Contractor Name & Company:

Where the answer to a question is NO, raise a Non Conformance Report. Include safety non-conformance details on the report.


Air Conditioning




Maintenance (routine)





Contractor Sign –In Process

Have all of the contractor's employees been inducted?

Have contractor/s signed in using Upstream?

Has the contractor completed a scope of work?

Has the contractor completed the necessary permits?

SWMS/ JSA's have been provided and reviewed by Building Management?

The contractor was observed to (generally) be working in accordance with their SWMS/ JSA?

Have the required isolation's been actioned?

Are the Contractor identification label visible?

Organisation of the site

Work areas are barricaded to prevent non-authorized access?

Access/egress is available for facility staff/visitors around work area?

Site/work area is free from rubbish and obstructions?

Contractor is present in site/work area and is secure from passer-bys entering the site/work area?

Openings in floors, trenches etc are covered or barricaded?

Scaffolding is secured?


Electrical equipment – power tools, leads etc are tested and tagged?

Leads, plugs, sockets and switches appear to be in good condition (no exposed wires, no mechanical damage)?

Portable RCD’s are used for portable electrical equipment?

Insulated ladders are used near live exposed electrical equipment?

Prevention of Falls from Heights (>1.8metres)

Elevated work platforms have handrails and kick-boards?

Perimeter guard railing and screening is in place?

Work positioning and fall injury prevention systems are in place?

Safe access systems to prevent climbing falls (stairway or ladders)?

Single and extension ladders are effectively secured?

Material Storage

Building materials are stored within the confines of the work area?


Material safety data sheets (current)are able to be produced within the work area?

Current Safety Data Sheets (SDSs), within five years from the date of issue, are available for all the contractor’s hazardous chemicals on site?
SDSs must include Australian emergency contact details?

Personal Protective Equipment

PPE is being used, if mentioned on the SWMS/JSA?


Are there any site specific items that are not on this list that need to be addressed:
If YES – please list them?


Is there any issue the contractor wishes to raise?


In your observations is the Contractor meeting their obligations as assessed in this criteria?

Have identified Non-Conformance (s) observations been discussed with the contractor?

Has the Contractor agreed to/or rectified the non-conformance(s)?

Sign Off?
Engineering Sign Off
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.