Thiess/WGPSN Field Surveillance Inspection Check (Revision 10/7/2013)

• MW Permit Number:

Work Order Number:

Job Description

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Thiess Personnel/Sub-Contractors

SAFETY

• Risk / Hazard Assessment available and control measures being followed?

  Yes

  No

  N/A

• Works Procedures / Instructions available and being followed?

  Yes

  No

  N/A

• Trenching activities:<br>Have suitable ground support<br>Spoil min 0.5mt from edge of excavation<br>W/safe notification for excavations >1.5 mt<br>Nominated competent person to manage the excavation

  Yes

  No

  N/A

• Permits / Documentation / Notifications obtained and available?

  Yes

  No

  N/A

• Licences / Tickets / Training Documents available for operators/CSE/Chemicals?

  Yes

  No

  N/A

• CSE Procedures being adhered to ?<br>Personnel roles nominated<br>Equipment inspected<br>Entry permit completed <br>Training current

  Yes

  No

  N/A

• Gas Detector calibration ? <br>Serial number:

  Yes

  No

  N/A

• Plant / Equipment Records available and complete? (Pre Start Inspections)

  Yes

  No

  N/A

• Site and Vehicles generally clean, tidy and presentable?

  Yes

  No

  N/A

• Wheel nut indicators in place and serviceable?

  Yes

  No

  N/A

• Personal protective equipment (min. safety glasses and long/long clothing available and used correctly)

  Yes

  No

  N/A

• Adequate facilities for materials handling and storage available?

  Yes

  No

  N/A

• Regulatory requirements for works being observed?

  Yes

  No

  N/A

• Other services near works located and safe working distances maintained?

  Yes

  No

  N/A

• Mechanical / Electrical hazards identified and isolated/tagged correctly?

  Yes

  No

  N/A

• Adequate site security and safety including barricades and signage in place?

  Yes

  No

  N/A

• Appropriate means of communication available?

  Yes

  No

  N/A

• Adequate and compliant fire suppression equipment onsite?

  Yes

  No

  N/A

• Fully stocked and appropriate First Aid Kit available on site?

  Yes

  No

  N/A

ENVIRONMENT:

• SEPHA or other site specific environmental checklist completed and control measures incorporated?

  Yes

  No

  N/A

• Adequate protection measures in place for specific flora and fauna species?

  Yes

  No

  N/A

• Contingency measures in place to minimise risk and control of spill / mishap?

  Yes

  No

  N/A

• AAV sites confirmed and adequate control measures in place to protect sites?

  Yes

  No

  N/A

QUALITY

• Appropriate standard of workmanship achieved?

  Yes

  No

  N/A

• TS Minor Work Pack/Site Management Plan available and work undertaken in compliance with the stated requirements?

  Yes

  No

  N/A

INSPECTION COMPLETION

• Add signature

  Sign

NOTE* This an IPad/IPhone version of TS-037090-MTP-FO-701