Safety Inspections Checklist QF 084-08 Revision 2

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. GENERAL

• A1. Has a daily risk and hazard assessment been completed prior to starting work?

  Yes

  No

  N/A

• A2. Have all employees or visitors signed the daily risk and hazards assessment sheet?

  Yes

  No

  N/A

• A3. Has the daily risk and hazard sheet been completed correctly?

  Yes

  No

  N/A

• A4. Overhead hazards have been identified?

• Why not?

• A5. Traffic has been identified correctly?

• Why not?

• A6. Location has been accessed properly?

• Why not?

• A7. Are bush fire safety measures in place?

• Why not?

• A8. Site specific environmental issues identified?

• Why not?

• If reason is not listed please explain.

• A9. Is there a controlled, approved and current copy of the safety management plan on site?

  Yes

  No

  N/A

• A10. Is there a controlled and current copy of Safe Work Method Statements on site?

  Yes

  No

  N/A

• A11. Have there been any issues raised on the site that have not been identified in the Safe Work Method Statement?

  Yes

  No

  N/A

• Provide more information:

• A12. Are Material Safety Data Sheets on site?

  Yes

  No

  N/A

• A13. Are all personnel inducted to this contract?

  Yes

  No

  N/A

• Provide more information:

• A14. Has the induction been registered into the passport book?

  Yes

  No

  N/A

• A15. Are personnel carrying identification tags which are in reasonable condition?

  Yes

  No

  N/A

• A16. Are first aid kits readily available and fully stocked?

  Yes

  No

  N/A

• A17. Is there a fire extinguisher on the vehicle and is it operational?

  Yes

  No

  N/A

• A18. Is the fire extinguisher within the tagged service date?

  Yes

  No

  N/A

• Provide more information:

• A19. Is the security pin in the fire extinguisher secured?

  Yes

  No

  N/A

• A20. Is there suitable access to the extinguisher around the work site?

  Yes

  No

  N/A

• A21. Is there adequate lighting?

  Yes

  No

  N/A

• A22. Are hand tools in good condition?

  Yes

  No

  N/A

• A23. Are air hoses in good condition?

  Yes

  No

  N/A

• A24. Are the air hose connections secured with safety pins?

  Yes

  No

  N/A

• A25. Is there any hose running across the roadway?

  Yes

  No

  N/A

• A26. Is there a person monitoring the hose running across the roadway?

  Yes

  No

  N/A

• A27. Are fuel containers properly labelled?

  Yes

  No

  N/A

• A28. Are fuel containers stored in the appropriate container (150% of volume)?

  Yes

  No

  N/A

• A29. Are the fibreglass push rods in satisfactory condition?

  Yes

  No

  N/A

B. Sub-Contractor

• Are there any Sub-Contractors on site?

  Yes

  No

  N/A

• B1. Has the sub-contractor been approved to work on site?

  Yes

  No

  N/A

• B2. Has the client been notified via the the daily location sheet?

  Yes

  No

  N/A

• B3. Does the sub-contractor need an Authority To Work permit?

  Yes

  No

  N/A

• B4. Is the Authority To Work permit on site?

  Yes

  No

  N/A

• B5. What is the Authority To Work permit number?

C. Clothing (PPE)

• C1. Regulation helmets worn correctly at all times and remain within their expiry period?

  Yes

  No

  N/A

• C2. Appropriate safety glasses or face shields worn when necessary?

  Yes

  No

  N/A

• C3. Are the appropriate respirators/filters being used when necessary?

  Yes

  No

  N/A

• C4. Are gloves worn when required?

  Yes

  No

  N/A

• C5. Is correct safety footwear worn?

  Yes

  No

  N/A

• C6. Are earmuffs or ear plugs worn when required?

  Yes

  No

  N/A

• C7. Are safety vests/high visibility shirts in good condition?

  Yes

  No

  N/A

D. Confined spaces

• D1. Have site required confined space procedures to be implemented?

  Yes

  No

  N/A

• D1.1. Has the gas monitor been response tested and recorded on the appropriate documentation?

  Yes

  No

  N/A

• D1.2. Serial number of gas monitor.

• D1.3. Is gas monitor within calibration date?

  Yes

  No

  N/A

• D1.4. Calibration due date

  Date

• D1.5. Has testing of maintenance hole been recorded on entry permit or the daily risk assessment sheet?

  Yes

  No

  N/A

• D1.6. Record names and Confined Space Certificate Number of all staff entering the confined space.

• D1.7. Who is the nominated person for maintenance hole entry?

• D1.8. Who is the nominated person for standby duties?

• D1.9. Is the nominated standby person currently confined space trained?

  Yes

  No

  N/A

• D1.10. Are correct confined space procedures being followed?

