Information
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Site
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Alpha Code
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Select date
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Location
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For this assessment the following applies
Safe -
At Risk -
Fail -
Section 1.0 - Site planning and mangement
Site Management and Planning
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Scope of Works
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Add media
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Expected duration of works (days)
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Is the site access information correct and up to date?
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Is the Health and Safety plan on site, accessible and legible?
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Outline areas to improve the Health and Safety plan with dates for completion
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Select date
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Stop work until this has been undertaken.
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Has a hazard and risk assessment been undertaken for the site?
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Outline areas to improve the Health and Safety plan with dates for completion
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Select date
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Ensure that a hazard and risk assessment is completed for the site before any further work is undertaken on site.
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Have Safe Work Method Statements or JSA's been prepared for high risk activities on site and are being followed?
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- Falls
- Asbestos
- Confined Space
- Live Electrical Work
- Remote and Isolated Work
- Falling objects
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Select date
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Ensure that a SWMS or JSA are completed for high risk activities before work continues
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Outline areas to improve the Health and Safety plan with dates for completion
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Select date
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All contractors (including sub contractors) have been provided with information relating to health and safety for the work they are undertaking?
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Is the time allowed suitable for the scope of work to be undertaken?
Summary
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Site Management and Planning
Safety Gear
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Hi Viz
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Safety Helmet
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Safety glasses
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Appropriate clothing for the environmental conditions
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Safety boots (or appropriate footwear for working on roofs)
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Hearing protectors of the appropriate class
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Sunscreen
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Gloves
Summary
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Safety Gear appropriate to the task is in being worn and is in good condition?
Competency
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Principal Contractor Network Requirements
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2 Degrees
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Vodafone Sites
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Telecom Sites - PTN Training
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Workers on roofs with proprietary anchor systems in place have completed US23229 and have a copy of their current certification on site?
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Workers on communication towers, poles and roofs have completed US 23229, 15757 and 17025 and have a copy of their current certificate on site?
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Are all persons on site competent and trained to undertake the tasks on site?
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Work should cease until persons competent to undertake the required tasks are on site. An incident report should also be sent to the relevant Principal Contractor
Summary
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Competency
Emergency planning and equipment
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Is the site able to call for emergency assistance - Fire, Police Ambulance?
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Are appropriate Fire Extinguishers on site?
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Emergency assembly point identified?
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Are first aid kits, current, we'll stocked and readily available?
Summary
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Emergency planning
Environmental
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Working hours restrictions are being adhered to?
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Noise and vibration are kept to acceptable levels?
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Are hazardous substances clearly labelled and stored appropriately?
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There is a spill kit on site appropriate for the type and amount of substances on site?
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All site areas are kept tidy with litter removed from site appropriately?
Summary
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Environmental
General
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Have all visitors signed the visitor log?
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Are hazards, risks and controls discussed with visitors prior to entering the site?
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Incident report register on site and up to date?
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Is the work site (including footpaths and roadways) clear and free from debris, rubbish and obstructions?
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Are slip and trip hazards being adequately managed?
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Is lighting adequate for carrying out tasks and and/or safe access?
Summary:
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General
Section 2.0 Access to Roofs, Brittle Roofs and RF
Roof Access
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Are persons on site working on the roof of a building?
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An assessment has been made of any internal ladders used to gain access to the roof to ensure they are structurally sound?
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Handrails are in place for ladders if required?
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Ladders extends 1 metre above the landing platform?
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Portable ladders meet AS/NZS 1892?
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Portable ladders are secured at the top and the bottom?
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If access to the roof is via an internal crawl space this should be considered a restricted space and a safe work method planned. (This must include a standby person who does not enter the restricted space).
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If work is being undertaken in a restricted space has a safe work method statement been established and implemented?
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Work should cease until a safe work procedures are in place
Summary
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Access to Roof
Brittle Roofs (Skylights, Asbestos Roofs, Openings, Roofs in Poor Condition)
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Is the roof surface brittle, in poor condition or has skylights?
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An assessment of the roof has been made to ensure it is strong enough to support the work activities being carried out. (Asbestos roofs are the majority of brittle roofs).
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Has the roof been inspected internally (if possible) to ensure it is sound?
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Has an competent person undertaken this assessment?
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Are areas such as skylights, roof openings designated as no go zones and barricaded off or covered if required?
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Are walkways with guardrails provided when work on fragile roofs cannot be avoided?
