Vodafone Mobile Sites

• Site

• Alpha Code

• Select date

  Date
• Location
  Address

• For this assessment the following applies
  
  Safe -
  At Risk -
  Fail -

Site Management and Planning

• Is the site access information correct and up to date?

  Yes

  No

• Is the Health and Safety plan on site, accessible and legible?

  Safe

  At Risk

  Fail

  N/A

• Has a hazard and risk assessment been undertaken for the site?

  Safe

  At Risk

  Fail

  N/A

• Outline areas to improve the Health and Safety plan with dates for completion

• Select date

  Date

• All contractors (including sub contractors) have been provided with information relating to health and safety for the work they are undertaking?

  Safe

  At Risk

  Fail

  N/A

• Is the time allowed suitable for the scope of work to be undertaken?

  Safe

  At Risk

  Fail

  N/A

Summary

• Site Management and Planning

  Safe

  At Risk

  Fail

  N/A

Safety Gear

• Hi Viz

• Safety Helmet

• Safety glasses

• Appropriate clothing for the environmental conditions

• Safety boots (or appropriate footwear for working on roofs)

• Hearing protectors of the appropriate class

Summary

• Safety Gear appropriate to the task is in being worn and is in good condition?

  Safe

  At Risk

  Fail

  N/A

• Principal Contractor Network Requirements

• Vodafone Sites

• Workers on roofs with proprietary anchor systems in place have completed US23229 and have a copy of their current certification on site?

  Safe

  At Risk

  Fail

  N/A

• Workers on communication towers, poles and roofs have completed US 23229, 15757 and 17025 and have a copy of their current certificate on site?

  Safe

  At Risk

  Fail

  N/A

• Are all persons on site competent and trained to undertake the tasks on site?

  Safe

  At Risk

  Fail

  N/A

• Work should cease until persons competent to undertake the required tasks are on site. An incident report should also be sent to the relevant Principal Contractor

Summary

• Competency

  Safe

  At Risk

  Fail

  N/A

Emergency planning and equipment

• Is the site able to call for emergency assistance - Fire, Police Ambulance?

  Safe

  At Risk

  Fail

  N/A

• Are appropriate Fire Extinguishers on site?

  Safe

  At risk

  N/A

• Emergency assembly point identified?

  Safe

  At risk

  N/A

• Are first aid kits, current, we'll stocked and readily available?

  Safe

  At Risk

  Fail

  N/A

Summary

• Emergency planning

  Safe

  At Risk

  Fail

  N/A

Environmental

• Working hours restrictions are being adhered to?

  Safe

  At risk

  N/A

• Noise and vibration are kept to acceptable levels?

  Safe

  At risk

  N/A

• All site areas are kept tidy with litter removed from site appropriately?

  Safe

  At risk

  N/A

Summary

• Environmental

  Safe

  At Risk

  Fail

  N/A

General

• Have all visitors signed the visitor log?

  Safe

  At Risk

  Fail

  N/A

• Are hazards, risks and controls discussed with visitors prior to entering the site?

  Safe

  At Risk

  Fail

  N/A

• Incident report register on site and up to date?

  Safe

  At Risk

  Fail

  N/A

• Is the work site (including footpaths and roadways) clear and free from debris, rubbish and obstructions?

  Safe

  At Risk

  Fail

  N/A

• Are slip and trip hazards being adequately managed?

  Safe

  At Risk

  Fail

  N/A

• Is lighting adequate for carrying out tasks and and/or safe access?

  Safe

  At risk

  N/A

Summary:

• General

  Safe

  At Risk

  Fail

  N/A

Roof Access

• Are persons on site working on the roof of a building?

  Yes

  No

• An assessment has been made of any internal ladders used to gain access to the roof to ensure they are structurally sound?

  Safe

  At Risk

  Fail

  N/A

• Handrails are in place for ladders if required?

  Safe

  At Risk

  Fail

  N/A

• Ladders extends 1 metre above the landing platform?

  Safe

  At Risk

  Fail

  N/A

• Portable ladders meet AS/NZS 1892?

  Safe

  At Risk

  Fail

  N/A

• Portable ladders are secured at the top and the bottom?

  Safe

  At Risk

  Fail

  N/A

Summary

• Access to Roof

  Safe

  At Risk

  Fail

  N/A

Brittle Roofs (Skylights, Asbestos Roofs, Openings, Roofs in Poor Condition)

• Is the roof surface brittle, in poor condition or has skylights?

  Yes

  No

• An assessment of the roof has been made to ensure it is strong enough to support the work activities being carried out. (Asbestos roofs are the majority of brittle roofs).

