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

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

• 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?

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

  Yes

  No

• How can site be made safe for workers and public?

• 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

• 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

• Has proper access to side roads and buildings been provided?

  Yes

  No

  N/A

• In case of emergency - call 000, stay calm and describe the situation clearly to emergency operator. Then call a coordinator, secure the site and begin to complete an incident report

• 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?

• Has power to the light box been turned off?

  Yes

  No

  N/A

• Where is the switch and who turned power off?

• 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?

• Station

  WPP

  Protection Officer (PO)

• 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

• Insert name of M5 control officer contacted on 02 9820 0051

• 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