Information
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Document No.
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Company Name:
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ConSol Number:
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Auditee's Name:
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Audit Location:
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Location
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Conducted on
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Auditor's Name:
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Vehicle Registration Number:
1.0 Personal Protective Equipment (PPE)
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1.1. Safety Boots (steel capped) X 2?
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1.2. Riggers Gloves?
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1.3. Safety Helmet / Hard Hat? (3 years from manufacture date)?
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Expiry date?
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1.4. Safety Helmet / Harness? (2 years from manufacture date)?
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Expiry date?
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1.5. Safety Glasses (AS stamped AS 1891)?
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1.6. Wide. Brimmed hat?
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1.7. Hearing Protection - General purpose ear muffs?
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1.8. High Visibility Safety Vest?
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1.9. Full Body Harness? (within 10 years)
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1.9.1. Serial Number
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1.9.2. Expiry date
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1.10. Pole Strap? (within 10 years)
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1.10.1. Serial Number
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1.10.2. Expiry date
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1.11. Safety rope?
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1.12. LVIV Rubber Gloves 650V (Electrical)
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1.12.1. Expiry Date (12 months from stamped date on glove)
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1.13. P2 masks available (asbestos work)?
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1.14. Disposable coveralls for asbestos work?
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1.15. Long sleeved high visibility UV protective clothing available including long pants?
2.0 Gas Detection
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2.1. Gas Detector - 4 sensors?
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2.1.1. Serial Number
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2.1.2. Expiry date for calibration certificate
3.0 First Aid
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3.1. First Aid Kit (Approved Marking +) meets Model Code of Practice contents?
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3.2. Signage on Vehicle to indicate location of First Aid Kit?
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3.3. Contents within expiry date?
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3.3.1. Expiry Date of Eye wash
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3.4. Is there evidence of an annual inspects of first aid kit (i.e. sticker)
4.0 Licences and Accreditation
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4.1. ISGM letter of Introduction Issued?
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4.1.1. Date of issue
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4.2. Drivers Licence? (current and relevant for applicable vehicle)
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4.2.1. Drivers Licence number?
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4.2.2. Drivers Licence Expiry Date
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4.3. Plant licence or accreditation
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4.3.1. Date of Licence or letter of accreditation
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4.4. Power Awareness Card? (For prisons working within 3m restricted zone to .5m no go zone)
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4.4.1. Power Awareness Card number?
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4.4.2. Power Awareness Card Expiry Date
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4.5. Telstra Accreditation manholes/poles/ladders (or similar)?
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4.5.1. Telstra Accreditation manholes/poles/ladders (or similar) Expiry Date
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4.6. Construction Induction Card?
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4.6.1. Construction Induction Card number?
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4.6.2. Construction Induction Card Issue Date
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4.7. First Aid Trained?
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4.7.1. First Aid training Expiry Date
5.0 Vehicle Inspection
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5.1. Make?
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5.2. Model?
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5.3. Registered?
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5.3.1. Registration Number?
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5.3.2. Registration Expires?
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5.4. Colour of Vehicle
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5.5. Lights - Check operation of brake, indicator and reversing lights. All operational?
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5.6. Cargo Barrier Installed?
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5.7. Vehicle in good condition - free of damage?
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5.8. Windscreen condition OK, no chips or cracks?
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5.9. Vented gas safe storage adequate?
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5.10. Open tray vehicles gas. Containers stored upright and secured?
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5.11. Ladders secured effectively?
6.0 Safety Equipment
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6.1. Sharps kit available?
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6.2. Rubber Mat electrical 650V rated?
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6.3. Manhole Guards (minimum 1x full set)?
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6.4. Reflective cones / witches hats x 6 (450mm)?
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6.5. Road Safety Sign ('Workman Ahead')?
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6.6. Road Safety Pedestrian Sign ('Pedestrians with arrow' left and right arrow)?
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6.7. Safety Sign ('Asbestos Removal in Progress' or similar)?
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6.8. 240v Electrical Leads and tools (6 monthly test and tagged)?
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6.8.1. Date Next Test Due
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6.9. RCD Tested if 240v tools or leads carried?
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6.9.1. Date Next RCD Test Due
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6.10. Lock Out Tags available?
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6.11. Fire Blanket available?
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6.12. Fire Extinguisher (2kg) available (and in date)?
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6.12.1. Next Test Date for Fire Extinguisher (tested every 6 months)
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6.13. Equipotential Bonding Straps available (HFC work only)?
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6.14. Pole bag available?
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6.15. Insulated Rods and Reel available? (For Pre-pro, BCIMs and Jointers only)
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6.16. Insulated 'fishing' device available? (For Pre-pros, BCIMs and Jointers)
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6.17. Test Set no.2 (insulated clips) available, with working buzzer and flashing light (cable work)?
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6.18. Industrial Fibreglass Extension Ladder available and in good condition?
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6.19. Industrial Fibreglass Step Ladder available and in good condition?
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6.20. Gas Bottle LPG 1kg in good condition?
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6.20.1. Testing date for bottle (Bottles to be tested every 10 years)
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6.21. Gas regulator, hand piece, burner, neck tube all in good condition?
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6.22. Hose for gas bottle longer than 10 metres?
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6.23. Insulated Screwdriver available?
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6.24. Wooden/Fibreglass handled crowbar available?
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6.25. Long Handled ( Wooden/Fibreglass) Shovel available?
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6.26. Torch available?
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6.27. Seal breaker available?
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6.28. Pit Key - size appropriate?
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6.29. Cable Locator?
7.0 Documentation
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7.1. Safety Management Plan
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7.2. Site Safety Rules
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7.3. Working Access to Relevant Safe Work Method Statements (SWMS)
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7.4. Copies of Relevant Daily JSEA form, if required
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7.5. Safety Data Sheets (SDS) for all chemicals carried
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7.6. Emergency Contact List
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7.7. DBYD site plans and statement
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7.8. Traffic Control Plans
BRIEF DESCRIPTION OF NON CONFORMANCE ISSUES
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NON CONFORMANCE ISSUE 1.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 2.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 3.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 4.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 5.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 6.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 7.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 8.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 9.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
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NON CONFORMANCE ISSUE 10.0
- Attended to during review
- Immediately
- 5 days
- 14 days
- 30 days
Sign Off
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Contractor's Signature
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Reviewer's Signature
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Version Number 0.1 Dated 16 January 2013