  Yes

  No

  N/A

• D1.11. Has the confined space entry permit been filled out?

  Yes

  No

  N/A

• D1.12. Record the permit number

• D1.13. Are the chemicals used in confined spaces nominated on the confined space entry permit?

  Yes

  No

  N/A

• D1.14. Are all applicable sections addressed by either a tick or N/A?

  Yes

  No

  N/A

• D1.15. Has the responsible person signed off where required?

  Yes

  No

  N/A

• D1.16. Is there an approved tripod on site?

  Yes

  No

  N/A

• D1.17. Is the tripod engraved with an ID number?

  Yes

  No

  N/A

• D1.18. Record the ID number.

• D1.19. Is the tripod fully extended?

  Yes

  No

  N/A

• D1.20. Is there an Australian Standard approved harness on site?

  Yes

  No

  N/A

• D1.21. Is the harness in good condition?

  Yes

  No

  N/A

• D1.22. Record the serial number of the harness.

• D1.23. Is there an air rescuer on site and within its 10 year date?

  Yes

  No

  N/A

• D1.24. Is there a grate covering unattended maintenance hole?

  Yes

  No

  N/A

• D1.25. Is there "Confined Space Entry by Permit Only" signage displayed?

  Yes

  No

  N/A

E. Civils

• E1. Is the current activity Civil Construction?

  Yes

  No

  N/A

• E1.1. Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• E1.2. Is there 'Dial Before You Dig' information on site?

  Yes

  No

  N/A

• E1.3. What is the job number on the 'Dial Before You Dig' job caller confirmation sheet?

• E1.4. Has a dig/cut permit (QF 137) been completed?

  Yes

  No

  N/A

• E1.5. Have precautions been taken to positively identify and locate the position and lie of any underground services, before excavation has started?

  Yes

  No

  N/A

• E1.6. Has the work area been barricaded, bollards placed and sign posted to warn residents or pedestrians of potential hazards?

  Yes

  No

  N/A

• E1.7.1. Has the trench/excavation been identified as a confined space?

  Yes

  No

  N/A

• E1.7.2. Is there an escape/access route in place?

  Yes

  No

  N/A

• E1.7.3. Is there a gas monitor in position?

  Yes

  No

  N/A

• E1.7.4. Is the self rescuer within reach?

  Yes

  No

  N/A

• E1.8. If trenches 1.5m or more in depth correctly shored or battered?

  Yes

  No

  N/A

• E1.9. Is the edge of the trench clear of spoil (minimum 1000mm)

  Yes

  No

  N/A

• E1.10. Are correct techniques being used when lowering items into the trench?

  Yes

  No

  N/A

• E1.11. Are the persons in the trench clear when items are being lowered?

  Yes

  No

  N/A

• E1.12. Are ladders used adequate and in good condition?

  Yes

  No

  N/A

• E1.13. Are ladders secured correctly, at the right height and angle?

  Yes

  No

  N/A

F. Ex Method

• F1. Is the current activity Ex Lining?

  Yes

  No

  N/A

• F1.1. Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• F1.2. Have persons been instructed on the work instruction for this process?

  Yes

  No

  N/A

• F1.3. Has a hot work permit been completed to work Instruction (W1012)?

  Yes

  No

  N/A

• F1.4. Have employees been provided with appropriate P.P.E. for this process?

  Yes

  No

  N/A

• F1.4.1. Leather gloves

  Yes

  No

  N/A

• F1.4.2. Eye protection

  Yes

  No

  N/A

• F1.4.3. Leather Arm Guards

  Yes

  No

  N/A

• F1.4.4. Dust Mask or Respirator

  Yes

  No

  N/A

• F1.4.5. Are these being worn when required?

  Yes

  No

  N/A

• F1.5. Boiler Truck

• F1.5.1. Is there a current boiler inspection certificate on the truck?

  Yes

  No

  N/A

• F1.5.2. Does the stand pipe have a backflow prevention device attached?

  Yes

  No

  N/A

• F1.5.3. Is there a current certificate for the backflow prevention device?

  Yes

  No

  N/A

• F1.5.4. Are steam hoses in satisfactory condition?

  Yes

  No

  N/A

• F1.6. Winch Truck

• F1.6.1. Does the tray need to be degreased?

  Yes

  No

  N/A

• F1.6.2. Is the truck crane free of leaks?

  Yes

  No

  N/A

G. Tiger Tees/Patching

• G1. Is the current activity Tiger Tees/Patching?

  Yes

  No

  N/A

• G1.1. Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• G1.2. Have persons been instructed on the work instructions for this process?

  Yes

  No

  N/A

• G1.3. Are employees or the public protected from the winch when it is able to start?

  Yes

  No

  N/A

• G1.4. Have employees been provided with the appropriate P.P.E. for this process?

