Title Page
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Site conducted
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Conducted on
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Inspected by
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Signature
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Location
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Specific Station Name
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Job Type
- Plumbing
- Electrical
- Plumbing
- Remediation
- Carpentry
- Soft Strip Out
- Demolition
- Plastering
- Brickworks
- Tiling
- Waterproofing
- Air-conditioning Works
- Fire-Fighting Equipment Works
- Fire Protection & Equipment
- Garage Door/Gates
- Change Air Conditioning to HVAC Systems
- Mechanical Services
- Builder
- Painter
- Ground Maintenance
- Lifts & Cranes
- Locksmith
- Electronic Access Control
- CCTV
Worker Safety Peformance Review
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Name of Worker
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Company Name
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Is the worker aware of emergency procedures?
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Has the worker been inducted to the station by the Station Manager or completed the induction sheet as per the work order?
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Is the worker aware of how to report an incident to Fire & Rescue NSW?
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Does the worker have a copy of the SWMS/Safety Data Sheets required for the job?
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Is the worker following procedures in the SWMS?
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Comments on Safety Standards - What aspects is the worker completing well?
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Corrective Action Required - What can the worker improve on?
Administration and Records
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Has the worker completed their Property Work Order and Site Induction before commencing work?
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Has the worker reviewed the Site Specific Hazards and Site HAZMAT QR codes on the work order form?
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Is the worker wearing the required PPE (e.g., safety glasses, respirator mask)?
Work Environment
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Are controls in place to prevent workers and objects from falling from heights e.g. edge, protection, EWP, etc.?
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Are there Hot Works (e.g., welding) being undertaken? If so, have controls been implemented to mitigate Hot Work hazards?
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Is there excavation work being undertaken? If so, have controls been implemented to mitigate excavation hazards (e.g. falls, engulfment, etc.)
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Are there any confined spaces? If so, has a competent person completed and documented a risk assessment? Has a Permit been developed?
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Are there any noise-related health and safety risks been identified and managed? If so, have controls been implemented to mitigate noise hazards?
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Have essential services been identified and isolated where required (e.g. Electrical, Water, Gas)?
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Have risks to health and safety associated with traffic in the vicinity of the workplace been managed?
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Is work area been adequately secured to prevent public and unauthorized access e.g. perimeter fencing, physical barricades?
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Have adequate facilities been provided and are in good working order, including toilets, drinking water, washing facilities, and eating facilities?
Access and Exit Emergency Procedures
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Is access to all work areas free from obstruction?
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Are doors, doorways, emergency exits kept clear and able to be accessed by workers?
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Is the worker aware of the evacuation assembly point of the site?
First Aid Facilities/Fire Fighting Equipment
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Is the worker aware where the First Aid Facilities are?
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Is the worker aware of where the fire extinguishers and other firefighting equipment are?
Lighting
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Is there adequate lighting to perform work tasks?
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Is external lighting e.g., work lights, lamps, temp lighting being utilised.
Electrical Testing and Management
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Are all Electrical Devices Tested and Tagged where necessary?
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Are the tested and tagged equipment within their inspection dates, i.e., three months from last inspection?
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Are leads in good condition?
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Are leads and cords maintained out of the work path and walkways (e.g., lead stands utilised)?
Housekeeping
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Is the workplace free from any Slip, Trip or Fall hazards e.g. walkways in good condition and free from litter?
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Is the work area clean and tidy?
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Has all rubbish and waste been disposed of appropriately and promptly?
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Are hazard signs used to identify wet, slippery or other risk areas?
Plant and Equipment
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Are the workers utilising any plant e.g. scissor lift, EWP, etc,?
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Are all plant operators have the required licences or have been deemed competent?
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Pre-start inspections being completed on equipment where required?
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Has Maintenance, inspection, and testing been carried out plant and equipment by a competent person? If are there records?
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Are log books, service records up to date for plant and equipment?