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If walkways are not provided is a fall arrest system being used?
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Work on the roof must stop until safe work methods are in place.
Summary
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Brittle Roofs
RF
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Are there RF hazards on site?
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RF warning signs are in place at access points?
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Ensure that a report is made to the Mobile Company concerned that signs are not present.
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Are persons trained/competent/certified in RF Awareness
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On co location sites, other mobile company antennae have been considered when planning the work?
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Have adjacent buildings be assessed as a possible source of RF?
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Are RF monitors calibrated?
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Are appropriate RF monitors available and being used?
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RF procedures and monitoring practices have been followed?
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Telecom RF Shutdown Procedure ND4027 Ver 6.0 has been followed?
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2 Degrees
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Vodafone
Summary
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RF
Section 3.0 - Equipment used for Working at Heights on Towers, Poles and Roofs
Machinery for working at Heights on Towers, Roofs and Structures
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MEWP, Crane Scaffold or Guardrails being used on Site?
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Move to the next section
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Are workers on the ground wearing appropriate PPE e.g. Safety Helmets, Safety Boots, High Viz Vests and Eye Protection?
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Have exclusion zones been implemented and sufficient for the tasks being carried out?
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Do the exclusion zones prevent members of the public accessing the site?
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Assess any of the following equipment on site
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Mobile Elevated Work Platfrom
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Has the operator carried out a carried out a pre start inspection of the MEWP that includes functional and visual tests (required each day)?
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Is the MEWP clearly marked with the rated lifting capacity
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Weight of lift?
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Essential operating and maintenance instructions permanently displayed or stored in a conspicuous place on the MEWP?
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Is the six monthly inspection certificate displayed?
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Operator is trained and competent (US 23966 v1) and the corresponding unit for the type of MEWP being used?
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Hazards associated with power lines are appropriately controlled (no closer than 6.4 metres, or between 4 - 6.4 metres with appropriate controls in place. No work can be carried out within 4 metres of a power line without the written consent of line owner and this consent must remain on site at all times?
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Weather conditions are suitable for using the MEWP?
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Are harnesses, lanyard and attachment points available to all workers undertaking tasks from the MEWP?
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Is the MEWP set up on firm and level ground?
Summary
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MEWP
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Crane
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Is the plan and information provided by the crane supplier signed and accepted by the contractor on site?
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Is the crane set up on firm, level ground with barriers in place?
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Safe working distances are maintained from overhead power lines?
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No persons are standing under suspended loads?
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Tag lines are used where there could be load spin?
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The load does not exceed the lifting capacity of the crane
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Lifting capacity of the crane
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Weight of lift
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Clear lines of communication exist between the dogman/persons in bucket and the crane operator?
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Weather conditions suitable for the use of a crane?
Summary
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Crane
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Scaffold or Mobile Scaffold
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Are the surface conditions suitable for scaffold access and stability - e.g level and safe to work on?
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Is there a health and safety management plan on site that clearly identifies those responsible for implementing control measures for the scaffold?
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Are site specific hazards e.g proximity to power lines and control measures included in the Safe Work Method Statement or JSA?
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The scaffold was erected, altered or dismantled by a person(s) who have been trained and have suitable experience with the type of scaffold being used?
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Are the wheels locked and turned out on mobile scaffolds?
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If a portion of the scaffold is above 5 metres above the ground the following conditions must be met
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The person assembling, altering or dismantling the scaffold have a certificate of competence
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Scaffold inspection card/register (Safety Tag) clearly visible in place by the access ladder and checked weekly?
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Notification has been sent to WorkSafe NZ
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The maximum load (weight of workers and materials) has been determined and the scaffold is capable of supporting the weight
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Edge protection provided where a person could fall 2 or more metres
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Scaffold protected from passing vehicles or plant
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Ladders are secured top and bottom.
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Ladder extended 900-1000 mm above the landing platform.
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Planks are in good condition, 3 planks minimum and butted and secured.
Summary
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Scaffolds
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Edge Protection?
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Designed and constructed to by a competent person?
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Positioned appropriately?
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Will barriers and guard rails be regularly inspected
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Includes a toe board or mesh infill to prevent tools, materials and debris falling from the roof?
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Not used on a roof with greater than 35 degree slope (In this instance a MEWP, or Fall Restraint/Arrest system must be used)
Summary
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Edge protection
Section 4.0 - Fall Restraint and Fall Arrest
Fall restraint and fall arrest systems
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Are fall restraint or fall arrest systems being used on site?
