Visionstream SHE Shutdown Checklist - Dec 2014

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Environment

• Have erosion, sediment controls and stock pile been removed from site

  Yes

  No

  N/A

• Have Fuels/Oils/Chemicals been removed from site?

  Safe

  At Risk

  N/A

• Is a monitoring/inspection program in place for active/secured sites? Is there a review in place to be carried out at least every 3 days?

  Yes

  No

  N/A

• Site access and security arrangements including fencing/hoarding in place for Christmas period, if required?

  Yes

  No

  N/A

• Contact person(s) agreed and communicated to relevant stakeholders (eg: Regulator/Client)

  Yes

  No

  N/A

• Has site equipment and machinery been removed from site watercourses and drainage lines?

  Yes

  No

  N/A

Safety

• All bins and skips on site removed

  Yes

  No

  N/A

• Are All work areas are clear from debris and equipment removed off site? eg: fencing, barriers.

  Yes

  No

  N/A

• Are safety barriers secure (tied/fixed in place)

  Yes

  No

  N/A

• Where practicable, have all excavation been back filled? If not why, and explain how they have protected them. E.g. Plate, safety fences

  Yes

  No

  N/A

• Where excavation are unable to be filled. Are the excavation sites secure? (Barricades have been put in place). Is all temporary reinstatements compliant? E.g. Cold mix

  Yes

  No

  N/A

• Have all trip hazards been eliminated?

  Yes

  No

  N/A

• Are all signs removed from site? (Except sites with open/secured excavations).

  Yes

  No

  N/A

• Other Comments

• Signature of Site Manager Representative

  Sign

• Date

  Date

• Completed checklists should be emailed to SEQ mailbox (vplseqnz@visionstream.co.nz) for entry into Cintellate.