Site Interaction Checklist

• Location
  Address

• Conducted on

  Date

• Prepared by

• Personnel

  Select Alex Bagshaw Ali Rahimi Ash Bray Attila Flaman Cameron Smith Chris Grover Craig Beschmann Dean Millard Donal McCarthy Gavin Connolly Jeremy Slater Kiel Poszeluk Matthew Bubb Matthew Prout Ryan Moult Seth Alexander Steve DeMuth GBJ Electrical Allrid Pest Control Other

  • Alex Bagshaw
  • Ali Rahimi
  • Ash Bray
  • Attila Flaman
  • Cameron Smith
  • Chris Grover
  • Craig Beschmann
  • Dean Millard
  • Donal McCarthy
  • Gavin Connolly
  • Jeremy Slater
  • Kiel Poszeluk
  • Matthew Bubb
  • Matthew Prout
  • Ryan Moult
  • Seth Alexander
  • Steve DeMuth
  • GBJ Electrical
  • Allrid Pest Control
  • Other

• Task

• Add media

  Media

• HIGH RISK WORK

HIGH RISK WORK

• Excavations

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• Comment?

• Excavation permit completed correctly?

  Yes

  No

  N/A

• Dial Before You Dig acquired and understood?

  Yes

  No

  N/A

• Site drawings acquired and understood?

  Yes

  No

  N/A

• Working at heights

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• Working at heights permit completed correctly?

  Yes

  No

  N/A

• Asbestos removal

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• Asbestos Removal Control Plan completed correctly?

  Yes

  No

  N/A

• Hot works

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• Hot works permit completed correctly?

  Yes

  No

  N/A

• Confined space

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• Confined space permit completed correctly?

  Yes

  No

  N/A

• Electrical/HV

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• RISK ASSESSMENTS

RISK ASSESSMENTS

• Take 5

  Yes

  N/A

• Completed correctly?

  Yes

  No

  N/A

• Hazard ID effective?

  Yes

  No

  N/A

• Controls successfully implemented?

  Yes

  No

  N/A

• JHA

  Yes

  N/A

• Completed correctly?

  Yes

  No

  N/A

• Hazard ID effective?

  Yes

  No

  N/A

• Controls successfully implemented?

  Yes

  No

  N/A

• SWP

  Yes

  N/A

• Read and understood by worker?

  Yes

  No

  N/A

• Signed onto by worker?

  Yes

  No

  N/A

• Referenced in JHA?

  Yes

  No

  N/A

• Guidelines followed and controls implemented?

  Yes

  No

  N/A

• HOUSEKEEPING & SITE SETUP

HOUSEKEEPING & SITE SETUP

• Site box in place and correctly set up?

  Yes

  No

  N/A

• Access to site clear?

  Yes

  No

  N/A

• Site barricading sufficient?

  Yes

  No

  N/A

• Sufficient signage in place?

  Yes

  No

  N/A

• Site secured when unattended?

  Yes

  No

  N/A

• Materials and equipment neatly organised?

  Yes

  No

  N/A

• Waste materials being correctly dealt with?

  Yes

  No

  N/A

• CHEMICALS

CHEMICALS

• Chemicals on approved list?

  Yes

  No

  N/A

• MSDS available for each product?

  Yes

  No

  N/A

• Storage method compliant?

  Yes

  No

  N/A

• Waste disposal methods suitable?

  Yes

  No

  N/A

• PPE

PPE

• Clothing and body protection required?

  Yes

  N/A

• Correctly implemented?

  SAFE

  AT RISK

• Eyewear / face protection required?

  Yes

  N/A

• Correctly implemented?

  SAFE

  AT RISK

• Head protection required?

  Yes

  N/A

• Correctly implemented?

  SAFE

  AT RISK

• Hearing protection required?

  Yes

  N/A

• Correctly implemented?

  SAFE

  AT RISK

• Protection class

  Select 3 5

  • 3
  • 5

• Respiratory protection required?

  Yes

  N/A

• Implemented?

  Yes

  No

• Fit test completed?

  Yes

  No

• User clean shaven and adhering to facial hair policy?

  Yes

  No

• Model used?

  9322 FFP2

  SR100

• Filter used:

  SR510

  SR218

  SR232

  SR315

• Correct for task?

  SAFE

  AT RISK

• Correct for task?

  SAFE

  AT RISK

• Gloves required?

  Yes

  N/A

• Correctly implemented?

  SAFE

  AT RISK

• MANUAL HANDLING

MANUAL HANDLING

Task

• Description

• Mechanical aids used

• Add media

  Media

• Back

• Risk level

  LOW

  MODERATE

  HIGH

  CRITICAL

• Shoulders

• Risk level

  LOW

  MODERATE

  HIGH

  CRITICAL

• Arms

• Risk level

  LOW

  MODERATE

  HIGH

  CRITICAL

• Legs

• Risk level

  LOW

  MODERATE

  HIGH

  CRITICAL

• USE OF PLANT / EQUIPMENT

USE OF PLANT / EQUIPMENT

• Portable power tools

  Yes

  N/A

• Tools used

  Select Drill Skill saw Drop saw Planer

  • Drill
  • Skill saw
  • Drop saw
  • Planer

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• Hand tools

  Yes

  N/A

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• Concrete saw

  Yes

  N/A

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• Jackhammer

  Yes

  N/A

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• Angle grinder

  Yes

  N/A

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• Other

  Yes

  N/A

• Description

• Prestart check completed?

  Yes

  No

  N/A

• Operator competent?

  Yes

  No

  N/A

• VEHICLES & MACHINERY

VEHICLES & MACHINERY

• Vehicle / machine inspection

Vehicle

• Description

• Correctly parked?

  Yes

  No

• Prestart check completed?

  Yes

  No

  N/A

• Mechanically sound?

  Yes

  No

  N/A

• Vehicle file complete and current?

  Yes

  No

  N/A

• Machine use?

  Yes

  No

• Machines used

  Select Excavator Backhoe Skid steer Forklift Potholing machine

  • Excavator
  • Backhoe
  • Skid steer
  • Forklift
  • Potholing machine

• Operator competent?

  Yes

  No

• Operated safely?

  Yes

  No

• Spotter in place?

  Yes

  No

  N/A

• ACTIONS

ACTIONS

Action

• Description

• By whom?