  Safe

  At risk

  N/A

• Are areas such as skylights, roof openings designated as no go zones and barricaded off or covered if required?

  Safe

  At Risk

  Fail

  N/A

• Are walkways with guardrails provided when work on fragile roofs cannot be avoided?

  Safe

  At Risk

  Fail

  N/A

• If walkways are not provided is a fall arrest system being used?

  Safe

  At Risk

  Fail

  N/A

• Work on the roof must stop until safe work methods are in place.

Summary

• Brittle Roofs

  Safe

  At Risk

  Fail

  N/A

RF

• Are there RF hazards on site?

  Yes

  No

• RF warning signs are in place at access points?

  Safe

  At Risk

  Fail

  N/A

• Ensure that a report is made to the Mobile Company concerned that signs are not present.

• Are persons trained/competent/certified in RF Awareness

  Safe

  At Risk

  Fail

  N/A

• On co location sites, other mobile company antennae have been considered when planning the work?

  Safe

  At Risk

  Fail

  N/A

• Have adjacent buildings be assessed as a possible source of RF?

  Safe

  At Risk

  Fail

  N/A

• Are RF monitors calibrated?

  Safe

  At Risk

  Fail

  N/A

• Are appropriate RF monitors available and being used?

  Safe

  At Risk

  Fail

  N/A

• RF procedures and monitoring practices have been followed?

  Safe

  At Risk

  Fail

  N/A

• Spark RF Shutdown Procedure ND4027 Ver 6.0 has been followed?

• 2 Degrees

• Vodafone

Summary

• RF

  Safe

  At Risk

  Fail

  N/A

Machinery for working at Heights on Towers, Roofs and Structures

• MEWP, Crane Scaffold or Guardrails being used on Site?

  Yes

  No

• Move to the next section

• Are workers on the ground wearing appropriate PPE e.g. Safety Helmets, Safety Boots, High Viz Vests and Eye Protection?

  Safe

  At Risk

  Fail

  N/A

• Have exclusion zones been implemented and sufficient for the tasks being carried out?

  Safe

  At Risk

  Fail

  N/A

• Do the exclusion zones prevent members of the public accessing the site?

  Safe

  At Risk

  Fail

  N/A

• Assess any of the following equipment on site

• Mobile Elevated Work Platfrom

  Yes

  No

• Has the operator carried out a carried out a pre start inspection of the MEWP that includes functional and visual tests (required each day)?

  Safe

  At Risk

  Fail

  N/A

• Is the MEWP clearly marked with the rated lifting capacity

  Safe

  At Risk

  Fail

  N/A

• Weight of lift?

• Essential operating and maintenance instructions permanently displayed or stored in a conspicuous place on the MEWP?

  Safe

  At Risk

  Fail

  N/A

• Is the six monthly inspection certificate displayed?

  Safe

  At Risk

  Fail

  N/A

• Operator is trained and competent (US 23966 v1) and the corresponding unit for the type of MEWP being used?

  Safe

  At Risk

  Fail

  N/A

• Hazards associated with power lines are appropriately controlled (no closer than 6.4 metres, or between 4 - 6.4 metres with appropriate controls in place. No work can be carried out within 4 metres of a power line without the written consent of line owner and this consent must remain on site at all times?

  Safe

  At Risk

  Fail

  N/A

• Weather conditions are suitable for using the MEWP?

  Safe

  At Risk

  Fail

  N/A

• Are harnesses, lanyard and attachment points available to all workers undertaking tasks from the MEWP?

  Safe

  At Risk

  Fail

  N/A

• Is the MEWP set up on firm and level ground?

  Yes

  No

  N/A

Summary

• MEWP

  Safe

  At Risk

  Fail

  N/A

• Crane

  Yes

  No

• Is the plan and information provided by the crane supplier signed and accepted by the contractor on site?

  Safe

  At Risk

  Fail

  N/A

• Is the crane set up on firm, level ground with barriers in place?

  Safe

  At Risk

  Fail

  N/A

• Safe working distances are maintained from overhead power lines?

  Safe

  At Risk

  Fail

  N/A

• No persons are standing under suspended loads?

  Safe

  At Risk

  Fail

  N/A

• Tag lines are used where there could be load spin?

  Safe

  At Risk

  Fail

  N/A

• The load does not exceed the lifting capacity of the crane

  Safe

  At Risk

  Fail

  N/A

• Lifting capacity of the crane

• Weight of lift

• Clear lines of communication exist between the dogman/persons in bucket and the crane operator?

  Safe

  At Risk

  Fail

  N/A

• Weather conditions suitable for the use of a crane?

