TDE HS Form 5.0 Job Site Health, Safety & Work Plan

Title Page

Site name/address
Document No.
Principal Contractor/Client
Completed on
Form completed by
Location

Information

JOB INFORMATION

Principal / Client
TDE Site Foreman
Description of scope of work
Take a photo of the work site - include as much as you can

Emergency Preparedness

EMERGENCY PREPAREDNESS

Where is your nearest after hours / emergency medical facility?
- 24 Hr Surgery (Madras St - previously Bealey Ave)
- Christchurch Hospital Emergency Dept.
- Linwood After Hours Surgery
- Moorhouse Medical
- Papanui After Hours Surgery
- Riccarton Clinic
The 24 Hr Surgery is open 24hrs daily. It has moved to 401 Madras Street, Christchurch. Phone: 03 365 7777.
Riccarton Clinic is open 8am - 8pm daily. 4 Yaldhurst Road, Church Corner, Christchurch. Phone: 03 343 3661.
Moorhouse Medical is open 8am - 8pm daily. 3 Pilgrim Place, Christchurch. Phone: 03 365 7900
Linwood After Hours Surgery is open 9am - 8pm Mon-Fri & 10am - 4pm weekends. 279 Linwood Avenue, Christchurch Phone: 03 389 2550
Papanui After Hours Surgery is open 8am - 6:30pm Mon-Wed, 8am - 5:30pm Thu-Fri & 9am - 12pm Sat. 438 Papanui Road, Christchurch. Phone: 03 352 9053
Christchurch Hospital Emergency Dept. is open 24 hours daily. 2 Riccarton Ave, Christchurch Central, Christchurch. Phone: 03 364 0640.
Where is the emergency evacuation assembly point for this site?

Environment, Contaminants and Heritage

ENVIRONMENT, CONTAMINANTS AND HERITAGE STATUS

Is any asbestos known or presumed to be present on this site?
An asbestos management plan (AMP) must be completed. You can do this using the Asbestos Management Plan form.
Are any soil contaminants known or presumed to be present on this site?
Ensure you have all the information you need and that control measures are in place. Ensure potentially contaminated material removed is disposed of at contaminated waste. Refer to the Site Monitoring and Contamination Discovery Procedure in Google Drive.
Does this site have any known archaeological significance?
Ensure the appropriate Heritage NZ authorities are in place and worked in accordance with. Ensure workers are familiar with accidental discovery procedures (see Google Drive).
Are any environmental risks likely to be created (e.g. sediment, run-off, dust, noise, adverse weather etc.) that will need to be controlled?
Ensure the environmental control measures are arranged.