  Yes

  No

  N/A

• G1.4.1. Respirator mask

  Yes

  No

  N/A

• G1.4.2. Inorganic filters A!, B1, E1, and P3 survivor

  Yes

  No

  N/A

• G1.4.3. Full face shield

  Yes

  No

  N/A

• G1.4.4. Rubber apron

  Yes

  No

  N/A

• G1.5. Are resin containers correctly labelled?

  Yes

  No

  N/A

• G1.6. Is quality QF063 Camera Ipex, Equipment Gas recording register being completed?

  Yes

  No

  N/A

H. CCTV/Jetting

• H1. Is the current activity CCTV/Jetting?

  Yes

  No

  N/A

• H1.1. Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• H1.2.1. Have employees been instructed on Work Instruction WI034 High Pressure Water Jetting Mainlines?

  Yes

  No

  N/A

• H1.2.2. Have employees been instructed on Safe Work Method Statements WMS003 Clean and CCTV Sewer Conduit?

  Yes

  No

  N/A

• H1.3. Is the jetted hose in good condition?

  Yes

  No

  N/A

• H1.4. Is access to the vehicle acceptable?

  Yes

  No

  N/A

• H1.5. Is there a 110mm gap to prevent backflow from the jetted reservoir?

  Yes

  No

  N/A

• H1.6. Is there a backflow prevention device on the stand pipe?

  Yes

  No

  N/A

• H1.7. Is there a current certificate for the backflow prevention device?

  Yes

  No

  N/A

• H1.8. Is quality QF063 Camera Ipex, Equipment Gas recording register being completed?

  Yes

  No

  N/A

I. Traffic Control

• I1. Is traffic control required on this site?

  Yes

  No

  N/A

• I1.1. Is there an approved traffic control plan in use?

  Yes

  No

  N/A

• I1.2. What is the Traffic Control Plan Number?

• I1.3. Are advisory signs as per Traffic Control Plan selected?

  Yes

  No

  N/A

• I1.4. Is there a requirement for traffic controllers?

  Yes

  No

  N/A

• I1.5. Does the traffic controller have a current Traffic Controllers Certificate?

  Yes

  No

  N/A

• I1.6. Provide the traffic controllers name and licence number.

• I1.7. Is there a requirement for a certified Traffic Control Agency?

  Yes

  No

  N/A

• I1.7.1 Do they have a traffic management plan on site that has been approved by the appropriate authorities?

  Yes

  No

  N/A

• I1.7.2 Are advisory signs as per the Traffic Control Plan?

  Yes

  No

  N/A

• I1.7.3 Provide controllers name and licence number?

• I1.7.4 Has a representative of Kembla Watertech sighted the traffic control plan?

  Yes

  No

  N/A

• I1.8. Is the access around the worksite safe for the public?

  Yes

  No

  N/A

• I1.9. Is there a current speed reduction in place?

  Yes

  No

  N/A

• I1.9.1. Provide the Speed Reduction Certificate Number.

• I1.10. Is there a current Council Permit or written Authorisation on site?

  Yes

  No

  N/A

• I1.11. Is there a current approved Police Permit on site?

  Yes

  No

  N/A

• I1.12. Are there adequate spare signs on site if required?

  Yes

  No

  N/A

• I1.13. Is there a copy of QF006 Traffic Control Site Appraisal on site?

  Yes

  No

  N/A

• I1.14. Is there a copy of QF015 Onsite Daily Inspection Checklist on site?

  Yes

  No

  N/A

• I1.15. Is there a copy of QF030-1 Traffic Control Management HIDRA on site?

  Yes

  No

  N/A

• I1.16. Are all traffic controllers correctly situated?

  Yes

  No

  N/A

• I1.17. Is there a qualified relief person on site?

  Yes

  No

  N/A

• I1.18. Are traffic controllers wearing correct vest or night overalls?

  Yes

  No

  N/A

• I1.19. Is signage in good condition?

  Yes

  No

  N/A

• I1.20. Do traffic controllers have escape routes?

  Yes

  No

  N/A

• I1.21. Are there night wands on site if required?

  Yes

  No

  N/A

• I1.21. Are pedestrians and cyclists catered for at site?

  Yes

  No

  N/A

• I1.22. Are pedestrian managers required at site?

  Yes

  No

  N/A

• I1.23. Are beacons and arrow boards on Traffic Control vehicles functioning correctly?

  Yes

  No

  N/A

J. Signage

• J1. Are there 2 'Pedestrians Watch Your Step' signs?

  Yes

  No

  N/A

• J2. Are there 2 'Part Road Closed' signs?

  Yes

  No

  N/A

• J3. Are there 4 'Dig Man Ahead' signs?

  Yes

  No

  N/A

• J4. Are there 2 chevron signs 'Left and Right'?

