Date and Time of Inspection

Site/Weather conditions

Plant on site

No. of personnel

Tasks being performed


General Site Photos

Have all workers been inducted to site (if not why not?)

Have all workers been inducted to their JSA ( if not why not ?)

Are relevant JSAs being followed

Is There a Fully Stocked First Aid Kit

Potential HAZARDS on Site

1. Airborne contaminants (gases, dust, sparks, fumes - ventilation, safety eyewear.)

2. Biological hazards (people, flora & fauna).

3. Chemicals ( MSDS, workers instructed, PPE, storage containment)

4. Dangerous goods ( flammables, prescribed wastes, corrosives - storage, handling)

5. Electricity ( ELCBs, elevated from damage and water - tested and tagged - RGBY)

6. Gravity ( fall prevention - from height, same level, down shafts)

7. Mechanical ( Pre- start checklist, leaks/spills, guarding , etc. )

8. Microbiological ( contact with bacteria - skin, breathing protection)

9.Musculoskeletal ( push, pull, hold, restrain, lift, lower- systems, mech. Assistance )

10. Noise ( plant or process - prefer block at source or pathway, then receiver)

11. Pressure ( hydraulics, pneumatics, springs, leaks/spills).

12. Psychosocial ( harassment, bullying , co-operation, compliance)

13. Radiation ( UV, welding, X- rays - protection for workers and passers-by )

14. Thermal ( excess heat, cold, Fire Fighting Equipment available and maintained)

15. Vibration ( whole or part body )

16. Water Quality ( sediment, discharge, groundwater )

17. Cultural heritage ( EMP, induction, etc ).


Confined Space

Working at Height

Chemical Spill

Overhead or underground power

Fire / Explosion

Special permits ( e.g. Confined space, hot work, near power or other services) If yes please list permit name.


Any written confirmations issued? If yes list numbers below.

Any infringements issued? If yes list numbers below.

Wannon Water Officer name :

Wannon Water Officer signature:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.