Work and Risk Management

WORK AND RISK MANAGEMENT

In addition to hi-viz and safety boots, the anticipated PPE requirements for this job are (select all that apply)
- Hard hat
- Hearing protection
- Safety glasses
- Safety goggles
- Heavy duty gloves
- Chemical resistant gloves
- Disposable mask
- Half face respirator
- Disposable coveralls
- Full face respirator
- Full face shield
- Boot covers or slip on boots only (asbestos work)
- Other (add to notes)
Use the below hazard identification tool to identify hazards that may be present SPECIFICALLY on this job. Think about the most critical risks.
Which critical risks do you expect to encounter on this job?
- Airborne contaminants
- Asbestos
- Confined or restricted spaces
- Contaminated soil
- Electrical equipment
- Hazardous products
- Load lifting / rigging
- Mobile plant
- Open excavations / trenches
- Overhead services
- Power tools
- Quick hitches
- Traffic
- Trailers, loads and tip trucks
- Underground services
AIRBORNE CONTAMINANTS Standard controls:
Dust extraction, watering.
Separate dusty areas.
Ensure adequate ventilation.
Identify type of dust, if it’s dangerous, re-assess risk and controls.
PPE, e.g. respiratory protection or dust mask, eye protection, protective clothing, gloves.
ASBESTOS Standard controls:
Isolate the asbestos, e.g. cover / enclose.
Low pressure watering.
Physically separate areas containing asbestos from other work areas / public.
Do not work with asbestos where reasonably practicable – engage a competent and/or licenced PCBU to remove it under the regulations.
Workers carrying out asbestos-related work must have training in the identification, safe handling, risks and controls, and follow SWMS.
Asbestos management plan in place where asbestos known or presumed present, compliant with ACOP.
Hygiene / decontamination facilities available.
Wear PPE/PPC, e.g. P2 disposable mask minimum, safety glasses/goggles, disposable coveralls, slip on safety footwear (no laces), shoe covers etc.
CONFINED / RESTRICTED SPACES Standard controls:
Do not work in a confined or restricted space where practicable; either conduct the task outside the space, or open it up.
Purge or ventilate space before entry if required.
Maintain a safe atmosphere with mechanical ventilation.
Only trained and competent workers to conduct work in a confined space.
Competent safety observer in place.
Maintain effective communication.
Confined space rescue plan in place, retrieval / response equipment available.
If risk of a hazardous or dangerous atmosphere, perform monitoring before entry and during work.
Wear PPE, e.g. suitable respirator, goggles, coveralls, safety boots, harness and safety line.
CONTAMINATED SOIL Standard controls:
Do not work with contaminated soils where reasonably practicable – ensure land remediated before starting work.
Use engineering controls, e.g. watering.
Physically separate contaminated areas from other work areas / public and install warning signage. Demarcate decontamination zones.
Follow the site contamination monitoring and discovery procedure.
If suspected contaminants identified during work, soil samples will be analysed and reported on by a suitably trained and competent person.
All relevant environmental reports and test results kept on site and stored in Google Drive.
Contaminated sites posing a high risk will have a Site Management Plan (SMP) developed by a competent person for. SMP kept on site and followed.
Washing / hygiene facilities available.
Wear appropriate PPE/PPC, e.g. P2 disposable mask at a minimum, safety glasses/goggles, disposable coveralls, slip on safety footwear (no laces), shoe covers etc.
ELECTRICAL EQUIPMENT Standard controls:
Organise leads out of the way, protect from water and vehicles.
Use commercially rated RCD, suitable for outdoor use, test regularly.
Switch off and unplug equipment before cleaning, maintaining or changing parts.
Restricted electrical work by a registered electrician only.
Don’t use multi-plug adapters in multiple combinations.
Regular visual inspections.
Remove damaged or faulty equipment from service and get repaired.
Engage a registered electrician to investigate all faults.
Equipment tested and tagged 3-monthly, even if new.
HAZARDOUS PRODCUTS Standard controls:
Substitute for less hazardous alternatives where possible.
Use mechanical controls, e.g. extraction, watering down.
Store hazardous substances in appropriate containment, with incompatible materials stored apart and keep locked up as required.
Store in original containers if possible and keep quantities to a minimum.
Hazardous substances register and MSDS stored in Google Drive.
Instructions and controls regarding transport, storage, labelling, use, PPE, emergency response and disposal of hazardous substances must be followed.
If decanting chemicals into another container, it must be an appropriate container for the chemical and clearly labelled, including precautions.
