Information

  • Site

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  • Alpha Code

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  • Location
  • For this assessment the following applies

    Safe -
    At Risk -
    Fail -

Section 1.0 - Site planning and mangement

Site Management and Planning

  • Scope of Works

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  • Expected duration of works (days)

  • Is the site access information correct and up to date?

  • Is the Health and Safety plan on site, accessible and legible?

  • Outline areas to improve the Health and Safety plan with dates for completion

  • Select date

  • Stop work until this has been undertaken.

  • Has a hazard and risk assessment been undertaken for the site?

  • Outline areas to improve the Health and Safety plan with dates for completion

  • Select date

  • Ensure that a hazard and risk assessment is completed for the site before any further work is undertaken on site.

  • Have Safe Work Method Statements or JSA's been prepared for high risk activities on site and are being followed?

  • Select date

  • Ensure that a SWMS or JSA are completed for high risk activities before work continues

  • Outline areas to improve the Health and Safety plan with dates for completion

  • Select date

  • All contractors (including sub contractors) have been provided with information relating to health and safety for the work they are undertaking?

  • Is the time allowed suitable for the scope of work to be undertaken?

Summary

  • Site Management and Planning

Safety Gear

  • Hi Viz

  • Safety Helmet

  • Safety glasses

  • Appropriate clothing for the environmental conditions

  • Safety boots (or appropriate footwear for working on roofs)

  • Hearing protectors of the appropriate class

  • Sunscreen

  • Gloves

Summary

  • Safety Gear appropriate to the task is in being worn and is in good condition?

Competency

  • Principal Contractor Network Requirements

  • 2 Degrees

  • Vodafone Sites

  • Telecom Sites - PTN Training

  • Workers on roofs with proprietary anchor systems in place have completed US23229 and have a copy of their current certification on site?

  • Workers on communication towers, poles and roofs have completed US 23229, 15757 and 17025 and have a copy of their current certificate on site?

  • Are all persons on site competent and trained to undertake the tasks on site?

  • Work should cease until persons competent to undertake the required tasks are on site. An incident report should also be sent to the relevant Principal Contractor

Summary

  • Competency

Emergency planning and equipment

  • Is the site able to call for emergency assistance - Fire, Police Ambulance?

  • Are appropriate Fire Extinguishers on site?

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  • Emergency assembly point identified?

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  • Are first aid kits, current, we'll stocked and readily available?

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Summary

  • Emergency planning

Environmental

  • Working hours restrictions are being adhered to?

  • Noise and vibration are kept to acceptable levels?

  • Are hazardous substances clearly labelled and stored appropriately?

  • There is a spill kit on site appropriate for the type and amount of substances on site?

  • All site areas are kept tidy with litter removed from site appropriately?

Summary

  • Environmental

General

  • Have all visitors signed the visitor log?

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  • Are hazards, risks and controls discussed with visitors prior to entering the site?

  • Incident report register on site and up to date?

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  • Is the work site (including footpaths and roadways) clear and free from debris, rubbish and obstructions?

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  • Are slip and trip hazards being adequately managed?

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  • Is lighting adequate for carrying out tasks and and/or safe access?

Summary:

  • General

Section 2.0 Access to Roofs, Brittle Roofs and RF

Roof Access

  • Are persons on site working on the roof of a building?

  • An assessment has been made of any internal ladders used to gain access to the roof to ensure they are structurally sound?

  • Handrails are in place for ladders if required?

  • Evidence

  • Ladders extends 1 metre above the landing platform?

  • Portable ladders meet AS/NZS 1892?

  • Portable ladders are secured at the top and the bottom?

  • If access to the roof is via an internal crawl space this should be considered a restricted space and a safe work method planned. (This must include a standby person who does not enter the restricted space).

  • If work is being undertaken in a restricted space has a safe work method statement been established and implemented?

  • Work should cease until a safe work procedures are in place

Summary

  • Access to Roof

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Brittle Roofs (Skylights, Asbestos Roofs, Openings, Roofs in Poor Condition)

  • Is the roof surface brittle, in poor condition or has skylights?

  • An assessment of the roof has been made to ensure it is strong enough to support the work activities being carried out. (Asbestos roofs are the majority of brittle roofs).

  • Has the roof been inspected internally (if possible) to ensure it is sound?

  • Has an competent person undertaken this assessment?

  • Are areas such as skylights, roof openings designated as no go zones and barricaded off or covered if required?

  • Are walkways with guardrails provided when work on fragile roofs cannot be avoided?

  • If walkways are not provided is a fall arrest system being used?