  Safe

  At Risk

  Fail

  N/A

Summary

• Crane

  Safe

  At Risk

  Fail

  N/A

• Scaffold or Mobile Scaffold

  Yes

  No

• Are the surface conditions suitable for scaffold access and stability - e.g level and safe to work on?

  Safe

  At Risk

  Fail

  N/A

• Is there a health and safety management plan on site that clearly identifies those responsible for implementing control measures for the scaffold?

  Safe

  At Risk

  Fail

  N/A

• Are site specific hazards e.g proximity to power lines and control measures included in the Safe Work Method Statement or JSA?

  Safe

  At Risk

  Fail

  N/A

• The scaffold was erected, altered or dismantled by a person(s) who have been trained and have suitable experience with the type of scaffold being used?

  Safe

  At Risk

  Fail

  N/A

• Are the wheels locked and turned out on mobile scaffolds?

  Safe

  At Risk

  Fail

  N/A

• If a portion of the scaffold is above 5 metres above the ground the following conditions must be met

  Yes

  No

  N/A

• The person assembling, altering or dismantling the scaffold have a certificate of competence

• Scaffold inspection card/register (Safety Tag) clearly visible in place by the access ladder and checked weekly?

• Notification has been sent to WorkSafe NZ

• The maximum load (weight of workers and materials) has been determined and the scaffold is capable of supporting the weight

• Edge protection provided where a person could fall 2 or more metres

• Scaffold protected from passing vehicles or plant

• Ladders are secured top and bottom.

• Ladder extended 900-1000 mm above the landing platform.

• Planks are in good condition, 3 planks minimum and butted and secured.

Summary

• Scaffolds

  Safe

  At Risk

  Fail

  N/A

• Edge Protection?

  Yes

  No

• Designed and constructed to by a competent person?

  Safe

  At Risk

  Fail

  N/A

• Positioned appropriately?

  Safe

  At Risk

  Fail

  N/A

• Will barriers and guard rails be regularly inspected

  Safe

  At Risk

  Fail

  N/A

• Includes a toe board or mesh infill to prevent tools, materials and debris falling from the roof?

  Safe

  At Risk

  Fail

  N/A

• Not used on a roof with greater than 35 degree slope (In this instance a MEWP, or Fall Restraint/Arrest system must be used)

  Safe

  At Risk

  Fail

  N/A

Summary

• Edge protection

  Safe

  At Risk

  Fail

  N/A

Fall restraint and fall arrest systems

• Are fall restraint or fall arrest systems being used on site?

  Yes

  No

• Move to the next section

• All personnel trained and certified for working at height?

  Safe

  At Risk

  Fail

  N/A

• Has the rigger undertaken a visual inspection of the structure, pole etc prior to work commencing?

  Safe

  At Risk

  Fail

  N/A

• Is each person familiar with the work plan?

  Safe

  At Risk

  Fail

  N/A

• Are personnel attached at all times while working at height?

  Safe

  At Risk

  Fail

  N/A

• Has a drop zone been implemented and sufficient for the tasks being carried out?

  Safe

  At Risk

  Fail

  N/A

• Is all equipment secure to prevent a fall from height?

  Safe

  At Risk

  Fail

  N/A

• Does each member of the team have the required PPE?

  Yes

  No

  N/A

• Riggers gloves

• A rescue, climbing or caving safety helmet

• Self rescue kit carried

• Clothing to suit the environmental conditions

• Eye protection from glare and also flying objects/particles.

• First aid kit?

• Boots that are appropriate to the task ( AS 2210)

• Is there a written rescue plan that is known to each member of the team?

  Safe

  At Risk

  Fail

  N/A

• Two certified rescue climbers are on site at all times?

  Safe

  At Risk

  Fail

  N/A

• Notification has been sent to WorkSafe NZ of the work?

  Safe

  At Risk

  Fail

  N/A

• Are all members of the team trained and competent for the tasks they are carrying out?

  Safe

  At Risk

  Fail

  N/A

• Has a SWMS or JSA been prepared for height work on site?

  Safe

  At Risk

  Fail

  N/A

• Are there established safe access pathways to the anchor points?

  Safe

  At Risk

  Fail

  N/A

• Is a certified fall restraint system available for use?

  Safe

  At Risk

  Fail

  N/A

• If using a fall arrest system are suitable certified anchor points being used?

  Yes

  No

• Date anchor points certified to?

  Date

• Certified load?

• If certified anchor points are not available a Temporary Anchor Point Permit must be completed and a copy held on site

• The temporary anchor point permit has been signed by a competent rigger?

