropriate?

  • Is marker tape being installed 300mm below ground for ALL open trenches?

  • Is Pit/Pillar being installed correctly?

  • Is crushed rock being used as a foundation for the pit?

  • Are distances for conduit/warning signs/cover strips/warning tape being noted and observed?

  • Are cable ends being sealed?

  • Is the method being used appropriate? (state method)

E - ENVIRONMENTAL

E1 - Site Management

  • Has an Environmental Management Plan been developed for the job site and available? (e.g. Hydro Excavation, Delivery and/or Removal of soil, sand, Transportation SF6 Switch gear, asbestos panel being drilled/screwed/removed etc)

  • Is it a separate plan or linked to JSA and/or SWMS?

  • Does the Environmental Management Plan include adequate transportation for removal of waste?

  • Does the Work Site Leader have a plan for the disposal of wastes?

  • Are all temporary stockpiles appropriately located and/or bunded?

  • Is water used in under road bores/concrete and or bitumen cutting being contained and/or disposed of appropriately?

  • Are all exposed drains and open waterways in the vicinity of the work site appropriately protected?

  • Is the storm water system, e.g. spoon drains, kerbs and channel, pits etc in the vicinity of the works clean of clippings and debris generated by the work?

  • Are any waste going off site? (e.g. Soil, Concrete, Bitumen etc)

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

E2 - Incident Response

  • Does the Work Site Leader know the appropriate emergency contact phone numbers in the event of an incident?

  • 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?

  • Are the spill kit contents sufficient to initially contain a spill situation for the job being performed?

E3 - Vehicle Washing

  • Is there Powercor Weeds and Seeds Guide available? (if applicable)

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

  • Have pest plants on work site been identified and management plan been put in place?

E4 - Housekeeping

  • If the job has been completed, was the work site left orderly, neat and debris free?

  • Are hazardous areas protected?

  • Are hazardous goods clearly labelled and being stored appropriately?

  • Are dusts, fumes or mists being controlled?

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.