Title Page

  • Site

  • Conducted on

  • Prepared by

  • Personnel

Traffic/Pedestrian Management

  • Is Traffic/pedestrian management required<br>

  • Is there a TGS<br>

  • Does the TGS appear compliant

  • Are staff/pedestrians segregated from equipment where possible

  • Any other issues

  • Refer to HSW traffic management officer

Power and Services

  • Is there risk of hitting overhead powerlines

  • Authorised spotter in place

  • Spotter clearly identifiable

  • Does spotter have adequate communication to operator and whistle

  • Is spotter doing any other duties

  • Any other issues

  • Is there risk of hitting underground services

  • Dial before you dig completed and available

  • Services located and marked

  • Services isolated where required

  • Any other issues


  • Plant/vehicles in use

  • Operator VOC completed/licensed where required

  • Prestart completed (spot check)

  • PPE worn for vehicles in use (helmets for excavator etc)

  • Exclusion zones established and in force where required

  • Lifting/working at heights equipment tagged in date and and appears suitable for use

  • Loads are restrained/covered adequately

  • Equipment guarding in good condition and being utilised

  • Hearing protection worn where required operating or near plant and equipment (quick cut saw etc)

  • Any other issues

Confined Space

  • Confined space

  • Permit current

  • Gas detector being used and calibrated (6 month)

  • SWMS relevant to task

  • Any other issues


  • Excavation

  • Is excavation over 1.5m

  • Is excavation benched battered or shored

  • Do controls appear sufficient

  • Excavation sufficiently barricaded

  • Any intrusions (water etc)

  • Are staff in the trench

  • Is there any at risk activity

  • Do staff have any concerns

  • Is there a mechanism in place for excavation checks/inspections


  • Asbestos

  • Asbestos management plan

  • Appears compliant

  • Any other issues

Manual Handling

  • Manual handling

  • Are staff using gloves where required

  • Are mechanical aids available when needed

  • Are staff suitably trained

  • Any other issues

Hazardous Materials/Chemicals

  • Hazardous materials/chemicals

  • Stored correctly

  • Segregated correctly

  • SDS present, current and relevant

  • Labelling correct per GHS

  • Evidence of material/chemical being used correctly and handled as per SDS (PPE)

  • Spill kit/Emergency equipment available

  • Eye wash station/shower required

  • Is water cool and station free of debris

  • Are there procedures in place for testing station

  • Any other issues

Working at Heights

  • Working at heights

  • Scaffolding being used

  • Erected by competent persons

  • Fitted with scafftags (signed and in date)

  • EWP being used

  • Operator licensed and trained

  • Appears to be operated correctly as per operators manual

  • Ladders being used and have load rating and are undamaged

  • Permit current for tasks over 1.5m

  • SWMS relevant to task

  • Any other issues

General Site

  • SWMS being used for high risk activities

  • Personnel inducted to site (spot check)

  • Site personnel adhering to PPE procedure

  • Slips trips and falls/ site hazards appear adequately managed

  • Adequate facilities onsite for staff (Toilets, hygiene, fresh water, shade)

  • Electrical equipment test and tagged and plugged into RCD

  • Hot work hazards managed

  • First aid kit/s available and current

  • Adequately trained first aid persons available

  • Suitable fire extinguishers available and tested

  • Sunscreen available

  • Any other issues

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.