• MW Permit Number:

Work Order Number:

Job Description

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Thiess Personnel/Sub-Contractors


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

  • Works Procedures / Instructions available and being followed?

  • 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

  • Permits / Documentation / Notifications obtained and available?

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

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

  • Gas Detector calibration ? <br>Serial number:

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

  • Site and Vehicles generally clean, tidy and presentable?

  • Wheel nut indicators in place and serviceable?

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

  • Adequate facilities for materials handling and storage available?

  • Regulatory requirements for works being observed?

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

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

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

  • Appropriate means of communication available?

  • Adequate and compliant fire suppression equipment onsite?

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


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

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

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

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


  • Appropriate standard of workmanship achieved?

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


  • Add signature

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

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.