  • Work on the roof must stop until safe work methods are in place.

Summary

  • Brittle Roofs

RF

  • Are there RF hazards on site?

  • RF warning signs are in place at access points?

  • Ensure that a report is made to the Mobile Company concerned that signs are not present.

  • Evidence

  • Are persons trained/competent/certified in RF Awareness

  • On co location sites, other mobile company antennae have been considered when planning the work?

  • Have adjacent buildings be assessed as a possible source of RF?

  • Are RF monitors calibrated?

  • Are appropriate RF monitors available and being used?

  • RF procedures and monitoring practices have been followed?

  • Telecom RF Shutdown Procedure ND4027 Ver 6.0 has been followed?

  • 2 Degrees

  • Vodafone

Summary

  • RF

Section 3.0 - Equipment used for Working at Heights on Towers, Poles and Roofs

Machinery for working at Heights on Towers, Roofs and Structures

  • MEWP, Crane Scaffold or Guardrails being used on Site?

  • Move to the next section

  • Are workers on the ground wearing appropriate PPE e.g. Safety Helmets, Safety Boots, High Viz Vests and Eye Protection?

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  • Have exclusion zones been implemented and sufficient for the tasks being carried out?

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  • Do the exclusion zones prevent members of the public accessing the site?

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  • Assess any of the following equipment on site

  • Mobile Elevated Work Platfrom

  • Has the operator carried out a carried out a pre start inspection of the MEWP that includes functional and visual tests (required each day)?

  • Is the MEWP clearly marked with the rated lifting capacity

  • Weight of lift?

  • Essential operating and maintenance instructions permanently displayed or stored in a conspicuous place on the MEWP?

  • Is the six monthly inspection certificate displayed?

  • Operator is trained and competent (US 23966 v1) and the corresponding unit for the type of MEWP being used?

  • Hazards associated with power lines are appropriately controlled (no closer than 6.4 metres, or between 4 - 6.4 metres with appropriate controls in place. No work can be carried out within 4 metres of a power line without the written consent of line owner and this consent must remain on site at all times?

  • Weather conditions are suitable for using the MEWP?

  • Are harnesses, lanyard and attachment points available to all workers undertaking tasks from the MEWP?

  • Is the MEWP set up on firm and level ground?

Summary

  • MEWP

  • Crane

  • Is the plan and information provided by the crane supplier signed and accepted by the contractor on site?

  • Is the crane set up on firm, level ground with barriers in place?

  • Safe working distances are maintained from overhead power lines?

  • No persons are standing under suspended loads?

  • Tag lines are used where there could be load spin?

  • The load does not exceed the lifting capacity of the crane

  • Lifting capacity of the crane

  • Weight of lift

  • Clear lines of communication exist between the dogman/persons in bucket and the crane operator?

  • Weather conditions suitable for the use of a crane?

Summary

  • Crane

  • Scaffold or Mobile Scaffold

  • Are the surface conditions suitable for scaffold access and stability - e.g level and safe to work on?

  • Is there a health and safety management plan on site that clearly identifies those responsible for implementing control measures for the scaffold?

  • Are site specific hazards e.g proximity to power lines and control measures included in the Safe Work Method Statement or JSA?

  • The scaffold was erected, altered or dismantled by a person(s) who have been trained and have suitable experience with the type of scaffold being used?

  • Are the wheels locked and turned out on mobile scaffolds?

  • If a portion of the scaffold is above 5 metres above the ground the following conditions must be met

  • The person assembling, altering or dismantling the scaffold have a certificate of competence

  • Scaffold inspection card/register (Safety Tag) clearly visible in place by the access ladder and checked weekly?

  • Notification has been sent to WorkSafe NZ

  • The maximum load (weight of workers and materials) has been determined and the scaffold is capable of supporting the weight

  • Edge protection provided where a person could fall 2 or more metres

  • Scaffold protected from passing vehicles or plant

  • Ladders are secured top and bottom.

  • Ladder extended 900-1000 mm above the landing platform.

  • Planks are in good condition, 3 planks minimum and butted and secured.

Summary

  • Scaffolds

  • Edge Protection?

  • Designed and constructed to by a competent person?

  • Positioned appropriately?

  • Will barriers and guard rails be regularly inspected

  • Includes a toe board or mesh infill to prevent tools, materials and debris falling from the roof?

  • Not used on a roof with greater than 35 degree slope (In this instance a MEWP, or Fall Restraint/Arrest system must be used)

Summary

  • Edge protection

  • Photo showing MEWP or CRANE

Section 4.0 - Fall Restraint and Fall Arrest

Fall restraint and fall arrest systems

  • Are fall restraint or fall arrest systems being used on site?