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Move to the next section
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All personnel trained and certified for working at height?
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Has the rigger undertaken a visual inspection of the structure, pole etc prior to work commencing?
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Is each person familiar with the work plan?
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Are personnel attached at all times while working at height?
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Has a drop zone been implemented and sufficient for the tasks being carried out?
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Is all equipment secure to prevent a fall from height?
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Does each member of the team have the required PPE?
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Riggers gloves
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A rescue, climbing or caving safety helmet
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Self rescue kit carried
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Clothing to suit the environmental conditions
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Eye protection from glare and also flying objects/particles.
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First aid kit?
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Boots that are appropriate to the task ( AS 2210)
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Is there a written rescue plan that is known to each member of the team?
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Two certified rescue climbers are on site at all times?
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Notification has been sent to WorkSafe NZ of the work?
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Are all members of the team trained and competent for the tasks they are carrying out?
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Has a SWMS or JSA been prepared for height work on site?
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Are there established safe access pathways to the anchor points?
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Is a certified fall restraint system available for use?
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If using a fall arrest system are suitable certified anchor points being used?
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Date anchor points certified to?
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Certified load?
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If certified anchor points are not available a Temporary Anchor Point Permit must be completed and a copy held on site
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The temporary anchor point permit has been signed by a competent rigger?
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Rope access work must cease until the permit is completed
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The temporary anchor point permit has been signed by the rescue climber?
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Rope access work must cease until the permit is completed
Summary
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Fall restraint and fall arrest
Section 5.0 - Other Safety Critical Risks
Pedestrian and Public Safety
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Are members of the public/pedestrians passing the site?
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Is a spotter required on site?
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Is safe pedestrian access maintained on site at all times?
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Are appropriate barriers in place that create a safe zone around activities that involve working at height?
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When plant and machinery are in operation (e.g. MEWP, Crane, Container Delivery) these are isolated from the general public?
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Work vehicles are parked safely?
Summary
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Pedestrian and public safety
Electrical Safety
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Is electrical work being undertaken on site?
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Procedures are in place for ensuring electrical equipment is de-energised before electrical work is carried out and methods in place to ensure that it cannot <br>be inadvertently re-energised (isolation, tagging and lockout)?
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Persons conducting work on electrical equipment are appropriately trained, registered and hold a practising license for the type of work being undertaken?
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Proven to be de-energised before work commences?
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Only ladders constructed of timber or fibreglass are to be used for work on or near electrical apparatus?
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All electrical equipment, extension leads and portable power tools are in good condition and regularly inspected, tested and tagged?
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Undertaken a CPR course (within the last 12 months) and Basic First Aid course (within the last 2 years)?
Live electrical work
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Is live electrical work being undertaken on site?
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A risk assessment and safe work method statement has been prepared before any live work is undertaken?
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When working on or near live electrical apparatus the following Safety Gear (PPE) is being worn
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Clothing covers the body from neck to wrist to ankle, (cotton)
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Sleeves rolled down and shirts tucked into trousers (protecting against entanglement and arc flash)
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Non metallic fasteners (or fasteners are protected by a layer of the same material as that of the garment)?
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Suitable eye protection?
Summary
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Electrical
Traffic Management
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Is the worksite in the road corridor or subject to frequent vehicle movements?
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Copy of the traffic management plan signed by the contractor and maintained on site?
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Traffic management setup is correct and according to the TMP?
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STMS contact number listed?
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Is there an escape route for the traffic controller?
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Comes and barriers in good condition?
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After hours TMP in place if necessary?
Summary
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Traffic Management
Section 6.0 - Health and Safety Summary
Summary
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If any of the following areas are not being managed appropriately then work at the site should be halted until the area(s) of concern are addressed.
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Site planning and management
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Roof access, brittle roofs and RF
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Equipment and plant for working on towers, roofs and structures
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Fall restraint, arrest and anchor points
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Pedestrian, Public and Traffic Safety
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Competency of workers on site?
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Are any other hazards present on site, list below
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Are these hazards and risks being appropriately controlled?
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Were any unsafe work practices observed at the time of the assessment
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Please describe the unsafe practice observed below
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Comments -enter below
Agreement
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Required corrective actions
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Agreed date for completion of corrective actions
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Assessor
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Company
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Site representative
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Company
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Select date
