Site Visits

• Audit Title

• Document No.

• Activity

  Select Dig Out Rehab Mill and Fill Footpaths Reseals Unsealed Roads Shoulder Maintenance Drainage Bridge Maintenance Other

  • Dig Out
  • Rehab
  • Mill and Fill
  • Footpaths
  • Reseals
  • Unsealed Roads
  • Shoulder Maintenance
  • Drainage
  • Bridge Maintenance
  • Other
• Location
  Address

• Crew

• Site activity level

  Operational

  Break

  Unattended

• Conducted on

  Date

• Prepared by

Induction / Paperwork

• Approached by STMS

  Yes

  No

  N/A

• Comprehensive Induction

  Yes

  No

  N/A

• Pre-Start Tailgate Complete

  Yes

  No

  N/A

• Hazard Register Reviewed

  Yes

  No

  N/A

• Emergency Plan

  Yes

  No

  N/A

• Subcontractors have cards

  Yes

  No

  N/A

• Permit to dig

  Yes

  No

  N/A
Tap to enter information

• Is the latest form being used

  Yes

  No

  N/A

• Permit to work

  Yes

  No

  N/A
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• Is all paperwork completed

  Yes

  No

  N/A

• Is everybody trained

  Yes

  No

  N/A

Traffic Management

• Site feels safe

  Yes

  No

  N/A

• TTM is appropriate

  Yes

  No

  N/A

• Approved CAR onsite

  Yes

  No

  N/A

• Sign visibility distance adequate

  Yes

  No

  N/A

• TSLs gated

  Yes

  No

  N/A

• Adequate safety zones

  Yes

  No

  N/A

• MTCs appropriately set up

  Yes

  No

  N/A

• Adequate pedestrian controls

  Yes

  No

  N/A

• Monitoring completed

  Yes

  No

  N/A

• Min PPE required worn

  Yes

  No

  N/A

• Are gloves being worn for manual handling tasks

  Yes

  No

  N/A

• Specialised PPE Identified

  Yes

  No

  N/A
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• Is it being worn correctly

  Yes

  No

  N/A

• Is plant/ equipment fit for purpose

  Yes

  No

  N/A

• Is Plant road legal

  Yes

  No

  N/A

• Is plant / equipment stored in dripline

  Yes

  No

  N/A

• Is work within the dripline

  Yes

  No

  N/A
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• Is the resource consent on site

  Yes

  No

  N/A

• Are required controls in place

  Yes

  No

  N/A

• Are catchpit controls required

  Yes

  No

  N/A
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• Are controls in place

  Yes

  No

  N/A

• Are they effective

  Yes

  No

  N/A

• Are they being maintained

  Yes

  No

  N/A

• Is a site specific EMP required

  Yes

  No

  N/A
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• Type

  Select Noise Emulsion Stabilising

  • Noise
  • Emulsion
  • Stabilising

• Is it on site

  Yes

  No

  N/A

• Have all controls been implemented

  Yes

  No

  N/A

• Site tidy no S/T/F hazards

  Yes

  No

  N/A

• Unattended site left in safe condition

  Yes

  No

  N/A

• Other observations