Information
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Document No.
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Project Number/Job
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Conducted on
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Prepared by
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Location of First Aid Kit and Fire Extinguisher
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Name of First Aider
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Location
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Site Emergency Assembly Area
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Personnel
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Any work on Asbestos materials? If yes, STOP WORK and Call Team Leader/Director
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Do we have to do Civil Works If so - lists SWMS that apply below.
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Dial Before You Dig Obtained? You need to check in Email job folder. NO ground penetration is allowed without this.
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All Plant Operators licenced and accredited? Check Google Drive if in doubt.
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All workers hold current: Construction Awareness Card (white/blue card), Trackson Induction, operators tickets ?). Workers are not allowed on site without ALL of these certs.
Site Conditions
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Ground surfaces - is there a risk of trips and falls? If so, list SWMS that apply.
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Are there potentially dangerous animals or plants? If so, list SWMS that apply.
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Are there electrical hazards or ignition sources? If so, list SWMS that apply.
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Use of hazardous substances or dangerous goods? If so - refer to MSDS for safe handling and what to do in the event of an emergency.
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Biological hazards - eg syringes, contaminated water? If so, list SWMS that apply.
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Pole check needed? If so, list SWMS that apply.
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Will you be working in confined spaces? If so, list SWMS that apply.
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Are you working on or near a service station? Is there a danger of fumes near pit/manhole/ducts? If so, list SWMS that apply.
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Will you be making excessive noise? Have you informed the neighbours? List SWMS/Management techniques that apply.
Climate Conditions
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Is there sufficient light for all tasks? If not, list safety procedures/SWMS that apply.
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Are climate conditions suitable for performing tasks? If not, list SWMS that apply.
Environmental Hazards
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Contaminated soil/water? If so, list SWMS that apply.
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Pesticides/Insecticides used? If so, list SWMS/MSDS that apply.
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Stormwater or sediment controls? Dewatering? If so, list SWMS that apply.
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Air quality? Dust emissions? Noise or vibrations? If so, list SWMS that apply.
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Disturbance to flora/fauna? Potential for spreading of weeds/pests? If so, list SWMS that apply.
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Will you be disposing of waste from site? If so, where/how?
Traffic Management
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Traffic/Pedestrian management needed? Refer to Traffic Management Plan and write scenario below.
Plant
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Plant/Equipment used? Have the pre-start checks been completed?
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Elevated Work Platform being used? Refer to SWMS.
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Is a gas detector needed?
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Are there overhead electrical hazards? If so, list SWMS that apply.
Manual Handling
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Possibility of awkward postures, pushing or pulling? If so, list SWMS that apply.
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Will you be lifting, lowering or will there be sudden body movements? If so, list SWMS that apply.
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Will you be subjected to sustained vibrations? If so, list SWMS that apply.
Working at Heights
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Is there ladder use? If so, list SWMS that apply.
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Are there unprotected ledges on site resulting in fall hazards? If so, list SWMS that apply.
Working with Tools
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Are power tools being used for drilling/cutting? If so, list SWMS that apply.
Other safety concerns/hazards.
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List any other safety concerns/hazards.
Sign-on
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Employee sign on
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Employee