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
Quality Check
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Correct Screws on site and checked?
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Tracking checked for right site?
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Tracking Location installed correctly and securely?
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Correct Banner for the right Site?
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Quality Checklist completed?
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Banner Correctly installed visually checked and photo taken to supply client
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Sweep Completed for loose debris?
Site/Access Hazards
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Have all workers sanitized or washed their hands before starting work?
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It is the team leader's responsibility to ensure all workers are practicing good hygiene
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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
- Work is indoor, not relevant
- Extra installers will minimise risk
- Changing install method will minimise risk
- Site needs to be held
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Ring coordinator immediately and submit a site hold form
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Are there any obstructions to the access point of the site?
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Ensure objects are moved to a suitable and safe area to access site
If objects cannot be moved, stop works and call Coordinators immediately -
Has everyone been signed in to this site?
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Can all material and equipment used be transported to the site safely?
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Explain method?
Ladders
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Which ladder are you using?
- Fibreglass Extension 22ft
- Fibreglass Extension 30ft
- Aluminium Extension 22ft
- Aluminium Extension 30ft
- Aluminium Extension 40ft
- Aluminium Step Ladder
- Fibreglass Step Ladder
- Aluminium Platform 1.8m
- Fibreglass Platform 1.8m
- Fibreglass Platorm 2.4m
- Aluminium Platform 2.4m
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Are the ladders free from major dents or cracks?
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Are the ladders safe to use?
In case of emergency
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In case of emergency - call 000, stay calm and describe the situation clearly to emergency operator. If its a minor incident, near miss or verbal altercation you can call USI - Matthew Lombardi, Steve Balbi or Lee Swale.
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Are all installers 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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Have site supervisors been identified?
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Find out who the site supervisor is.
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Does your team have a designated PO assigned to your team?
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You will need a PO at all times, reach out to site office to have a PO assigned to you prior to commencement of task.
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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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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What size ladder is used for this site?
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Please show ladder set up, secured and using correct access point
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Ladders must be placed at a slope of 4:1
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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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- Fibreglass Extension 22ft
- Fibreglass Extension 30ft
- Aluminium Extension 22ft
- Aluminium Extension 30ft
- Aluminium Extension 40ft
- Aluminium Step Ladder
- Fibreglass Step Ladder
- Aluminium Platform 1.8m
- Fibreglass Platform 1.8m
- Fibreglass Platorm 2.4m
- Aluminium Platform 2.4m
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Insert photo of ladder set up, secured at correct access point
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Ladder must be placed at a slope of 4:1
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Have all permanent anchor points been inspected, tested and Certified?
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Are the inspection tags for permanent anchor points in date
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Are all permanent anchor points / static lines on site considered safe?
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Is there suitable secured anchor points or alternate secure anchor points on the structure available?
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Cease install and notify installs manager/coordinator
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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 SDS 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
Have you discussed the following Toolbox Topics?
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Falls from Heights
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Avoiding Manual Handling when handling material and equipment
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Access points/Ladder Brackets
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Static Lines
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Anchor Points
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Inspecting Harness including double yokes, lanyard & shock absorbers
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