USI Pre-Work Assessment - 2023

• Person conducting Assessment

• Vehicle Registration (Number Plate) of Vehicle being used for the Day

• Full Name of the Driver for the Day

• Document No.

• Conducted on

  Date

• By signing this document the above employees agree to having taken part in the Toolbox talk and agree that the checklist items have been completed as indicated

COVID-19 Declaration

• Do any workers feel unwell?

  Yes

  No

• Please notify your USI coordinators

• Do any workers have any cold & flu symptoms?

  Yes

  No

Pre-Work Information

• Does the work party have all SWMS required for the shift?

• Have the site SWMS been read and understood by all workers on site?

• Confirm all workers have current ID cards?

• If required, do all workers have their RIW, ASIC, MSIC and/or site induction cards with them?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are all workers inducted to the sites they will be working on during the shift?

• Are all required SDS's and a hazardous substances register present?

• Has day sheet been obtained for the day?

• Is there at least one functioning mobile phone in the team?

• Are all power tools and electrical leads tested and tagged and in date?

• Are all required permits to work with the team?

• Is there a fully stocked first aid kit with the team?

  Select Yes No

  • Yes
  • No

• If required, has the EWP logbook been completed?

• Works of Methodology been read and understood?

  Yes

  No

  N/A

• Comments

• Quality Management Plan (QMP) been read and understood and on site?

  Yes

  No

  N/A

Toolbox talk topics of discussion

• 
  (Thought points to consider - weather conditions, workers notes, safety issues, aspects specific to job being performed during the day)

• Have you discussed the following:

• Toolbox topic 1: Preventing Falls

  Yes

  No

• Toolbox topic 3: Quality Checklist

  Yes

  No

• Toolbox topic 4: EWP pre start

  Yes

  No

  N/A

• Toolbox topic 5: Inspecting harnesses - double yokes, lanyards & shock absorbers

  Yes

  No

• Toolbox Topic 6: Reporting Incidents, Near miss or verbal altercations

  Yes

  No

• Toolbox Topic 8: Ground sweep loose debris

  Yes

  No

  N/A

• Toolbox Topic 9: Tracking to be installed securely and in correct position

  Yes

  No

  N/A

• Toolbox Topic 10: Banner installed correctly and wrinkle free

  Yes

  No

  N/A

• Toolbox Topic 12: Ladder Secured? ladder bracket being used? kickbaord or footed by second person?

  Yes

  No

  N/A

• Toolbox Topic 13: Ladder to be fully collapsed/retracted when repositioning or entering/exiting the site?

  Yes

  No

  N/A

• Any additional notes?

• Harnesses being used? (Record whether abseil or full body)

  Full Body Harness

  Abseil

All workers must complete the full Harness Inspection:

• CHECK ALL STITCHING AND WEBBING FOR SIGNS OF FRAYING

• CHECK ALL FIXINGS ARE TIGHT AND SECURED

• CHECK ALL D RINGS AND HOUSING ARE IN GOOD ORDER

• CHECK LANYARDS AND DOUBLE YOLKS FOR EXCESSIVE WEAR

• CHECK ALL SAFETY CLIPS AND HOOKS FOR BENDING, CRACKS OR STRESS FRACTURES

• CHECK THAT THE FALL ARREST SECTION IS INTACT AND NOT DISTURBED

• Are all karabiners free of cracks, bends or dents?

  Yes

  No

• Are all attachments like yokes and shock absorbers on your harnesses?

  Yes

  No

• Are team members harnesses free from rips, tears, burns, fraying edges and chemical spills?

  Yes

  No

• Are any signs of wear above listed?

  Yes

  No

• DO NOT USE YOUR EQUIPMENT IF SIGHTING ANY OF THE ABOVE FAULTS.
  REMEMBER TO REPORT ANY FALLS AND HAVE YOUR EQUIPMENT CHECKED BY MANAGEMENT IF ANY SIGNS OF WEAR LISTED ABOVE ARE SIGHTED
  

• All harnesses are subject to 3 monthly inspections and recorded, it is the installers responsibility to visually check all safety gear (harnesses and attachments) prior to all work activity. YOUR SAFETY EQUIPMENT IS A VITAL PART OF YOUR ONGOING SAFETY, ALWAYS RESPECT AND MAINTAIN YOUR EQUIPMENT
  

Equipment Checks

• Do all workers have access to Hand Sanitiser?

  Yes

  No

• Please ask management for hand sanitiser

• Which ladders are you using?

  Select Fibreglass Extension 22ft Fibreglass Extension 30ft Aluminium Extension 22ft Aluminium Extension 30ft Aluminium Extension 40ft Fibgreglass Step ladder Aluminium Step ladder N/A 2.4 Platform Ladder

  • Fibreglass Extension 22ft
  • Fibreglass Extension 30ft
  • Aluminium Extension 22ft
  • Aluminium Extension 30ft
  • Aluminium Extension 40ft
  • Fibgreglass Step ladder
  • Aluminium Step ladder
  • N/A
  • 2.4 Platform Ladder

• Are all ladders free from major dents and crack?

• Are all ladders safe to use?

• Is ladder secured in ladder bracket or to the structure?

• is Ladder footed by second person or againist kickboard?

• Ladder fully collapsed/retracted when repositioning/entering/exiting Site?

PPE - all workers must check they have the following items present with them and that they are in serviceable condition

• Do all staff have a hi-vis vest in an approved colour and style?

  Yes

  No

• Are all staff wearing steel capped boots (lace up for Rail Sites)?

  Yes

  No

• Is sunscreen available?

• All staff wearing face masks when required with the NSW Health Laws?

  Yes

  No

  N/A

• Do all staff have their harness with double yolks and lanyards?

• Do all workers have their hard hat?

• If on Rail Sites, do all staff have long sleeve shirts and pants, safety glasses and gloves?

Sign off

• Team Leader

  Sign

• Installer

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• Installer

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• Installer

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• Installer

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• Installer

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• Installer

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• Installer

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• Installer

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• Installer

  Sign

• Insert photo of my issues

  Media