Title Page

  • Project Number/Site Location

  • Conducted on

  • Prepared by

  • Task description

Pre-Task Checklist

  • Do I have the correct: • Access to property • Service delivery support • Information • BYDA(DBYD)

  •  Think about: ·People/Systems affected ·Safe access/exits ·Nearby equipment or tasks ·Task set up ·Environmental impact ·Alternate method

Page 1

  • Can I strain or over exert myself (Lifting, twisting, pulling or reaching)?

  • Use appropriate tools and manual handling techniques. If opening covers that are heavy or that are unable to be slid open organise service delivery assistance.

  • Can I slip or trip (Wet surface, obstacles, uneven surfaces, steps up/down)?

  • Appropriate footwear. Assess ground conditions. Avoid slippery and unstable surfaces if possible. Use paths if possible. 3 points of contact when climbing steep steps or on steep terrain.<br>

  • Can I damage any equipment?

  • Assess risk to equipment. Are there alternatives? If working in public or busy areas, use one instrument at a time.

  • Can I be caught in, on or between any equipment, tools or objects?

  • Stop work. JSEA required.

  • Could there be any uncontrolled movement (vehicle, mobile plant, equipment)?

  • Suitable PPE (e.g., high vis, foot protection, long sleeves and trousers, gloves, safety glasses), Maintain situational awareness. Comply with any traffic controls.

  • Can I come into contact with traffic?

  • Do the traffic conditions meet the criteria in AGTTM-05 4.2 or 4.3 (Working in gaps between traffic), or 5.1/TW TM Proc01 (Work outside traffic lane), or TW 5E (Frequently changing work area outside traffic lane).

  • Shadow vehicle as per TW TMP 5A

  • Is traffic management arranged?

  • By whom?

  • T1-5 signs to be placed 45m up from work area. Check every 2 hours. Log traffic plan.

Part 2

  • Can I come into contact with something that may harm me (heat, fumes, electricity, gas, stored energy, traffic, hydraulics)?

  • Are you using the hydraulic lifter. If so follow Survey SWMS.

  • Stop work. JSEA required.

  • Do I need to enter a confined space?

  • Stop work. Organise access with Service Delivery. Requires multiple trained personnel and JSEA.

  • Can I fall from a height or a live edge with no barriers (Not maintenance holes)?

  • Stop work. JSEA required. Organise access with service delivery or revise work method.

  • Are you surveying/inspecting maintenance holes or similar pits?

  • Follow SWMS. Laser scan holes deeper than ~1.3m to avoid crossing live edge. Watch footing and minimise work near live edge. Hole must be barricaded or actively attended at all times. Follow confined space gas test procedure (crack/check) if holes suspected of containing gases (long residence times/slow flows).

  • Could something fall on me or strike me (lifting operations, work overhead)?

  • Stop work. JSEA required.

  • Do I need to identify an exit path in case of emergency?

  • Stop work. JSEA required

  • Does anything need to be isolated (pump, valve, switch, equipment)?

  • Stop work. JSEA required. Liaise with other teams.

  • Do I have work mates or contractors I need to inform of the risk of my task?

  • Stop work. JSEA required. Liaise with other teams.

Part 3 - Environmental hazards

  • Am I working in adverse weather conditions (wind, heat, cold, lightning)?

  • Use appropriate PPE. If windy, check for potential falling branches and avoid working in potential fall zones. If lightning, stop work and wait.

  • Can I get sunburnt?

  • Sunblock, hat, long sleeves/pants

  • Am I working on a treatment plant or other similar complex site

  • Are there any hazardous areas (e.g., digesters)?

  • Identify hazardous areas, or ensure none within your work area.

  • Is there a chlorine store on site?

  • Identify chlorine storage, or ensure none within your work area.

  • Any other chemicals to be aware of?

  • Identify chemicals, or ensure none within your work area.

  • Is there a likelihood of wildlife - snakes, insects?

  • Appropriate PPE - foot protection, gloves, long sleeves/pants

  • Am I working in an area of high bushfire risk?

  • Have you checked for any nearby fires - http://www.fire.tas.gov.au/Show?pageId=colCurrentBushfires

  • Am I working near or on water?

  • Life jacket as per Survey SWMS. Spotter required if exiting water likely to be difficult.

  • Stop work. JSEA required.

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.