Information
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Document No.
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Name of Supervisor/Leading Hand
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Name of worker conducting assessment?
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Site Number and Location
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Conducted on
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Task Being Carried Out
- Copy Change
- Graffiti Clean
- Maintenance
- Vegetation
- Site Measure
- Site Inspection
- Private Job
- Site Clean Up
- Installation
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Have all workers on site read and understood the SWMS and Site Cards for this site?
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Read SWMS and Site Card immediately
M2 Page
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Are you doing work on the M2 as this form is only for M2 work?
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Carry on using this form
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Please discard this form and use the regular form
Site/Access Hazards
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Are the weather conditions suitable for safe work?
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Insert photo of weather hazard
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Select from list regarding weather hazards
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Ring coordinator immediately and submit a site hold form
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Has the M2 Control Room been contacted on 02 9868 5136?
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If yes who was contacted?
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Time control room was contacted?
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Do you consider the Site safe for all workers and the public?
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How can site be made safe for workers and public?
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Can all material and equipment used be transported to the site safely?
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Explain method?
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Can the skin be secured to the structure before installation and positioned safely during install?
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Explain method
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Are all vehicles parked correctly?
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Parking location
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Insert photo of parking hazard
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Does the site require traffic management?
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Are there any additional public road hazards?
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Has worksite been cordoned off correctly?
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Equipment used to secure worksite?
- Witches hats
- Barricades
- Tape
- Signage
- Other
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For other, describe cordon method
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Are there any additional site or access hazards to report?
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List additional hazards
In case of emergency
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In case of emergency - call 000, stay calm and describe the situation clearly to emergency operator. Then cal a coordinator, secure the site and begin to complete an incident report
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Are all installer aware of emergency procedures for this site?
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Hold site until all workers are aware of emergency procedures
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Has an ambulance pick up point been identified?
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Hold site until all workers are aware of emergency procedures
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What is the Pick up point location and suburb?
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What is the nearest cross street?
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Is there an abseiler on site
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Do you have the safety rescue pulley on site?
Electrical Hazards
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Have all Electrical Hazards been identified and recorded on Site Cards
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What hazards have been added to site cards?
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Are there Overhead Power lines (OHPL)?
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What is the distance (m) and voltage (kV)?
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What hazard elimination method has been used?
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List other method used to eliminate hazard of OHPL?
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Has power to the light box been turned off?
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Where is the switch and who turned power off?
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If working near an electrical area like switchboard, have precautions been taken?
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What precautions have been taken?
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Why can no precautions be taken?
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Insert photo of any electrical hazards?
Height Hazards
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Are all workers using fall protection devices like harnesses and are they wearing helmets?
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Why are workers not wearing fall protection?
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Are there any height hazards for this site?
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What is the install method for this site?
- Fixed ladder
- Portable ladder
- Scaffold
- EWP
- Abseil
- Other
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Is fixed ladder in good condition?
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What size ladder is used for this site?
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Can ladder be placed on even ground and secured to sign?
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How is ladder secured?
- Ladder brackets
- Ratchets
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Insert photo of ladder hazards?
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Is ladder being used by one person at a time, footed correctly and the climber has three points of attachment?
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Describe restrictions in ladder use?
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Is scaffold in good working order?
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Insert photo of scaffold hazard
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Who is ticketed operator?
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Has operator deemed EWP suitable to task, set up on firm, level ground and completed logbook?
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Explain EWP hazards?
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Are all workers trained and deemed competent by management?
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Hold install and call coordinators immeditely
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Are all ropes and gear in good condition?
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Hold installs and ring Coordinator immediately
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Are anchor points assessed as suitable?
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Hold installs and call Coordinator immediately
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Explain other height hazards that may exist?
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Are all permanent anchor points / static lines on site considered safe?
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Hold install and call coordinators immeditely
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Insert photo of height hazards
Tool Safety
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Are all tools in good condition and been accounted for?
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Explain tool hazards
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Are tools and equipment able to be secured when used at heights
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Explain tool hazards
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Are all tools required to be used able to be kept inside cordoned off area?
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Explain tool hazards
Chemical Hazards
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Is there an MSDS for all chemicals being used on site?
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Stop work and ring a Coordinator immediately
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Have chemical spill procedures been discussed?
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Stop work and ring a Coordinator immediately
General Comments/ Further informtion
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Supervisors must make sure to write down and discuss hazards and controls as well as any other hazard not recorded elsewhere on the risk assessment
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Insert toolbox talk topics
Sign Off Section
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Supervisor sign off: this risk assessment have been checked by me and verified as true and correct
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Insert Supervisors name
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Does the site card or power card require updating for this site
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Once both the risk assessment and SWMS have been consulted and completed, please sign below to state that you have read and understood all the safety conditions
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert Worker signature
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Insert any photos of miscellaneous hazards here
