Take 5 Works

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safe Work Procedure - Plant / Equipment

• SWP - Skid steer loader

  Yes

  No

  N/A

• SWP - Street sweeper

  Yes

  No

  N/A

• SWP - Backhoe or Loader

  Yes

  No

  N/A

• SWP - Drive and Manoeuvre Trailers

  Yes

  No

  N/A

• SOP - Vibrating Plate Compactor (Wacker Packer)

  Yes

  No

  N/A

• SWP - concrete saw (quick cut)

  Yes

  No

  N/A

Safe Work Procedure - Works

• SWP - Bituminous surfacing repairs - repairing roads in the LGA using bitumen (hot mix)

  Yes

  No

  N/A

• SWP - Working near overhead power lines and underground services.

  Yes

  No

  N/A

• SWP - Setting up mobile traffic lights. - the setting up and removing of mobile traffic lights at worksites.

  Yes

  No

  N/A

• SWP - Traffic control, set up, maintenance and removal

  Yes

  No

  N/A

• SWP - Picking up sharps

  Yes

  No

  N/A

• SWP - pick up dead animals

  Yes

  No

  N/A

• SWP - working alone

  Yes

  No

  N/A

Hazard / Condition

• Site access / agrees poor

  Safe

  At Risk

  N/A

• Signs / lamp posts

  Safe

  At Risk

  N/A

• Scaffold secure

  Safe

  At Risk

  N/A

• Overhead power lines

  Safe

  At Risk

  N/A

• Other electrical hazards

  Safe

  At Risk

  N/A

• Underground services

  Safe

  At Risk

  N/A

• Exposed Reo

  Safe

  At Risk

  N/A

• Environment (ie noise, dust, fumes)

  Safe

  At Risk

  N/A

• Others working above / below

  Safe

  At Risk

  N/A

• Falling objects possible.

  Safe

  At Risk

  N/A

• Warning notices required.

  Yes

  No

  N/A

• No go zones in area.

  Yes

  No

  N/A

• Exclusion zone not set up

  Yes

  No

  N/A

• Pits / trenches

  Safe

  At Risk

  N/A

• Ground and support conditions poor.

  Safe

  At Risk

  N/A

• Not consulted with other work groups in area.

  Safe

  At Risk

  N/A

• Demolition work nearby.

  Safe

  At Risk

  N/A

• Working on / in / near water

  Safe

  At Risk

  N/A

• Inadequate traffic / pedestrian control

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Breathing

  Yes

  No

  N/A

• Eye protection

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• High vis

  Yes

  No

  N/A

• Hard hat

  Yes

  No

  N/A

• Harness

  Yes

  No

  N/A

• Long long

  Yes

  No

  N/A

• Face shield

  Yes

  No

  N/A

• Protective boots

  Yes

  No

  N/A

• Sun hat

  Yes

  No

  N/A