  • Move to the next section

  • All personnel trained and certified for working at height?

  • Has the rigger undertaken a visual inspection of the structure, pole etc prior to work commencing?

  • Is each person familiar with the work plan?

  • Are personnel attached at all times while working at height?

  • Has a drop zone been implemented and sufficient for the tasks being carried out?

  • Is all equipment secure to prevent a fall from height?

  • Does each member of the team have the required PPE?

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  • Riggers gloves

  • A rescue, climbing or caving safety helmet

  • Self rescue kit carried

  • Clothing to suit the environmental conditions

  • Eye protection from glare and also flying objects/particles.

  • First aid kit?

  • Boots that are appropriate to the task ( AS 2210)

  • Is there a written rescue plan that is known to each member of the team?

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  • Two certified rescue climbers are on site at all times?

  • Notification has been sent to WorkSafe NZ of the work?

  • Are all members of the team trained and competent for the tasks they are carrying out?

  • Has a SWMS or JSA been prepared for height work on site?

  • Are there established safe access pathways to the anchor points?

  • Is a certified fall restraint system available for use?

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  • If using a fall arrest system are suitable certified anchor points being used?

  • Date anchor points certified to?

  • Certified load?

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  • If certified anchor points are not available a Temporary Anchor Point Permit must be completed and a copy held on site

  • The temporary anchor point permit has been signed by a competent rigger?

  • Rope access work must cease until the permit is completed

  • The temporary anchor point permit has been signed by the rescue climber?

  • Rope access work must cease until the permit is completed

Summary

  • Fall restraint and fall arrest

Section 5.0 - Other Safety Critical Risks

Pedestrian and Public Safety

  • Are members of the public/pedestrians passing the site?

  • Is a spotter required on site?

  • Is safe pedestrian access maintained on site at all times?

  • Are appropriate barriers in place that create a safe zone around activities that involve working at height?

  • When plant and machinery are in operation (e.g. MEWP, Crane, Container Delivery) these are isolated from the general public?

  • Work vehicles are parked safely?

Summary

  • Pedestrian and public safety

Electrical Safety

  • Is electrical work being undertaken on site?

  • Procedures are in place for ensuring electrical equipment is de-energised before electrical work is carried out and methods in place to ensure that it cannot <br>be inadvertently re-energised (isolation, tagging and lockout)?

  • Persons conducting work on electrical equipment are appropriately trained, registered and hold a practising license for the type of work being undertaken?

  • Proven to be de-energised before work commences?

  • Only ladders constructed of timber or fibreglass are to be used for work on or near electrical apparatus?

  • All electrical equipment, extension leads and portable power tools are in good condition and regularly inspected, tested and tagged?

  • Undertaken a CPR course (within the last 12 months) and Basic First Aid course (within the last 2 years)?

Live electrical work

  • Is live electrical work being undertaken on site?

  • A risk assessment and safe work method statement has been prepared before any live work is undertaken?

  • When working on or near live electrical apparatus the following Safety Gear (PPE) is being worn

  • Clothing covers the body from neck to wrist to ankle, (cotton)

  • Sleeves rolled down and shirts tucked into trousers (protecting against entanglement and arc flash)

  • Non metallic fasteners (or fasteners are protected by a layer of the same material as that of the garment)?

  • Suitable eye protection?

Summary

  • Electrical

Traffic Management

  • Is the worksite in the road corridor or subject to frequent vehicle movements?

  • Copy of the traffic management plan signed by the contractor and maintained on site?

  • Traffic management setup is correct and according to the TMP?

  • STMS contact number listed?

  • Is there an escape route for the traffic controller?

  • Comes and barriers in good condition?

  • After hours TMP in place if necessary?

Summary

  • Traffic Management

Section 6.0 - Health and Safety Summary

Summary

  • If any of the following areas are not being managed appropriately then work at the site should be halted until the area(s) of concern are addressed.

  • Site planning and management

  • Roof access, brittle roofs and RF

  • Equipment and plant for working on towers, roofs and structures

  • Fall restraint, arrest and anchor points

  • Pedestrian, Public and Traffic Safety

  • Competency of workers on site?

  • Are any other hazards present on site, list below

  • Are these hazards and risks being appropriately controlled?

  • Were any unsafe work practices observed at the time of the assessment

  • Please describe the unsafe practice observed below

  • Comments -enter below

Agreement

  • Required corrective actions

  • Agreed date for completion of corrective actions

  • Assessor

  • Company

  • Site representative

  • Company

  • Select date

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