Site/Access Hazards

Check box if more than skin is being installed at a single location

Are the weather conditions suitable for safe work?

Insert photo of weather hazard

Select from list regarding weather hazards

Ring coordinator immediately and submit a site hold form

Does this site require you to sign in with Site Management or Security?

If yes who was contacted?

Do you consider the Site safe for all workers and the public?

How can site be made safe for workers and public?

Can all material and equipment used be transported to the site safely?

Explain method?

Are all vehicles parked correctly?

Parking location

Insert photo of parking hazard

Has worksite been cordoned off correctly?

Equipment used to secure worksite?

For other, describe cordon method

In case of emergency

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

Are all installer aware of emergency procedures for this site?

Hold site until all workers are aware of emergency procedures

Has an ambulance pick up point been identified?

Hold site until all workers are aware of emergency procedures

What is the Pick up point location and suburb?

What is the nearest cross street?

Is there an abseiler on site

Do you have the safety rescue pulley on site?

Electrical Hazards

Have all Electrical Hazards been identified and recorded on Site Cards

What hazards have been added to site cards?

Are there Overhead Power lines (OHPL)?

What is the distance (m) and voltage (kV)?

What hazard elimination method has been used?

List other method used to eliminate hazard of OHPL?

Has power to the light box been turned off?

Where is the switch and who turned power off?

If working near an electrical area like switchboard, have precautions been taken?

What precautions have been taken?

Why can no precautions be taken?

Insert photo of any electrical hazards?

Height Hazards

Are all workers using fall protection devices like harnesses and are they wearing helmets?

Why are workers not wearing fall protection?

Are there any height hazards for this site?

What is the install method for this site?

Is fixed ladder in good condition?

What size ladder is used for this site?

Can ladder be placed on even ground and secured to sign?

How is ladder secured?
Insert photo of ladder hazards?

Is ladder being used by one person at a time, footed correctly and the climber has three points of attachment?

Describe restrictions in ladder use?

Is scaffold in good working order?

Insert photo of scaffold hazard

Who is ticketed operator?

Has operator deemed EWP suitable to task, set up on firm, level ground and completed logbook?

Explain EWP hazards?

Are all workers trained and deemed competent by management?

Hold install and call coordinators immeditely

Are all ropes and gear in good condition?

Hold installs and ring Coordinator immediately

Are anchor points assessed as suitable?

Hold installs and call Coordinator immediately

Explain other height hazards that may exist?

Are all permanent anchor points / static lines on site considered safe?

Hold install and call coordinators immeditely

Insert photo of height hazards

Tool Safety

Are all tools in good condition and been accounted for?

Explain tool hazards

Are tools and equipment able to be secured when used at heights

Explain tool hazards

Are all tools required to be used able to be kept inside cordoned off area?

Explain tool hazards

Chemical Hazards

Is there an MSDS for all chemicals being used on site?

Stop work and ring a Coordinator immediately

Have chemical spill procedures been discussed?

Stop work and ring a Coordinator immediately

Rail Site Hazards

Is work to be performed on a Rail site?

Is access to the site acceptable?

Hold site and contact Coordinator immediately

Do you cross an active rail track?

Will all equipment remain clear of the rails, and not cause damage to trains or rail operator property?

Hold site and contact Coordinator immediately

Select Hazard category for Rail work

Have you contacted the station master?

See Station Master before work performed

Has a WPP that has been prepared by a PO4 been reviewed, completed and signed?

Hold site and contact Coordinator immediately

PO4 and Worker communication method: all communication will be established by the PO4, in the event of malfunction, mobile phones will be used. Both will exchange numbers during briefing

What is the PO Officers mobile number?

What is the safe area on track?

Have workers been given a copy of the briefing?

Obtain a copy of briefing from PO

Any accident or incident on Rail Sites needs to be reported on 1800 772 779 once you have spoken to your Coordinator or if the PO cannot report the incident

M5 specific hazards

Is work being completed on M5

Insert name of M5 control officer contacted on 02 9820 0051

Will you ensure gates are locked after installation?

Service Station Specific Hazards

Are you conducting work at a service station site?

Has a Service Station Risk Form been completed?

Hold site and call coordinator

General Comments/ Further informtion

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

Insert toolbox talk topics

Sign Off Section

Supervisor sign off: this risk assessment have been checked by me and verified as true and correct

Insert Supervisors name

Does the site card or power card require updating for this site

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

Insert Worker signature
Insert Worker signature
Insert Worker signature
Insert Worker signature
Insert Worker signature
Insert Worker signature
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Insert any photos of miscellaneous hazards here
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.