Safety Observation (Level B)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Employee name:

• Staff number:

• Manager:

• Designation:

• Location:

1.0 Personal Protective Equipment

• Guideline: Minimum site safety requirements. Specific machinery / tooling requirements and any additional items identified in the Job Plan are in use (e.g. hi-visibility jacket worn in rail corridor, ankle to elbow cover, steel top capped above ankle lace up boots, eye protection, hard hat (where applicable and within certification date).

• Boots

  Used

  Not used

  Not applicable

• Gloves

  Used

  Not used

  Not applicable

• Earmuffs

  Used

  Not used

  Not applicable

• Hard hat

  Used

  Not used

  Not applicable

• Safety glasses

  Used

  Not used

  Not applicable

• Hi-visibility

  Used

  Not used

  Not applicable

• Full body cover

  Used

  Not used

  Not applicable

• Spats

  Used

  Not used

  Not applicable

• Chaps

  Used

  Not used

  Not applicable

• Hot gloves

  Used

  Not used

  Not applicable

• Sun hat

  Used

  Not used

  Not applicable

• Sun screen

  Used

  Not used

  Not applicable

• Harness

  Used

  Not used

  Not applicable

• Lanyard

  Used

  Not used

  Not applicable

• Pole strap

  Used

  Not used

  Not applicable

• Rail puppy

  Used

  Not used

  Not applicable

• Climbing helmet

  Used

  Not used

  Not applicable

• Head light

  Used

  Not used

  Not applicable

• Helmet issue date:

• General comments

• Add media

  Media

2.0 Protection Applied

• Current daily information bulletin sighted. Communications plan recorded (where required). Protection obtained (including all tracks fouled).

  Yes

  No

  N/A

• General comments

• Add media

  Media

3.0 Pre-start safety briefing / job plans

• Briefing conducted for all personnel on site. Briefing included contractors and visitors. Evidence of briefing and signatures.

  Yes

  No

  N/A

• General comments

• Add media

  Media

4.0 Hazard identification

• Evidence of hazards being identified, communicated and effectively controlled. Confirm compliance with Job Plans.

  Yes

  No

  N/A

• General comments

• Add media

  Media

5.0 Hazardous materials

• Up to date Safety Data Sheets are available for hazardous products being used on site. Confirm staff understanding of controls necessary (e.g. personal protective equipment, first aid requirements, environmental issues, product reactivity).

  Yes

  No

  N/A

• General comments

• Add media

  Media

6.0 Housekeeping and the environment

• Worksite is clear of trip hazards. Waste is collected and and disposed of appropriately. Environmental impacts have been considered before and during tasks performed. Appropriate spill kits are available (if required).

  Yes

  No

  N/A

• General comments

• Add media

  Media

7.0 Adequate facilities

• Guideline: Potable water is available? Adequate shelter? Hand washing facilities?

• Potable water?

  Available

  Unavailable

  Not applicable

• Adequate shelter?

  Available

  Unavailable

  Not applicable

• Hand wipes?

  Available

  Unavailable

  Not applicable

• General comments

• Add media

  Media

8.0 Manual handling

• Good manual handling practices observed?

  Yes

  No

  N/A

• General comments

• Add media

  Media

9.0 Incident reporting

• Guideline: Staff understand how to report incident both verbally and written?

• Staff understand the incident reporting process?

  Yes

  No

  N/A

• General comments

10. 0 Emergency planning

• Emergency plans are available and emergency assembly areas have been identified and communicated to staff?

  Yes

  No

  N/A

• General comments

• Add media

  Media

11.0 Plant and equipment

• Correct plant being used for the task?

  Yes

  No

  N/A

• Plant certified safe for use?

  Yes

  No

  N/A

• Danger tags in use?

  Yes

  No

  N/A

• General comments

• Add media

  Media

SITE SPECIFIC CRITERIA

12.0 Electrified areas (AC and DC)

• Minimum approach distances (MAD) understood and followed for people and plant?

  Yes

  No

  N/A

• Permit to work issued?

  Yes

  No

  N/A

• Approved tools / methods used in electrified areas?

  Yes

  No

  N/A

• Add media

  Media

13.0 Contractor management (Supervisor only)

• All contractors have been inducted?

  Yes

  No

  N/A

• Contractors are adequately supervised by Network employees?

  Yes

  No

  N/A

14.0 Working at height

• Height safety equipment registered and certified?

  Yes

  No

  N/A

• Adequate protection provided for staff working at height?

  Yes

  No

  N/A

• "Work Safe" notification procedure for working at height understood?

  Yes

  No

  N/A

• Add media

  Media

15.0 Working in tunnels

• Gas monitors in use?

  Yes

  No

  N/A

• Gas detectors within calibration period?

  Yes

  No

  N/A

• Gas monitors "bump tested" before use?

  Yes

  No

  N/A

• Gas masks and emergency rescue equipment available?

  Yes

  No

  N/A

• Confined space permit issued?

  Yes

  No

  N/A

• Staff understand required response and evacuation procedures if gas alarm or warning sounds?

  Yes

  No

  N/A

• Add media

  Media

16.0 Lone worker

• Lone worker process understood and used

  Yes

  No

  N/A

17.0 Traffic management plan

• Staff understand when a traffic management plan is required?

  Yes

  No

  N/A

• Plans are available (if applicable)?

  Yes

  No

  N/A

• Adequate equipment available to implement the traffic management plan?

  Yes

  No

  N/A

• Site Traffic Management Supervisor (STMS) identified and qualified?

  Yes

  No

  N/A

• Add media

  Media

18.0 Corrective actions

• Add signature

  Sign

• Observee:

• HSE Coordinator:

• Select date

  Date

• Forward completed and signed copy to KiwiRail's Training Team to record in the Training Database.