Use substances in a well-ventilated environment.
Have appropriate emergency provisions available, e.g. eyewash, running water, spill kits etc.
Wear PPE as required, e.g. gloves, goggles, mask, respirator etc.
LOAD LIFTING / RIGGING Standard controls:
Certified safety chains, lifting hooks etc.
Cordon off area below the lifting operation; no person is permitted under a raised load and keep workers not involved in the lift away.
Physically secure loads.
Trained and competent workers to rig loads, perform lifting operations or act as dogmen, operating in accordance with manufacturer instructions and limits, ACOPs, standards, regulations and SWMS.
Machinery on stable, level ground with adequate load bearing capacity.
Lifting equipment kept in safe operational order, maintained to manufacturer specifications, certified by an approved tester six-monthly and visually inspected before each use.
Use taglines to swing loads.
Stay clear of stationary objects you could be pinned against by a swinging load.
Flat, clear set down area of adequate size for load.
Suspend load lifting operations in adverse weather.
Wear PPE, e.g. safety boots, hard hats, high-viz.
MOBILE PLANT Standard controls:
Engineering controls operable, e.g. warning lights and signals (for operators and others), emergency stops, emergency brakes, guards, mirrors, seatbelts.
Physically isolate machinery working area where practicable, ensure no unauthorised access. Otherwise, clearly demarcate no-go zones.
Stay well clear of operating machinery where practicable. If not, be alert within the swing area, don’t go under a raised boom, communicate with operator and wear PPE.
Maintain plant to manufacturer specifications, service regularly, keep manuals with plant.
Weekly plant inspection and daily visual inspection/grease.
Ensure compliant Operator Protective Structures are in place as required and in good operable condition.
Ensure proper site and ground assessment of soil and stability before mobile plant is used. Stabilise as necessary.
Identify underground cavities that mobile plant could collapse, make safe before work commences.
Trained, competent and licenced operators using fit-for-purpose plant in accordance with manufacturer’s instructions, regulations, ACOPs and SWMS and within safe limits.
Maintain three points of contact climbing in/out of machines and ensure boots and steps as clean and dry as practicable.
Lockout machinery when being maintained or faulty.
Wear PPE, e.g. hi-viz clothing, safety footwear, protective eyewear and hearing protection, hard hat.
OPEN EXCAVATIONS/TRENCHES Standard controls:
Close trenches ASAP – don’t leave open if avoidable.
Pump out accumulated water as required.
Cover or barrier open holes where practicable, otherwise clearly mark, e.g. use bunting flags, hazard tape, barriers etc.
Secure temporary fencing around excavations and trenches when unattended.
Shore, brace or use trench shields in trenches as required, (especially >1.5m deep) to prevent collapse/cave-in.
Material and spoil at least 600 mm from edge and machinery as far back from edges as practicable.
Don’t work in excavations during rain and inspect after rain.
Use ladders / access ways to prevent destabilizing slopes.
Trained and competent workers, follow SWMS.
Never work alone in an excavation/trench.
Emergency provisions available and procedures in place.
Wear PPE, e.g. protective clothes, appropriate safety footwear, hand, eye and face and respiratory protection as required.
OVERHEAD SERVICES Standard controls:
Don’t work near overhead services where practicable.
Have services decommissioned where practicable - obtain confirmation in writing from a competent person or relevant authority, that all services have been either close approach consent where within 4m of power lines. Keep a safe distance as specified on the consent.
Emergency provisions available, procedures in place
Use a spotter when required, including during delivery of machinery to site.
POWER TOOLS Standard controls:
On-tool extraction, dead-man switches.
Guards / safety devices operable.
Physically separate areas tools create noise, dust, fumes etc. from other workers / public.
Trained, competent operators using fit-for-purpose tools in accordance with manufacturer instructions / limits, ACOPS, regulations, standards, good practice guidelines and SWMS.
No loose clothing / jewellery that can catch in moving parts.
Maintain to manufacturer specifications.
Use the correct tool for the job and ensure correct attachments for tool and materials, e.g. blades, discs, bits and attachments in safe condition.
Use clamps / vice to hold work where practicable, keep both hands free to operate tool.
Disconnect tools when not in use, before servicing, and when changing accessories /attachments.
