Title Page

  • Program Name

  • Reason for visit

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Pre-site checks

Pre-site checks

  • Have you arranged the visit

  • Have you been site inducted

  • Am I wearing the correct PPE

Site Assessment - Part 1

Site Assessment Mandatory Section

  • Is the Hazard/Risk Register board in place

  • Has the Hazard/Risk Register board been updated today

  • Are the PPE requirements displayed

  • Is signage in place and appropriate for risk (e.g. report to site office, no entry, asbestos, danger)

  • Is access control effective, no unauthorised access

  • Is induction or discussion of site risks held

  • Do the risks mentioned match the Hazard/Risk Register board

  • Are PPE requirements described

  • Is the induction/discussion recorded

Site Assessment - Part 2

Site Assessment Optional Section depending on activities on site/to be targeted

  • Emergency Equipment Section

  • Is a fire extinguisher available

  • Is the first aid kit complete and available

  • Is a spillage kit on site

  • Are risk specific Emergency Response Plans available and easy to access

  • Are emergency numbers available and easy to access

  • Documentation Section

  • Are clearance certificates on site e.g. asbestos

  • Is a SSSP available on site

  • Are safety meeting minutes added to SSSP

  • Is the SSSP in daily use

  • Is SSSP content known on site

  • Are SDS available and easy to access

  • If asbestos being removed, is an Asbestos Removal Control Plan at site and being followed

  • Site housekeeping and facilities Section

  • General site tidy and orderly, free of trip hazards

  • Are materials stacked safely

  • Are stacking areas demarcated

  • Are hazards demarcated (e.g. trenches)

  • Are waste materials stored in bins

  • Are bins used for hazardous materials lined

  • Are exposed reinforcing bars capped

  • Are toilet facilities and running water accessible on site

  • Personnel on site Section

  • ID tags carried and current

  • Are all trades onsite signed in

  • Supervisor or designated backup available on site during visit

  • PPE and manual handling Section

  • Are requirements known on site

  • Are all workers wearing correct PPE

  • Are acceptable manual handling methods being used for tasks observed

  • Working at Height Section

  • Has the most appropriate equipment been chosen for work at height e.g. scaffolding, mobile scaffolding, elevated platform, ladder

  • If work is being conducted within 4m of overhead power lines is effective isolation in place (e.g. power disconnection, sleeving, or close approach consent).

  • Has the chosen equipment for working at height been assembled by a competent worker

  • Scaffolding Section

  • Is the tag valid (present, weekly inspection recorded, completed in full)

  • If the scaffolding exceeds 5m in height has WorkSafe been notified<br>

  • If the scaffolding exceeds 5m in height has it been erected by a holder of a current certificate of competence

  • Is scaffolding installed to standard (e.g. soleboards 500mm x 200mm x 38mm thick, base boards, platforms, toe boards, stabilising legs, stand offs, gates, ladder attachments, edge protection installed effectively)

  • Ladders Section

  • Is the ladder set up at 1:4 ratio (1m horizontal to 4m vertical)

  • Can users maintain 3 points of contact at all times

  • Is the ladder secured at top and base to prevent slipping sideways/out

  • Do all ladders have more than 3 steps

  • Power Supply Section

  • If power isolated is a lock out device in place with tag

  • Are appropriate safety devices in place

  • Have power source (e.g. distribution box) leads been tagged

  • Are tags valid and leads in good working order

  • Are leads used in a safe manner

  • Tools & Machinery Section

  • Are the right tools or machinery being used for the job

  • Are power tool tags valid

  • Are all dangerous parts guarded

  • Do all tools and machinery appear to be in good working order

  • Hazardous Substances Section

  • Is dust control in place at source for respirable dust and/or paint particles e.g. timber, silica, lead based paint

  • Is waste from any dust extraction system disposed of safely

  • Is correct Personal Protective Equipment (PPE) for cutting, drilling, sanding or mixing activities available and being worn (e.g. ear protection, eye protection, P2 dust mask)

  • Are results on site for any hazardous materials being disturbed during works, e.g. asbestos, lead based paint, mould

  • Are containment controls sufficient and in good condition

Summary

Positive Observations

  • Add media

Opportunities for improvement

  • Add media

Actions completed at site

  • Add media

Agree future/corrective actions

  • Add media

General comments

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.