Title Page
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Conducted on
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Prepared by
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Location
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Document No:
1. Work at Height - Leading edge protection / Fall protection in place
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Photo
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Comment
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Overall Result
2. Void Protection - Guardrails or securely covered
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Photo
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Comment
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Overall Result
3. Scaffolding - Designed, Inspected & Tagged
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Photo
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Comment
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Overall Result
4. Temporary Work - Design available & compliant with design drawing
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Photo
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Comment
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Overall Result
5. Ladder Use - Short duration work only, stable & footed, industrial type to EN131 Class 1 or equivalent
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Photo
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Comment
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Overall Result
6. Mobile Towers - Guardrails, toe boards & correctly braced
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Photo
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Overall Result
7. Electricity - Condition, protected, life risk / fire risk
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Photo
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Comment
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Overall Result
8. Traffic Management - People & plant separated, demarked
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Photo
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Comment
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Overall Result
9. Plant & Equipment - In good working order & operated correctly
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Photo
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Comment
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Overall Result
10. Excavations - Inspected / shoring in place, gas level
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Photo
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Comment
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Overall Result
11. Permit Systems - Permit in place and being followed, competence person for Gas Tester, Excavation, Crane Operator, Shot Firer
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Photo
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Comment
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Overall Result
12. Fire Safety - Fire points with extinguishers & alarm available
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Photo
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Comment
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Overall Result
13. Safe Access & Egress
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Photo
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Comment
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Overall Result
14. Housekeeping - No waste build up, slip & trip hazards and unsafe condition
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Photo
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Comment
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Overall Result
15. Lifting Equipment - Crane & Pile Rig
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Photo
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Comment
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Overall Result
16. Confined Spaces
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Photo
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Comment
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Overall Result
17. Storage of Materials
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Photo
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Comment
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Overall Result
18. Signages
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Photo
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Comment
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Overall Result
20. Harmful Substances
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Photo
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Comment
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Overall Result