Title Page
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Inspection Title
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Conducted on
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Prepared by
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Location
- Area Inspection
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Location or Asset Number
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Current Status
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Other Information
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Further Action Required
Task Inspection
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Task Description
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Location or Asset Number
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Work Order #
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Work Group Details
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High Risk Tasks
- Cranes & Lifting
- Working at Heights
- Confined Spaces
- Inrush & Outburst
- Hot Work
- Blasting & Explosives
- Vehicle Interaction
- Geotechnical
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Permits In Place
- Group Isolation
- Hot Work
- Confined Space
- Working at Heights
- Critical Lift
- Concealed Services
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Permit Quality
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STAR
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JSA
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Supervision
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Understanding of Task
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Understanding of SHMS requirements
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Isolation
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Equipment Compliance
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PPE
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Housekeeping
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Current Competencies
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Other Information
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Further Action Required
Equipment Inspection
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Equipment Description
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Asset Number or Equipment ID
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Prestart
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Equipment Condition
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Equipment Owner
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Equipment Owner
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Site Compliant
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Other Information
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Further Action Required
Supervision Safe Work Model Inspection
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Was this inspection conducted as a Supervision Safe Work Model Inspection
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Complete the following prompts as per the Supervision Safe Work Model form and attach report to FPe Safety Interaction.
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Competent People - Ensure that YOU and all employees under your control are fit for duty, and that they are trained, competent and authorised to perform the task YOU direct them to do safely.
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Status - Competent People
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Safe Work Practices - Ensure that you give clear instruction and that you and your team know what procedures relate to the tasks your team are doing and that they comply with them.
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Status - Safe Work Practices
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Fit for Purpose Equipment - Make sure that all tools, equipment and safety devices are fit for purpose and used safely and correctly.
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Status - Fit For Purpose Equipment
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Controlled Work Environment - Ensure that the hazards in the environment your team are working in are controlled.
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Status - Controlled Work Environment
