SITE SAFETY SPOT CHECK FORM

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Site audit date/time:

  Date

• Project/Site/Maintenance Activity:

• Main Contractor:

1) GENERAL

a) Site Safety Plan in Place

• i) Hazard Board

  Yes

  No

  N/A

• ii) Hoardings

  Yes

  No

  N/A

• iii) Signage

  Yes

  No

  N/A

• iv) Evacuation plan in place and assembly point identified

  Yes

  No

  N/A

• v) Site Induction Register available and up to date

  Yes

  No

  N/A

• vi) Site Induction received by all workers on site

  Yes

  No

  N/A

• vii) Traffic Management Plan (TMP) endorsed and implemented

  Yes

  No

  N/A

b) Site Safe

• i) All site personnel are Site Safe qualified

  Yes

  No

  N/A

• ii) Site Safe register and proof of qualification is available

  Yes

  No

  N/A

c) Site Environment

• i) Clear site access

  Yes

  No

  N/A

• ii) Site clean and tidy

  Yes

  No

  N/A

• iii) Waste containment adequate

  Yes

  No

  N/A

2) CRITICAL

a) PPE

• i) Appropriate Personal Protective Equipment is available and being worn

  Yes

  No

  N/A

b) First Aid

• i) First aid equipment available and locatable

  Yes

  No

  N/A

c) Notifiable/Permitable Works

• i) Has a Permit to Work been issued for all notifiable works from the appropriate authority (DPG, DOL, NAVOSH, DASH, FIRE)

  Yes

  No

  N/A

• ii) Scaffolding is clear of hazards

  Yes

  No

  N/A

• iii) Excavations correctly shored and isolated

  Yes

  No

  N/A

• iv) Appropriate restraint methods used for work above heights

  Yes

  No

  N/A

• v) Hot works are being performed in accordance with SOPs (PPE, Fire Extinguishers on hand, Hot Works Permit)

  Yes

  No

  N/A

d) Site and Equipment

• i) Materials stored in a safe and appropriate manner

  Yes

  No

  N/A

• ii) Use of RCDs where appropriate

  Yes

  No

  N/A

• iii) All leads are currently tagged, damage free and appropriately laid

  Yes

  No

  N/A

• iv) Any hazardous substances on site are being used and stored appropriately

  Yes

  No

  N/A

• Checkers name:

• Checkers Signature

  Sign

• Pass / Fail

  Pass

  Fail

• Contractor's Name:

• Contractor's Signature

  Sign

• Notes for guidance:
  1. In order to PASS this site check, the Contractor will have no more than TWO 'NO's' in the General category and will have achieved ALL the standards listed under Critical.
  2. If ANY activity is assessed as a 'NO' a comment MUST be made as to the specifics
  3. No's ARE to be rectified as soon as possible, followed by re-inspection and this form signed below.
  4. Site/Work activities ARE to cease until CRITICAL 'NO's' are rectified
  5. On completion of the site check, a copy should be kept on file and a copy given to the contractor and Facilities Manager.
  6. The Facility Manager is to ensure that results are recorded in the Contractor's KPIs and reports.

• COMMENTS (Add additional paper if necessary)

Post Check:

• No's have been rectified - Signature

  Sign

• Date: