SEM 2.13.3.1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety

• Capabile to perform task

  Yes

  No

  N/A

• Competent artisans / operators

  Yes

  No

  N/A

• Authorised to perform task

  Yes

  No

  N/A

• SLAM / JRA completed for taks

  Yes

  No

  N/A

• Safe declaration

  Yes

  No

  N/A

• PPE (Condition, use & issue)

  Yes

  No

  N/A

Permits

• Isolation / lockout

  Yes

  No

  N/A

• Live testing

  Yes

  No

  N/A

• Hot & cold

  Yes

  No

  N/A

• Working on heights

  Yes

  No

  N/A

• Working in close proximity of power lines

  Yes

  No

  N/A

• Excavation

  Yes

  No

  N/A

Site setup

• Housekeeping

  Yes

  No

  N/A

• Mobile facilities / toilets

  Yes

  No

  N/A

• Refuse bins

  Yes

  No

  N/A

• 1st aid box, stretcher, assembly point

  Yes

  No

  N/A

• Barricade & signs

  Yes

  No

  N/A

Tools / special tools

• Condition of tools

  Yes

  No

  N/A

• Signed off drawing (Special tools)

  Yes

  No

  N/A

• Unique number, inspected and on file

  Yes

  No

  N/A

• Electrical tools (Grinders etc.)

  Yes

  No

  N/A

• Gas cutting equipment

  Yes

  No

  N/A

• Lifting equipment (Slings, chain blocks - condition and colour coding)

  Yes

  No

  N/A

• Welding equipment

  Yes

  No

  N/A

• Mobile pumps - pre-start, unique number, inspected and on file

  Yes

  No

  N/A

What are the employees busy to do?

• Any risk associated with the work?

  Yes

  No

  N/A

• Have risks been identified?

  Yes

  No

  N/A

• Have the risk been communicated?

  Yes

  No

  N/A

Signatures

• 2.17.1 / 2.18.1 / operator

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• 2.6.1 / 2.9.2

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• 2.13.3.1

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