Site Hazard Evaluation

• Document No.

• Company name

• Location
  Address

• Main contact/title

• Health and safety contact

• Completing audit for following roles:

  Select Warehousing Trucking Forklifing Manufacturing Supervisors/admin Machine operation Labourer Other

  • Warehousing
  • Trucking
  • Forklifing
  • Manufacturing
  • Supervisors/admin
  • Machine operation
  • Labourer
  • Other

• If other, please state

• Conducted on

  Date

• Prepared by

• Agoge does not have day to day control of our clients' sites, therefore the purpose of this document is to have an indication of the Health and Safety practices on this site, which may influence the way we conduct business or induct our staff.

General Health and Safety

• If affiliated with ACC Work safe management programme, please state level

  Primary

  Secondary

  Tertiary

  ACC partnership

  Other

• Have you had and reported any serious harm incidents to Worksafe in the last 5 years?

  Yes

  No

• Have you caused any significant environmental incidents that required notification to regional authorities in the last 5 years?

  Yes

  No

• A formal health and safety policy is in place and visible (dated no older than a year ago)

  Yes

  No

• Incidents are to be reported immediately to:

• Health and safety participation is welcome and staff are aware (rep meetings are held are staff feedback is welcome)

  Yes

  No

• Please state what personal protective equipment is required on site:

  Select Boots Ear muffs Ear plugs Hi vis Hard hat Gloves Gas mask Special clothing Hair net Other

  • Boots
  • Ear muffs
  • Ear plugs
  • Hi vis
  • Hard hat
  • Gloves
  • Gas mask
  • Special clothing
  • Hair net
  • Other

• If other, please state, along with particular grading needed.

• Company has their own doctor or physio contact

  Yes

  No

• If so, please provide contact details:

• Any further comments?

Site compliance

• Company has systems in place to ensure own and hired plant is safe for use

  Yes

  No

• Is there adequate ventilation and lighting on site? (Reflected light from walls and ceilings not causing glare to employees, is night lighting adequate?)

  Safe

  At risk

• Floor surfaces and footpaths even and uncluttered?

  Safe

  At risk

• Floors around racking, entry, walkways and intersections clear of rubbish or obstructions?

  Safe

  At risk

  n/a

• Pedestrian walkways adequate and clearly marked, with barriers in place (where needed)?

  Safe

  At risk

  n/a

• Non-pedestrian areas adequate and clearly marked, and mirrors in place for busy corners?

  Safe

  At risk

  n/a

• Are gas bottles secured?

  Safe

  At risk

  n/a

• No damaged hand tools, power tools or equipment/plant in use?

  Safe

  At risk

  n/a

• Are fall preventive measures in place and in good condition and used where gaps occur in railings?

  Safe

  At risk

  n/a

• Any further comments?

Emergency procedures and evaluation

• Do kits/cabinets include product/equipment that will aid in emergencies relevant to the site (burns, electrical, cuts, hazardous materials, eye washes etc) and are they clean and kept up to date?

  Yes

  No

• Evacuation plan up to date, displayed and understood by employees? (along with emergency numbers)

  Yes

  No

• Extinguishers up to date, in place, clearly marked for type of fire and clear of obstruction?

  Yes

  No

• Fire alarm system functioning correctly and checked at least twice a year?

  Yes

  No

• Exit doors marked clearly and easily opened from inside, and clear of obstruction?

  Yes

  No

• Any further comments?

Machinery (if applicable)

• Clear process in place to ensure only inducted, trained and competent staff use machinery (if applicable)

  Yes

  No

  n/a

• Machines and areas surrounding kept clean and serviced regularly?

  Safe

  At risk

  n/a

• Guards in place and in good condition?

  Safe

  At risk

  n/a

• Starting and stopping devices within easy reach of operator, and emergency shut down procedures in place?

  Safe

  At risk

  n/a

• Any further comments?

Transport/heavy machinery (if applicable)

• All drivers/operators skilled and qualified?

  Yes

  No

  n/a

• Effective process in place to ensure maintenance is carried out to acceptable industry standards, processes are supervised and recorded? Non-compliant are not in use until compliant.

  Yes

  No

  n/a

• Any further comments?

Induction/training/staff involvement

• Do you require workers with any particular certification, licences, skills or attributes?

• New staff members inducted and supervised until competent?

  Yes

  No

• What kind of induction and training will be provided?

• Staff are properly trained and supervised to ensure they work in a safe manner. The company acknowledges responsibility in training and supervising staff

  Yes

  No

• Handbooks/guidelines/standard operating procedures available to staff?

  Yes

  No

• Are there trained first aiders on site?

  Yes

  No

• Any further comments?

Hazards

• Company will report all incidents with injury and incidents without injury to Agoge Limited (when relating to Agoge on-site staff)

  Yes

  No

• The company has in place and operate a system for reporting and investigating incidents as well as incidents without injury, and maintain an appropriate accident register

  Yes

  No

• Company has and use a system for identifying and controlling hazards and maintain a hazard register (reviewed at least annually)

  Yes

  No

• Are there any specific high risk hazards that we should make our staff aware of before they commence work?

  Yes

  No

• Please state:

• What are three hazards that all staff are aware of?

• Any further comments?

Manual handling

• Manual handling training available to staff?

  Yes

  No

  n/a

• Staff are encouraged to use proper lifting technique

  Yes

  No

Signatures/Agreement

• Recommendations or further notes:

• Company representative

  Sign

• Agoge Manager

  Sign