Safezure Safety Management

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

HEALTH AND SAFETY FILE

• Is there a valid Letter of Good Standing on file?

  Yes

  No

  N/A

• Notification of Construction Work been done and send to DOL?

  Yes

  No

  N/A

• Is there a Health and Safety Specification available and on file?

  Yes

  No

  N/A

• Is the relevant Mandatories in place and been signed? 37.2 /5.1

  Yes

  No

  N/A

HEALTH AND SAFETY PLAN

• Is there a site specific Health and Safety Plan on file? Is it communicated ?

  Yes

  No

  N/A

• Health and Safety Policy signed and communicated?

  Yes

  No

  N/A

• HSE Reviewed monthly?

  Yes

  No

  N/A

APPOINTMENTS (HAS THE FOLLOWING BEEN APPOINTED)

• 16.1 Declaration

  Yes

  No

  N/A

• Competent Person 16.2?

  Yes

  No

  N/A

• Construction manager 8.1?

  Yes

  No

  N/A

• Sub Ordinate Construction Work Supervisor 8.7?

  Yes

  No

  N/A

• Risk Assessor?

  Yes

  No

  N/A

• Fall Protection Plan Developer?

  Yes

  No

  N/A

• Emergency Evacuation Controller?

  Yes

  No

  N/A

• Incident Investigator?

  Yes

  No

  N/A

• First Aider?

  Yes

  No

  N/A

• Fire Equipment Inspector?

  Yes

  No

  N/A

• Hand Tool Inspector?

  Yes

  No

  N/A

• Portable Electrical Tool Inspector?

  Yes

  No

  N/A

• Ladder Inspector?

  Yes

  No

  N/A

• Stacking and Storage Supervisor?

  Yes

  No

  N/A

• Excavation Supervisor?

  Yes

  No

  N/A

• Temporary works Supervisor?

  Yes

  No

  N/A

• Scaffold Erector?

  Yes

  No

  N/A

• Scaffold Supervisor?

  Yes

  No

  N/A

• Scaffold Inspector?

  Yes

  No

  N/A

INCIDENT AND ACCIDENT INVESTIGATION

• Relevant documentation on file for investigation? Sec 24

  Yes

  No

  N/A

• Accident reporting forms WCL 2 / WCL1

  Yes

  No

  N/A

EMERGENCY PLAN AND PREPAREDNESS

• Is there a site specific Emergency Evacuation Plan on file?

  Yes

  No

  N/A

• Is Emergency Contact Numbers available and are they displayed?

  Yes

  No

  N/A

RISK ASSESSMENT

• Is there a site specific and relevant Risk Assessment on file?

  Yes

  No

  N/A

• Risk Assessment reviewed monthly?

  Yes

  No

  N/A

• Has the Risk Assessment been communicated to all workers and proof on file?

  Yes

  No

  N/A

FALL PROTECTION PLAN

• Is there a site specific and relevant Fall Protection Plan on file?

  Yes

  No

  N/A

• Fall Protection Plan been reviewed monthly?

  Yes

  No

  N/A

• Has the Fall Protection Plan been communicated to all workers and proof on file?

  Yes

  No

  N/A

• Is there equipment available for all workers according to the Fall Protection Plan (Safety Harnesses and other related equipment)?

  Yes

  No

  N/A

INDUCTION TRAINING

• Has all workers been inducted an proof on file?

  Yes

  No

  N/A

• Has all visitors been inducted and proof on file?

  Yes

  No

  N/A

TOOLBOX TALKS/Dsti

• Has Toolbox Talks been done weekly with all workers and proof available on file?

  Yes

  No

  N/A

• Is the Toolbox Talks done relevant to the work being done?

  Yes

  No

  N/A

• Dsti available for current tasks ?

  Yes

  No

  N/A

REGISTERS AND CHECKLISTS (ARE THEY FILLED IN AND KEPT UP TO DATE)

• Fire Fighting Equipment/

  Yes

  No

  N/A

• First Aid Box?

  Yes

  No

  N/A

• Hand Tools?

  Yes

  No

  N/A

• Portable Electrical Tools?

  Yes

  No

  N/A

• Ladders?

  Yes

  No

  N/A

• Fall Protection Equipment?

  Yes

  No

  N/A

• Personal Protective Equipment (PPE)?

  Yes

  No

  N/A

• Construction Vehicles / Plant?

  Yes

  No

  N/A

• Excavations?

  Yes

  No

  N/A

• Formwork and Support Work?

  Yes

  No

  N/A

• Scaffolding?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Has the relevant PPE been issued to all workers and proof that they signed for it available?

  Yes

  No

  N/A

• Training been given with regards to PPE according to the Risk Assessment and Fall Protection Plan?

  Yes

  No

  N/A

SAFE GUARDING OF SITE AND / OR WORKING AREA

• Barricading Affective?

  Safe

  At Risk

  N/A

• Traffic Control Affective?

  Safe

  At Risk

  N/A

EXCAVATIONS

• Correctly sloped and shored as per RA?

  Safe

  At Risk

  N/A

• Correctly barricaded ?

  Safe

  At Risk

  N/A

• Excess soil removed from sides?

  Safe

  At Risk

  N/A

• Ladders used for entry and exit of deep excavation?

  Yes

  No

  N/A

• Inspection register.

  Yes

  No

  N/A

HOUSEKEEPING AND STACKING AND STORAGE

• Stacking and Storage done as per Safety Plan and RA?

  Yes

  No

  N/A

• No Tripping Hazards?

  Safe

  At Risk

  N/A

• Walkways Unobstructed?

  Safe

  At Risk

  N/A

• Effective Waste Removal?

  Yes

  No

  N/A

PPE COMPLIANCE ON SITE (ARE THE FOLLOWING BEEN USED)

• Workers - Safety Boots?

  Yes

  No

  N/A

• Workers - Reflective Vests?

  Yes

  No

  N/A

• Workers - Hard Hats?

  Yes

  No

  N/A

• Workers - Fall Protection Equipment?

  Yes

  No

  N/A

EMERGENCY EQUIPMENT

• First Aid Box available on site?

  Yes

  No

  N/A

• Adequate Fire Fighting Equipment available on site?

  Yes

  No

  N/A

SIGNAGE

• Site signage (multi board , ect)

  Yes

  No

  N/A

ABLUTION FACILITIES

• 1 x Toilet for every 30 Workers?

  Yes

  No

  N/A

• Seperate Male and Female Toilets?

  Yes

  No

  N/A

• Toilet Paper Available?

  Yes

  No

  N/A

• Water and Soap available to wash hands?

  Yes

  No

  N/A

• Is the Toilets Hygienic and Clean?

  Yes

  No

  N/A

• Site Supervisor / Manager

  Sign

• Representative of The Constructive Safety Company

  Sign