VS-HS-FRM-xxx

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Project

  Build

  M&P

  UFB

• Contractor Company

• Activity Observed

• SHEWMS Reference

• Add location
  Address

Telecommunications Safety Essentials

• 1. Electrical Work

  Yes

  No

  N/A

• 2. Working at Height

  Yes

  No

  N/A

• 3. Driver Alertness

  Yes

  No

  N/A

• 4. Working in the Vicinity of Utility Services<br>

  Yes

  No

  N/A

• 5. Excavation Works

  Yes

  No

  N/A

• 6. Working in the Vicinity of Vehicular Traffic

  Yes

  No

  N/A

• 7. Working in and around Mobile Plant

  Yes

  No

  N/A

• 8. Working in Remote or Isolated Locations

  Yes

  No

  N/A

• 9. Heavy Lifting

  Yes

  No

  N/A

• 10. Exposure to Asbestos

  Yes

  No

  N/A

Critical Risk Awareness

• 1.1 Have all workers on site completed the required online/ project-specific training inductions relating to the Safety Essentials.

  Yes

  No

  N/A

• 1.2 Are workers able to describe what the Safety Essentials are and how they are implemented?

  Yes

  No

  N/A

• 1.3 Are the workers able to describe which critical risks / Safety Essentials are applicable to the current activity?

  Yes

  No

  N/A

• 1.4 Are the workers able to describe the critical risk controls / working above the line principles they are implementing to control the critical risks?

  Yes

  No

  N/A

2. SHEWMS

• 2.1 Is there a relevant SHEWMS in place applicable to the works?

  Yes

  No

  N/A

• 2.2 Does the SHEWMS highlight the critical risks workers are exposed to?

  Yes

  No

  N/A

• 2.3 Does the SHEWMS clearly state the risk controls for those critical risks?

  Yes

  No

  N/A

• 2.4 Are those risk controls aligned with the Safety Essentials requirements?

  Yes

  No

  N/A

• 2.5 If risk controls are not aligned with the Safety Essentials requirements, has an exception been approved and registered?

  Yes

  No

  N/A

3. SHEWMS Implementation

• 3.1 Are the risk controls being implemented as per the SHEWMS and Safety Essentials requirements?

  Yes

  No

  N/A

• 3.2 Are the risk controls cost effective at controlling critical risk?

  Yes

  No

  N/A

• 3.3 Have all workers signed on to the SHEWMS as having read and understood the requirements?

  Yes

  No

  N/A

Findings and Actions

• Finding 1

  Yes

  No

  N/A

• Actions<br>

  Yes

  No

  N/A

• By Who

  Yes

  No

  N/A

• Required Date of Completion

  Date

• Finding 2

  Yes

  No

  N/A

• Actions

  Yes

  No

  N/A

• By Who

  Yes

  No

  N/A

• Required Date of Completion

  Date

• Finding 3

  Yes

  No

  N/A

• Actions

  Yes

  No

  N/A

• By Who

  Yes

  No

  N/A

• Required Date of Completion

  Date

• Finding 4

  Yes

  No

  N/A

• Actions

  Yes

  No

  N/A

• By Who

  Yes

  No

  N/A

• Required Date of Completion

  Date

• Finding 5

  Yes

  No

  N/A

• Actions

  Yes

  No

  N/A

• By Who

  Yes

  No

  N/A

• Required Date of Completion

  Date

• Auditor Signature

  Sign

• Select date

  Date

• Auditee Signature

  Sign

• Select date

  Date