UFL Worksite Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Work Order Number

• Contractor

TRAFFIC MANAGEMENT

• TMP On Site

  Yes

  No

  N/A

• Comment

• Clearly Designated Go/No Go Areas

  Yes

  No

  N/A

• Comment

• Trench Protection in Place

  Yes

  No

  N/A

• Comment

• Pedestrian Areas Well Defined & Safe

  Yes

  No

  N/A

• Comment

• STMS Available

  Yes

  No

  N/A

• Comment

TAILGATE & HAZARD ID

• Well Defined Work Location & Work Description

  Yes

  No

  N/A

• Comment

• Hazards Identified, EIM, appropriate control measures identified & implemented

  Yes

  No

  N/A

• Comment

• Site Supervisor identified & site induction completed

  Yes

  No

  N/A

• Comment

• Emergency Preparedness & method of stopping work

  Yes

  No

  N/A

• Comment

• Emergency Contact Numbers

  Yes

  No

  N/A

• Comment

• All Personnel Signed On

  Yes

  No

  N/A

• Comment

PERSONAL & SITE SAFETY

• Correct PPE used as required for the work being undertaken and is in good condition

  Yes

  No

  N/A

• Comment

• Safety Glasses

  Yes

  No

  N/A

• Comment

• Hi Viz

  Yes

  No

  N/A

• Comment

• Long / Long

  Yes

  No

  N/A

• Comment

• Hard Hats on When in Excavator Swing Zone

  Yes

  No

  N/A

• Comment

• Safety Footwear

  Yes

  No

  N/A

• Comment

• Hearing Protection When Requiired

  Yes

  No

  N/A

• Comment

COMPETENCY

• Competent Operators

  Yes

  No

  N/A

• Comment

• Seat Belts Worn When Operating Excavator

  Yes

  No

  N/A

• Comment

• Working Around Overhead Power Lines - Tip Trucks and Excavators

  Yes

  No

  N/A

• Comment

WORK METHOD STATEMENTS / PROCEDURES

• Permit Systems

  Yes

  No

  N/A

• Comment

• Safe Operating Procedures

  Yes

  No

  N/A

• Comment

• Current Site Specific Service Plans, Gas, Telco, Power, Council Services

  Yes

  No

  N/A

• Comment

ENVIRONMENTAL MANAGEMENT

• Oil Spill Kits

  Yes

  No

  N/A

• Comment

• Dirt/Soil Erosion/Site Run-Off is Controlled as Required

  Yes

  No

  N/A

• Comment

• Dust Control

  Yes

  No

  N/A

• Comment

• Concrete Cutting

  Yes

  No

  N/A

• Comment

REINSTATEMENT

• Site Left in a Safe Condition for Public or Workers

  Yes

  No

  N/A

• Comment

• Safe Vehicle or Pedestrian Crossing Installed

  Yes

  No

  N/A

• Comment

• Barriers Around Open Cuts

  Yes

  No

  N/A

• Comment

• Trenches Flush if No Barriers

  Yes

  No

  N/A

• Comment

• Trenches Compacted

  Yes

  No

  N/A

• Comment

GENERAL

• Actions Taken to Acknowledge/Reinforce Safe Behaviors/Conditions

  Yes

  No

  N/A

• Actions Taken to Confront/Correct Unsafe Behaviors/Conditions

  Yes

  No

  N/A

• General Comments

• Recommendations

• Audit Results & Recommendations discussed with Site Supervisor

  Yes

  No

  N/A

• Site Supervisor

  Sign

• Audit Completed By

  Sign