USI Site Risk Assessment - 2022

• Document No.

• Name of Supervisor/Leading Hand

• Name of worker conducting assessment?

• Site Number and Location

• Conducted on

  Date

• Task Being Carried Out

  Select Copy Change Graffiti Clean Maintenance Vegetation Site Measure Site Inspection Private Job Site Clean Up Installation

  • Copy Change
  • Graffiti Clean
  • Maintenance
  • Vegetation
  • Site Measure
  • Site Inspection
  • Private Job
  • Site Clean Up
  • Installation

• Have all workers on site read and understood the SWMS and Site Cards for this site?

  Yes

  No

• Read SWMS and Site Card immediately

• Correct Screws on site and checked?

  Yes

  No

• Aerobridge Fixing Form (Screw and Tracking Count)?

  Yes

  No

• Tracking checked for right site?

  Yes

  No

• Tracking Location installed correctly and securely?

  Yes

  No

• Correct Banner for the right Site?

  Yes

  No

• ITP Checklist completed?

  Yes

  No

• Quality Checklist completed?

  Yes

  No

• Banner Correctly installed visually checked and photo taken to supply client

  Yes

  No

• Sweep Completed for loose debris?

  Yes

  No

• Have all workers sanitized or washed their hands before starting work?

  Yes

  No

• It is the team leader's responsibility to ensure all workers are practicing good hygiene

• Are the weather conditions suitable for safe work?

  Yes

  No

• Insert photo of weather hazard

  Media

• Select from list regarding weather hazards

  Select Work is indoor, not relevant Extra installers will minimise risk Changing install method will minimise risk Site needs to be held

  • Work is indoor, not relevant
  • Extra installers will minimise risk
  • Changing install method will minimise risk
  • Site needs to be held

• Ring coordinator immediately and submit a site hold form

• Are there any obstructions to the access point of the site?

  Yes

  No

• Ensure objects are moved to a suitable and safe area to access site
  If objects cannot be moved, stop works and call Coordinators immediately
  

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

  No

  Yes

• If yes who was contacted?

• Are workers able to maintain a physical distance of 1.5m from depot staff and members of the public?

  Yes

  No

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

  Yes

  No

• Explain method?

• Has worksite been cordoned off correctly?

  Yes

  No

  N/A

• Equipment used to secure worksite?

  Select Witches hats Barricades Tape Signage Other

  • Witches hats
  • Barricades
  • Tape
  • Signage
  • Other

• For other, describe cordon method

• Which ladder are you using?

  Select 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

  • 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

• Are the ladders free from major dents or cracks?

  No

  Yes

• Are the ladders safe to use?

  No

  Yes

• Have all work vehicles been parked correctly and in a safe zone?

  No

  Yes

• If not, explain how the hazard can be eliminated

• Are clearances between workers and adjacent traffic being maintained?

  Yes

  No

  N/A

• Has the 'Workers Above"sign been placed on site?

  Yes

  No

  N/A

• Have safety barriers (where used) been installed correctly?

  Yes

  No

  N/A

• Have needs of other road users been provided for?<br>(eg. pedestrians, cyclists, wheelchairs)

  Yes

  No

  N/A

• 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.

• Are all installers aware of emergency procedures for this site?

  Yes

  No

• Hold site until all workers are aware of emergency procedures

• Has an ambulance pick up point been identified?

  Yes

  No

• 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

  Yes

  No

  N/A

• Do you have the safety rescue pulley on site?

  Yes

  No

• Have all Electrical Hazards been identified and recorded on Site Cards

  Yes

  No

• What hazards have been added to site cards?

• Are there Overhead Power lines (OHPL)?

  Yes

  No

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

• What hazard elimination method has been used?

  Shortened Tracking

  Isolation off power lines

  Caution

  Other

• List other method used to eliminate hazard of OHPL?

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

  Yes

  No

  N/A

• What precautions have been taken?

• Why can no precautions be taken?

• Insert photo of any electrical hazards?

  Media

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

  Yes

  No

• Why are workers not wearing fall protection?

• Are there any height hazards for this site?

  Yes

  No

• What is the install method for this site?

  Select Fixed ladder Portable ladder Scaffold EWP Abseil Other

  • Fixed ladder
  • Portable ladder
  • Scaffold
  • EWP
  • Abseil
  • Other

• What size ladder is used for this site?

• Please show ladder set up, secured and using correct access point

  Media

• Ladders must be placed at a slope of 4:1

  

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

  Yes

  No

• How is ladder secured?

  Select Ladder brackets Ratchets

  • Ladder brackets
  • Ratchets

• Insert photo of ladder hazards?

  Media

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

  Yes

  No

• Describe restrictions in ladder use?

• Is scaffold in good working order?

  Yes

  No

• Insert photo of scaffold hazard

  Media

• Who is ticketed operator?

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

  Yes

  No

• Explain EWP hazards?

• Are all workers trained and deemed competent by management?

  Yes

  No

• Hold install and call coordinators immeditely

• Are all ropes and gear in good condition?

  Yes

  No

• Hold installs and ring Coordinator immediately

• Are anchor points assessed as suitable?

  Yes

  No

• Hold installs and call Coordinator immediately

• Explain other height hazards that may exist?

• undefined

  Select 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

  • 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

• Insert photo of ladder set up, secured at correct access point

  Media

• Ladder must be placed at a slope of 4:1

  

• Have all permanent anchor points been inspected, tested and Certified?

  Yes

  No

  N/A

• Are the inspection tags for permanent anchor points in date

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Hold install and call coordinators immeditely

• Insert photo of height hazards

  Media

• Are all tools in good condition and been accounted for?

  Yes

  No

• Explain tool hazards

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

  Yes

  No

  N/A

• Explain tool hazards

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

  Yes

  No

  N/A

• Explain tool hazards

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

  Yes

  No

  N/A

• Stop work and ring a Coordinator immediately

• Have chemical spill procedures been discussed?

  Yes

  No

  N/A

• Stop work and ring a Coordinator immediately

• Is work being completed on M5

  Yes

  No

• Was M5 controller contacted?

  Yes

  No

  N/A

• Will you ensure gates are locked after installation?

  Yes

  No

• 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

Have you discussed the following Toolbox Topics?

• Falls from Heights

  Yes

  No

  N/A

• Avoiding Manual Handling when folding/unfolding skins

  Yes

  No

  N/A

• Access points/Ladder Brackets

  Yes

  No

  N/A

• Static Lines

  Yes

  No

  N/A

• Anchor Points

  Yes

  No

  N/A

• Inspecting Harness including double yokes, lanyard & shock absorbers

  Yes

  No

  N/A

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

• Insert Supervisors name

  Sign

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

  Yes

  No

• 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

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert Worker signature

  Sign

• Insert any photos of miscellaneous hazards here

  Media