Title Page
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Site Safety Observations Checklist - UFB Build
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ESQF012
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Note: To be viewed in conjunction with ESQG001 (Guide - Site Safety Observation Site Scenarios UFB Build)
Intro: S I T E S A F E T Y O B S E R V A T I O N
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Observers Name
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Select date
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GPS Capture - your location. (enable GPS on your device)
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Contractor Observed
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Cabinet Number
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Others (specify)
1) O B S E R V E D O N E N T E R I N G S I T E.
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You Noted staff putting on or not wearing appropriate PPE
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You were challenged to sign on to site
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Pot Holes
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Environment
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Foot Traffic Management is in place
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Machinery Barricades - are in place
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Others ( specify)
2) S I T E F O R M S
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Job START completed correctly, site hazards explained satisfactorily
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Site Emergency Procedure Staff understanding - ( prompt staff, what if ...... What would you do......)
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Job Safety Analysis (state)
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Emergency Assembly Point - you have been told where it is
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Consent to excavate near poles - complying with Electrical Amendment Reg 2011, Reg 7.
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Drill Calibration Record Sheet
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Daily Check Sheet - Excavator
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Daily Check sheet - Directional Drill
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Strike Alarm Test - Signed off
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Others (specify)
3) S I T E P R O C E D U R E S
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Emergency Procedure - Gas Strike
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Emergency Procedure - Electrical Strike
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Electrical Strike Alarm Test Instructions
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Others ( specify)
4) E N V I R O N M E N T / O T H E R
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Arborist sign-off
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Excavations complying with the. "rule of thumb" when working with tree roots
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Machinery oil / fuel spills are cleaned up
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Bunding to protect waterways - is in place
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Matting to protect waterways (from spoil)
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Environment spill ( Bore Gel ) clean up
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Surface cutting best practices followed
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POT HOLING - 10m rule followed when <1m from Critical Services (ie. 11kv or above, Gas, Fibre Network (>Medium capacity Fibre Network)
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Others (specify)
5) Q U A L I T Y
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Best practices Network lay path
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Reinstatement - Seal - Tack Coat 100% cover
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Others ( specify)
6) G E N E R A L S I T E S E T U P
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Safety around drill machine
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Safety around unloading
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Safety signage in place around fenced off areas
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Safety fencing around exposed trenches
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Safety fencing complies with COPTTM
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Good footpath management practices in place
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Protecting foot traffic (not creating additional hazards)
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Open trench is fenced off or protective plating is in place
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Working in confined space - correct safe practices followed
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Utility mark out-using correct colour identification
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When pressurised water excavating - correct practices are followed ( PPE and fencing (where applicable))
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Ground Penetration Radar (GPR) practices meet expectations
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Correct PPE used ( available) when mixing bore Gel
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Vehicle towing capacity not exceeded
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Excavator - Correct bucket securing practices followed ( look for the correct retainer pin and clip)
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Others (specify)
7) H & S C U L T U R E
8) C O M P L I A N C E O B S E R V E D
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What positive feedback was provided to encourage safe performance?
9) NON - C O M P L I A N C E O B S E R V E D
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What action was taken to modify behaviour?
10) R E P O R T C L O S E - O U T
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Discussed this observation findings with. (Sign here)
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Agreed on findings and follow up action (where identified) Observer sign here...
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Observe ( Site Field Manager or Site Manager ) - sign here
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Select date