Take breaks/rest as required, especially with vibrating tools.
Wear appropriate PPE for tool and task– protective eyewear, hearing protection, hi-viz, safety footwear, dust mask, respirator, heavy duty gloves, face shield.
QUICK HITCHES Standard controls:
Ensure locking pins are in place and are correct; do NOT use substitutes for the correct pin.
Ensure all automatic locking systems are engaged.
Correct attachments for machine, properly secured.
Maintain exclusion zones.
Wear PPE, e.g. safety footwear, hard hat.
TRAFFIC Standard controls:
Do not work in areas where there is traffic where practicable
Isolate workers/plant from traffic and pedestrians using barricades, barriers etc.
Plan/schedule work so that vehicles and pedestrians are not operating in the same area at the same time
Traffic Management Plan (TMP) in place for all work activities which vary or affect the normal operating condition of a road or footpath. TMP must comply with the Transit Code of Practice for Temporary Traffic Management and be submitted to council at least 5 working days before commencement, for approval.
Trained and competent workers to implement traffic management, e.g. TC, STMS qualifications
On site traffic to be managed by:
• Signs designating travel routes and directions, parking and/or loading areas, no-go zones
• Barriers, cones or demarcation of restricted areas
• Spotters to direct vehicles and pedestrians
• Hazard lights
• Audible signals, such as reversing signals or horns
TRAILERS, LOADS AND TIP TRUCKS Standard controls:
Engineering controls operable, e.g. lights, safety chains, locks.
Securely tie down / cover loads as required to prevent items falling off or material becoming airborne.
Lock out tip trucks during maintenance
Check for overhead obstacles and powerlines, keeping in mind the height of the load or raised trailer when tipping
When tipping loads, barricade unloading zone if practicable.
Current WOF/COF for trailers and tip trucks, maintain to manufacturer specifications, service and inspect regularly.
Trained and competent operators only.
Use appropriate strops or tie-downs and visually inspect to check in good condition.
Don’t overload, check trailer capacity.
Never leave truck with raised tray unattended, don’t move any more than one vehicle length with tray raised and ensure on stable, level ground before raising tray.
Follow SWMS.
UNDERGROUND SERVICES Standard controls:
Have services decommissioned where practicable - obtain confirmation in writing, that all services have been either, decommissioned or isolated.
Check sites for underground services and keep a safe working distance from them. Always physically locate full extent of the services, e.g. use location devices, pothole, hydro-vac etc. – do NOT rely on plans or assume locations.
Service location plans available.
Lines of all known power cables/underground services marked out, using waterproof means. Non encroachment lines minimum of 600mm from services.
Use hand tools to progressively and carefully undermine from outside non-encroachment lines toward services. Hand held powered tools must only be used to break up any hard surface. Use of powered tools must stop if at any time the cutting rate quickens, indicating softer ground.
Near power cables/underground services, only approved hand tools, that do not have sharp points, and which are unlikely to damage the underground services must be used in preference to powered tools.
use insulating hand tools.
Emergency provisions available and procedures in place.
Wear PPE, e.g. gloves, safety boots
Are there any hazards specific to this job, or that are unable to be controlled in the normal way? Add as many as you need. HINT: Especially think about anything not routinely encountered.
Use the below risk rating matrix and hierarchy of controls tools to select the most effective controls and ensure the risk is reduced to an acceptable level (moderate or less)
Add each hazard
Describe the hazard / risk (What harm could occur and how?)
Describe the control measures (How will you reduce the likelihood and/or consequence of harm?)
What is the risk rating for this hazard, with controls implemented? (Use the matrix)
STOP! That risk to too high. Re-think your controls as they are not effective enough. Once you have determined controls, re-assess the risk. You cannot proceed with work with a risk rating of High or Extreme. Call the office if you need help.

Sign Off

SIGN OFF

The foreman and ALL TDE workers must be involved in completing the Site Health, Safety and Work Plan, and must sign below to indicate they have understood the information.
The DAILY Site Health, Safety and Work Plan will be completed daily before work starts to identify daily risks and controls as the site changes.
Foreman sign off
Worker Sign Off
Worker Sign Off
Client / Main Contractor Sign Off (if required)
Client / Main Contractor Sign Off