Ventia - LWT form

• Conducted on

  Date

• Prepared by

• Project and work type

• Location
  Address

Questions

• Could the employees explain the task they were doing and what the critical safety risks were for the task? (Things that could cause injury/damage)

  Yes

  No

  N/A

• Critical safety risks

• What control measures have been put in place that are keeping the employees safe while doing the task?

• Are the controls keeping the employees safe and are they inline with the start card/SHEWMS/CRP's?

  Yes

  No

  N/A

• Comments

• CRP's observed;

  Select Lifting Live traffic Isolated work Confined space Mobile plant Live services ACM Excavation Heights Electrical Hazardous energies

  • Lifting
  • Live traffic
  • Isolated work
  • Confined space
  • Mobile plant
  • Live services
  • ACM
  • Excavation
  • Heights
  • Electrical
  • Hazardous energies

Environment

• Environmental considerations

  Select Cultural Heritage Noise / Air Pollution Vegetation clearance / Reinstatement Flora / Fauna Noxious weeds / Pests Fire Management Contaminated land Other

  • Cultural Heritage
  • Noise / Air Pollution
  • Vegetation clearance / Reinstatement
  • Flora / Fauna
  • Noxious weeds / Pests
  • Fire Management
  • Contaminated land
  • Other

• Other environmental considerations

• Monthly SHEQ topic discussed?

• Were any positive behaviours or conditions observed and discussed?

• Were any areas of improvement observed and discussed?

• Did you see any best practice or receive any great feedback that should be shared with others?

• Rate your interaction today overall (1 being poor, 5 being excellent)

• Rate your impression of the behavioural commitment to safety in the people you spoke with (1 being poor, 5 being excellent)

• Rate how engaged the workers were with you during your interaction (1 being poor, 5 being excellent)

Close out

• Were any actions identified and agreed upon during your interaction?

  Yes

  No

  N/A

• Action

• Responsible person

• Completion date

• Additional actions

Actions

• Action

• Responsible person

• Completion date

• Site photos

  Media

• Comments/Suggestions/Improvements/Innovations

• Personnel interviewed

  Sign

• Additional personnel interviewed

Sign on

• Add signature

  Sign

• Person completing

  Sign