• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work Environment and Conditions

  • Housekeeping and Layout

  • Security of equipment

  • Is the site compliant with the requirements of the Seqwater General Network Procedure (4.12/4.13)

  • Barricades and Signage

  • Environmental Controls


  • Lock-out and Tag-out

  • Has all relevant information relating to WQ been signed viewed and understood by the operative

  • Work Permits

  • Competence for Task

SWMS - Pre Start Checks - MSDS

  • Available

  • Adequate

  • Understood

  • Followed

Tools and Equipment

  • Condition

  • Availability

  • Are the tools stored & disinfected in accordance with the requirements of the procedure

  • Is there evidence of disinfection and correctly mixed solution in proximity of work being performed

  • Are materials stored in a position away from sources of potential contamination

People and Behaviours

  • Are employees Assessing and Re-assessing the area ?

  • Are employees maintaining Eyes on Path whilst moving around the worksite ?

  • Are employees Looking Before Moving ?

  • Are employees selecting appropriate Tools and Equipment and wearing correct PPE ?

  • Are employees keeping Eyes on Hands whilst doing works which could result in injury ?

  • Are employees ensuring they are not placing themselves in Line of Fire ?

  • Are employees Communicating their intent to others ?

  • Are employees using correct manual handling techniques to maintain correct Position and Effort ?

  • Does the operative understand the requirements of the General Network & Disinfection Procedure

  • Can the operative articulate how the disinfection solution was mixed & when (more than seven days is not acceptable)

  • Does the operative understand the escalation procedure in line with the requirements of the General Network Procedure

Protection systems

  • Is electrical equipment positioned appropriately with current test and tag ?

  • Are fire extinguishers positioned correctly with clear access and in test and tag ?

  • Are hazardous substances used and stored correctly with MSDS available ?

High Risk Activities

  • Are Confined Space Entries being carried out in accordance with procedural requirements ?

  • Ae Trenching activities being carried out in accordance with legislative requirements ?

  • Are activities being carried out On, Over or Near Water being undertaken in a safe manner

  • Are employees using appropriate controls for ascending and descending to and from work areas >2mt


  • Note Positive Observations:


  • Note Observations to be rectified by WHEN and WHO !

  • Provide a sketch of the area of concern if applicable to support findings


  • Select date

Note* IPad Version TS - H&S - FO - 043

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.