SL S IA

• Conducted on

  Date

• Auditor

Accident Incident Hazard Near Miss Procedure

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Do staff comply with this procedure

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do supervisors/managers comply with this work instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Executive Managers comply with this work instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

First Aid Work Instruction

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Are first aid boxes compliant.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are there appropriate numbers of first aid personnel for each shift/site

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Isolation and Tagging Procedure

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Are staff trained and do they act in compliance with this work instruction.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are appropriate tags available for use.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

JSA Risk Assessment Procedure

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Are risk assessments being completed where/when required.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are risk assessments being completed where/when required.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Is the required documentation compliant

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Manual Handling and Lifting Safe Work Instruction

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Can employees demonstrate the correct way to lift.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Mobile Electronic Device Work Instruction

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Do staff comply with the Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

PPE Work Instruction

• Departments audited

  Select Engineering Transport W/House Day W/House Night

  • Engineering
  • Transport
  • W/House Day
  • W/House Night

• Question X: Do staff comply with the work instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Is all required PPE available for workers.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do all contractors and visitors comply with this work instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Was the previous Engineering safety audit closed out

  Yes

  No

  N/A

General

• From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  Select Battery Cleaning Grinding Machine (Hand Held) Ladders Machinery Guarding Maintenance Work Order Request Noise Management Portable Power Tools Rubbish Crushing Safety Communication Working at Height

  • Battery Cleaning
  • Grinding Machine (Hand Held)
  • Ladders
  • Machinery Guarding
  • Maintenance Work Order Request
  • Noise Management
  • Portable Power Tools
  • Rubbish Crushing
  • Safety Communication
  • Working at Height

• Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Asbestos Management

• Question X: Is the Asbestos Management Plan & Asbestos Register current?

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Have all identified action/recommendations identified in the Asbestos Management Plan & Asbestos Register been addressed?

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Lifting Equipment Inspections

• Question X: Is any non-approved lifting equipment in use.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Is all lifting equipment recorded, inspected and marked as per the Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Permit to Work

• From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  Select Electrical Hazards Hot Works

  • Electrical Hazards
  • Hot Works

• Question X: Do contractors comply with the work instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do managers/supervisors comply with the work instruction(s)

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Traffic Management Plan

• Question X: Is the Traffic Management Plan current and observed by site users.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Vehicle and Mobile Plant

• Question X: Is maintenance for trucks and other mobile plant completed as per schedules and records maintained. <br>Note: Must audit 3 x trucks, 2 x reach or yard forklift, 2 x PR/PE/electric walk jack.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Vehicle - Maintenance Reporting Perth Metro Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Was the previous Transport safety audit closed out

  Yes

  No

  N/A

General

• From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  Select Palmyra gate operating Prision Supply

  • Palmyra gate operating
  • Prision Supply

• Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Driver Fatigue

• Question X: Are the steps in the Driver Fatigue Management Plan current and followed by supervisor's/managers.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are the steps in the Driver Fatigue Operating Standards and Procedure current and followed by drivers.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Vehicle

• Question X: Do Sealanes staff comply with the Tail Lift Operating Work Instruction.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Vehicle - Breakdown and Accident Work Instruction.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Vehicle - Maintenance Reporting Perth Metro Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Vehicle - Safe Entry and Exit of Trucks Work Instruction.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are all the vehicle work instructions current.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Was the previous Warehouse Day shift safety audit closed out

  Yes

  No

  N/A

General

• From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  Select Freezer Safe WI Loading Team Palmyra Gate Operating Telescopic Conveyor Belt Working in Racking Aisles

  • Freezer Safe WI
  • Loading Team
  • Palmyra Gate Operating
  • Telescopic Conveyor Belt
  • Working in Racking Aisles

• Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Working at Height

• Question X: Do Sealanes staff comply with the Working at Height Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Working at Height (Palmyra) Rescue Procedure and Plan

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are all rescue team members trained. <br>Note: Check training register and ask 3 people on the rescue team what their duties are.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are the work instructions current.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Was the previous Warehouse Night shift safety audit closed out

  Yes

  No

  N/A

General

• From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  Select Freezer Safe WI Loading Team Palmyra Gate Operating Telescopic Conveyor Belt Working in Racking Aisles

  • Freezer Safe WI
  • Loading Team
  • Palmyra Gate Operating
  • Telescopic Conveyor Belt
  • Working in Racking Aisles

• Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

Working at Height

• Question X: Do Sealanes staff comply with the Working at Height Work Instruction

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Do Sealanes staff comply with the Working at Height (Palmyra) Rescue Procedure and Plan

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are all rescue team members trained. <br>Note: Check training register and ask 3 people on the rescue team what their duties are.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Findings

• Question X: Are the work instructions current.

  Conforming

  Non Conforming

  Not Verified

• Corrective Actions

Corrective Action

• Corrective action to take

• Responsible Person

• Target Date

  Date

• Closed out date

  Date

• Determine how and when verification will occur.

• Responsible person

• Target Date

  Date

• Closed out date

  Date

• Findings