  Yes

  No

  N/A

• J5. Is there a 'Clients Information' sign on site?

  Yes

  No

  N/A

• J6. Is there a 'Confined Space Entry' sign?

  Yes

  No

  N/A

• J7. Is the signage in good condition?

  Yes

  No

  N/A

K. Plant

• K1. Is the plant/vehicle operator licensed?

  Yes

  No

  N/A

• K1.1. What is the Driver/Operators name?

• K1.2. What is the Class of Drivers License or Work Cover Ticket number?

• K2. Provide vehicle registration number.

• K3. Provide registration expiry date.

  Date

• K4. Perform visual inspection of plant.

• K4.1. Tyres

  Safe

  At Risk

  N/A

• K4.2. Headlights

  Safe

  At Risk

  N/A

• K4.3. Indicators

  Safe

  At Risk

  N/A

• K4.4. Tail Lights

  Safe

  At Risk

  N/A

• K4.5. Brake Lights

  Safe

  At Risk

  N/A

• K4.6. Horn

  Safe

  At Risk

  N/A

• K4.7. Windscreen

  Safe

  At Risk

  N/A

• K4.8. Windows

  Safe

  At Risk

  N/A

• K4.9. Bodywork

  Safe

  At Risk

  N/A

• K4.10. Hydraulics

  Safe

  At Risk

  N/A

• K4.11. Towing Mechanism secure

  Safe

  At Risk

  N/A

• K5. Is the cabin in a neat and tidy manner?

  Yes

  No

  N/A

• K6. Is there a spare tyre and jack for this unit?

  Yes

  No

  N/A

• K7. Is the 'DANGER' notice attached and clearly visible to the operator?

  Yes

  No

  N/A

• K8. Is the 'CAUTION' notice attached and clearly visible to the operator?

  Yes

  No

  N/A

• K9. Is there safe access onto or into the vehicle?

  Yes

  No

  N/A

• K10. Has the log book for the Truck Mounted Crane been completed for that day?

  Yes

  No

  N/A

• K11. Is the work area of the vehicle clean and tidy and is the equipment stored correctly?

  Yes

  No

  N/A

• K12. Does this plant tow a compressor/trailer

  Yes

  No

  N/A

• K12.1. What is the registration number?

• K12.2. What is the registration expiry date?

  Date

• K12.3. Tyres

  Safe

  At Risk

  N/A

• K12.4. Indicators

  Safe

  At Risk

  N/A

• K12.5 Tail Lights

  Safe

  At Risk

  N/A

• K12.6. Brake Lights

  Safe

  At Risk

  N/A

• K12.7. Towing Mechanism Secure

  Safe

  At Risk

  N/A

L. Scaffolding

• L1. Is scaffolding in use on site?

  Yes

  No

  N/A

• L1.1. Is the scaffold more than 4 metres high?

  Yes

  No

  N/A

• L1.2. Provide the name of the person who erected the scaffolding?

• L1.3. Sight the certificate of the above named person and record their certificate number?

• L1.4. Is the scaffold secure and stable?

  Yes

  No

  N/A

• L1.5. Are there the required top and mid handrails attached (after 1.8metres)?

  Yes

  No

  N/A

• L1.6. Is the working platform fully decked?

  Yes

  No

  N/A

• L1.7. Are toe boards fitted?

  Yes

  No

  N/A

M. Electrical

• M1. Are electrical leads, portable equipment and plant tested and tagged?

  Yes

  No

  N/A

• M1.1. Are tags within their expiry date?

  Yes

  No

  N/A

• M2. Are portable generators, extension leads/power tools protected with an earth leakage device?

  Yes

  No

  N/A

• M3. Is the earth lead being used?

  Yes

  No

  N/A

• M4. Is the electrical log book on site for this vehicle?

  Yes

  No

  N/A

• M5. Is the electrical log book completed correctly

  Yes

  No

  N/A

N. Slings

• N1. Persons slinging loads competent?

  Yes

  No

  N/A

• N2. Correct slings used and in good condition?

  Yes

  No

  N/A

• N3. Is a lead rope used to control loads where necessary?

  Yes

  No

  N/A

O. Housekeeping

• O1. Is the work area tidy and are materials stored properly?

  Yes

  No

  N/A

• O2. Are all steam hoses checked for leaks?

  Yes

  No

  N/A

• O3. Are noise requirements being adhered to?

  Yes

  No

  N/A

• O4. Is all rubbish and cigarette butts removed from site?

  Yes

  No

  N/A

• O5. Are bins being used?

  Yes

  No

  N/A

• O6. Are start times being adhered to (No work prior to 0700h)?

  Yes

  No

  N/A

• O7. Are the steel fittings covered to eliminate burns?

  Yes

  No

  N/A