USI Site Safety Inspection Checklist

• Document No.

• USI Site Safety Inspection Checklist

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site Brand Owner

  APN

  oOH!

  Other

• Site number

• Site address

• Visual size (if required)

• Overall material size (if required)

• Finish/edging (if required)

• What is the installation method on this site?

  Select standard ratchet site no special requirements special installation requirements

  • standard ratchet site
  • no special requirements
  • special installation requirements

• Detail special installation requirements?

• Detail tools needed for site, is pull up rope needed? Any special tools required?

• Detail PPE requirements, standard PPE required? Abseil gear required? Anything else needed?

• Are there any hazards to pedestrians or road traffic on this site?

  Yes

  No

• Detail hazards to pedestrians or road traffic

• Type of Structure

  Select Standard lightbox Monopole Wall Mount Bridge Mount Rooftop Freestander Spec Lightbox Other

  • Standard lightbox
  • Monopole
  • Wall Mount
  • Bridge Mount
  • Rooftop
  • Freestander
  • Spec Lightbox
  • Other

• Describe other type of structure

Access issues

• Access to site

  Select Is safe unobstructed Secure Adequate Parking

  • Is safe
  • unobstructed
  • Secure
  • Adequate Parking

• Insert photo of parking location

  Media

• Comments about parking location

• Installation Access Method

  Select Ladder/Catwalk EWP Abseil Ladder Only Free Climb Walk up

  • Ladder/Catwalk
  • EWP
  • Abseil
  • Ladder Only
  • Free Climb
  • Walk up

• Insert any comments about installation access method

• List any keys needed

• Detail any notice required to access site

• Hours of access to site

• Detail any permits needed for site

Safety Apparatus

• Fixed Ladder

  Select not needed for site Present and in good condition Present but in bad condition

  • not needed for site
  • Present and in good condition
  • Present but in bad condition

• Detail condition of structural ladder

• Hand rails

  Select Not needed for site Present in good condition and secure Hidden handrail Handrail present but not in good condition

  • Not needed for site
  • Present in good condition and secure
  • Hidden handrail
  • Handrail present but not in good condition

• Do you need a portable ladder to access this site?

  Yes

  No

• What size ladder do you need?

• Are there appropriate ladder brackets on site?

  Yes

  No

• Describe ladder brackets, are they in good condition and secure?

• Insert photo of ladder bracket

  Media

• Is the ladder footing adequate?

  Yes

  No

• Describe how the footing needs to be adjusted

• Insert photo of ladder footing

  Media

• Is there a static line on site?

  Yes

  No

• Describe the static line, is it appropriate thickness, in good condition, secure?

• What is the thickness of the static line?

• Is there a catwalk on site?

  Yes

  No

• Describe the catwalk, is it in good condition and secure?

• What is the width of the catwalk?

General Points to Inspect

• Is there cladding on this site?

  Yes

  No

• Site cladding, tick appropriate

  Select Cladding Present Cladding in good condition Cladding secure

  • Cladding Present
  • Cladding in good condition
  • Cladding secure

• Insert additional comment if required

• Is there external lighting on this site?

  Yes

  No

• Tick appropriate for external lighting

  Select top lit bottom lit lights are working all covers present lighting secure external arms in good condition no exposed wiring

  • top lit
  • bottom lit
  • lights are working
  • all covers present
  • lighting secure
  • external arms in good condition
  • no exposed wiring

• Insert additional comment if required

• Is there a winch on this site?

  Yes

  No

• Does this site need a winch?

  Yes

  No

• Is the winch in good condition and working ?

  Yes

  No

• Does this site have side poles?

  Yes

  No

• Are the side poles in good condition and have safe fall device like cuff and chain?

  Yes

  No

• What is needed to make side poles suitable?

• Is the tracking on site in good condition and secure?

  Yes

  No

• What tracking needs to be replaced?

• Are there enough ratchets on site and are they in good condition?

  Yes

  No

• Detail ratchets needs for this site, how many are missing of damaged?

• Is there border capping on this site?

  Yes

  No

• Is capping in good condition and secure?

  Yes

  No

• Is there any vandalism on this site?

  Yes

  No

• Detail vandalism on this site like grafitti

• Detail the general condition of the structure. E.g. Any rust, dents or other visible damage?

• Does power run into this site?

  Yes

  No

• Describe how power is avoided

• Are there Overhead Powerlines near this site?

  Yes

  No

• Describe installation method controls for this site?

• What is the distance to the Powerlines?

• What is the voltage of the Powerlines?

• Is this site at a service station?

  Yes

  No

• Is this a rail site?

  Yes

  No

• List controls needed like WPP or PO?

• Are there radio transmission towers on site? E.g. Telephone towers

  Yes

  No

• Can they be avoided?

  Yes

  No

• Detail any other hazards and the appropriate control that may exist for this site

• Is a road closure required?

  Yes

  No

• Can they be avoided?

  Yes

  No

• Are entry gates or hatches in good condition?

  Yes

  No

• Detail condition of gates or hatches

• Can entry gates of hatches be locked send are all locks present?

  Yes

  No

• Detail condition of gates or hatches

• Is the lighting entry guard present and in good condition?

  Yes

  No

• Detail condition of lighting entry guard

• Is the electricians ladder secure?

  Yes

  No

• Is internal lighting working, have all covers present and no exposed wiring?

  Yes

  No

• Detail condition of internal lighting

• Is there adequate room to setup?

  Yes

  No

• Describe how to rectify

• Does a spotter have a good visual?

  Yes

  No

• Describe how to rectify

• Detail anchor point location

• Are anchor points present, in good condition and inside inspection date?

  Yes

  No

• Describe how to rectify

• Are anchor points in suitable location?

  Yes

  No

• Describe how to rectify

• Detail why this site needs a travel tower

• Is there adequate room to setup?

  Yes

  No

• Describe how to rectify

• Does a spotter have good visual?

  Yes

  No

  N/A

• Describe how to rectify

• Is there clear access to post from the travel tower?

  Yes

  No

• Describe how to rectify

• Is this a new site bring inspected?

  Yes

  No

• Is site satisfactory for posting on?

  Yes

  No

• Sign to confirm site is safe to post on

  Sign

• Detail what this site needs to be safe to post on

• Sign to confirm inspection took place

  Sign

• Is this site upgrade or modification?

  Yes

  No

• Detail modifications or upgrades to this site

• Is site satisfactory for posting on?

  Yes

  No

• Sign to confirm site is safe to post on

  Sign

• Detail what this site needs to be safe to post on

• Sign to confirm inspection took place

  Sign

• Sign to confirm general site inspection is correct as described and site is safe to post on

  Sign