Title Page

  • Site conducted

  • Conducted on

  • Inspected by

  • Signature

  • Location
  • Specific Station Name

  • Job Type

Worker Safety Peformance Review

  • Name of Worker

  • Company Name

  • Is the worker aware of emergency procedures?

  • Has the worker been inducted to the station by the Station Manager or completed the induction sheet as per the work order?

  • Is the worker aware of how to report an incident to Fire & Rescue NSW?

  • Does the worker have a copy of the SWMS/Safety Data Sheets required for the job?

  • Is the worker following procedures in the SWMS?

  • Comments on Safety Standards - What aspects is the worker completing well?

  • Corrective Action Required - What can the worker improve on?

Administration and Records

  • Has the worker completed their Property Work Order and Site Induction before commencing work?

  • Has the worker reviewed the Site Specific Hazards and Site HAZMAT QR codes on the work order form?

  • Is the worker wearing the required PPE (e.g., safety glasses, respirator mask)?

Work Environment

  • Are controls in place to prevent workers and objects from falling from heights e.g. edge, protection, EWP, etc.?

  • Are there Hot Works (e.g., welding) being undertaken? If so, have controls been implemented to mitigate Hot Work hazards?

  • Is there excavation work being undertaken? If so, have controls been implemented to mitigate excavation hazards (e.g. falls, engulfment, etc.)

  • Are there any confined spaces? If so, has a competent person completed and documented a risk assessment? Has a Permit been developed?

  • Are there any noise-related health and safety risks been identified and managed? If so, have controls been implemented to mitigate noise hazards?

  • Have essential services been identified and isolated where required (e.g. Electrical, Water, Gas)?

  • Have risks to health and safety associated with traffic in the vicinity of the workplace been managed?

  • Is work area been adequately secured to prevent public and unauthorized access e.g. perimeter fencing, physical barricades?

  • 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

  • Is access to all work areas free from obstruction?

  • Are doors, doorways, emergency exits kept clear and able to be accessed by workers?

  • Is the worker aware of the evacuation assembly point of the site?

First Aid Facilities/Fire Fighting Equipment

  • Is the worker aware where the First Aid Facilities are?

  • Is the worker aware of where the fire extinguishers and other firefighting equipment are?

Lighting

  • Is there adequate lighting to perform work tasks?

  • Is external lighting e.g., work lights, lamps, temp lighting being utilised.

Electrical Testing and Management

  • Are all Electrical Devices Tested and Tagged where necessary?

  • Are the tested and tagged equipment within their inspection dates, i.e., three months from last inspection?

  • Are leads in good condition?

  • Are leads and cords maintained out of the work path and walkways (e.g., lead stands utilised)?

Housekeeping

  • Is the workplace free from any Slip, Trip or Fall hazards e.g. walkways in good condition and free from litter?

  • Is the work area clean and tidy?

  • Has all rubbish and waste been disposed of appropriately and promptly?

  • Are hazard signs used to identify wet, slippery or other risk areas?

Plant and Equipment

  • Are the workers utilising any plant e.g. scissor lift, EWP, etc,?

  • Are all plant operators have the required licences or have been deemed competent?

  • Pre-start inspections being completed on equipment where required?

  • Has Maintenance, inspection, and testing been carried out plant and equipment by a competent person? If are there records?

  • Are log books, service records up to date for plant and equipment?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.