  Yes

  No

• Rope access work must cease until the permit is completed

• The temporary anchor point permit has been signed by the rescue climber?

  Yes

  No

• Rope access work must cease until the permit is completed

Summary

• Fall restraint and fall arrest

  Safe

  At Risk

  Fail

  N/A

Pedestrian and Public Safety

• Are members of the public/pedestrians passing the site?

  Yes

  No

• Is a spotter required on site?

  Safe

  At Risk

  Fail

  N/A

• Is safe pedestrian access maintained on site at all times?

  Safe

  At Risk

  Fail

  N/A

• Are appropriate barriers in place that create a safe zone around activities that involve working at height?

  Safe

  At Risk

  Fail

  N/A

• When plant and machinery are in operation (e.g. MEWP, Crane, Container Delivery) these are isolated from the general public?

  Safe

  At Risk

  Fail

  N/A

• Work vehicles are parked safely?

  Safe

  At Risk

  Fail

  N/A

Summary

• Pedestrian and public safety

  Safe

  At Risk

  Fail

  N/A

Electrical Safety

• Is electrical work being undertaken on site?

  Yes

  No

• Procedures are in place for ensuring electrical equipment is de-energised before electrical work is carried out and methods in place to ensure that it cannot <br>be inadvertently re-energised (isolation, tagging and lockout)?

  Safe

  At Risk

  Fail

  N/A

• Persons conducting work on electrical equipment are appropriately trained, registered and hold a practising license for the type of work being undertaken?

  Safe

  At Risk

  Fail

  N/A

• Proven to be de-energised before work commences?

  Safe

  At Risk

  Fail

  N/A

• Only ladders constructed of timber or fibreglass are to be used for work on or near electrical apparatus?

  Safe

  At Risk

  Fail

  N/A

• All electrical equipment, extension leads and portable power tools are in good condition and regularly inspected, tested and tagged?

  Safe

  At Risk

  Fail

  N/A

• Undertaken a CPR course (within the last 12 months) and Basic First Aid course (within the last 2 years)?

  Safe

  At Risk

  Fail

  N/A

Live electrical work

• Is live electrical work being undertaken on site?

  Yes

  No

• A risk assessment and safe work method statement has been prepared before any live work is undertaken?

  Safe

  At Risk

  Fail

  N/A

• When working on or near live electrical apparatus the following Safety Gear (PPE) is being worn

  Yes

  No

• Clothing covers the body from neck to wrist to ankle, (cotton)

• Sleeves rolled down and shirts tucked into trousers (protecting against entanglement and arc flash)

• Non metallic fasteners (or fasteners are protected by a layer of the same material as that of the garment)?

• Suitable eye protection?

Summary

• Electrical

  Safe

  At Risk

  Fail

  N/A

Traffic Management

• Is the worksite in the road corridor or subject to frequent vehicle movements?

  Yes

  No

• Copy of the traffic management plan signed by the contractor and maintained on site?

  Safe

  At Risk

  Fail

  N/A

• Traffic management setup is correct and according to the TMP?

  Safe

  At Risk

  Fail

  N/A

• STMS contact number listed?

  Safe

  At Risk

  Fail

  N/A

• Is there an escape route for the traffic controller?

  Safe

  At Risk

  Fail

  N/A

• Comes and barriers in good condition?

  Safe

  At Risk

  Fail

  N/A

• After hours TMP in place if necessary?

  Safe

  At Risk

  Fail

  N/A

Summary

• Traffic Management

  Safe

  At Risk

  Fail

  N/A

Summary

• If any of the following areas are not being managed appropriately then work at the site should be halted until the area(s) of concern are addressed.

• Site planning and management

  Safe

  At Risk

  Fail

  N/A

• Roof access, brittle roofs and RF

  Safe

  At Risk

  Fail

  N/A

• Equipment and plant for working on towers, roofs and structures

  Safe

  At Risk

  Fail

  N/A

• Fall restraint, arrest and anchor points

  Safe

  At Risk

  Fail

  N/A

• Pedestrian, Public and Traffic Safety

  Safe

  At Risk

  Fail

  N/A

• Competency of workers on site?

  Safe

  At Risk

  Fail

  N/A

• Are any other hazards present on site, list below

  Yes

  No

• Are these hazards and risks being appropriately controlled?

  Yes

  No

• Were any unsafe work practices observed at the time of the assessment

  Yes

  No

• Please describe the unsafe practice observed below

• Comments -enter below

Agreement

• Required corrective actions

  Yes

  No

  N/A

• Agreed date for completion of corrective actions

  Date

• Assessor

  Sign

• Company

• Site representative

  Sign

• Company

• Select date

  Date