Site Interaction Checklist 2013 - duplicate - duplicate - duplicate

• Location
  Address

• Conducted on

  Date

• Prepared by

• Personnel

• Task

• Add media

  Media

• HIGH RISK WORK

HIGH RISK WORK

• Excavations

  Yes

  N/A

• Permit to work completed correctly?

  Yes

  No

  N/A

• 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?