Watertech Safety Environmental Site Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Project

• Client

• Contract Number

• Contractor or Crew

  Contractor

  Crew

• Name of Contractor or Crew

• Date

  Date

• Persons in attendance

Vehicle/Plant

• Vehicle Registration or ID No

• Plant/vehicle operator licensed?

  Yes

  No

  N/A

• Driver or Operators name

• Class of Licence

• Visual inspection of plant. Do the following elements seem to be in good condition?

• Tyres

  Yes

  No

  N/A

• Headlights

  Yes

  No

  N/A

• Indicators

  Yes

  No

  N/A

• Tail lights

  Yes

  No

  N/A

• Brake lights

  Yes

  No

  N/A

• Horn Working

  Yes

  No

  N/A

• Windscreen

  Yes

  No

  N/A

• Windows

  Yes

  No

  N/A

• Bodywork

  Yes

  No

  N/A

• Hydraulics

  Yes

  No

  N/A

• Towing mechanism secure

  Yes

  No

  N/A

• Is cabin in neat a tidy?

  Yes

  No

  N/A

• Is there a spare tyre and jack for this unit?

  Yes

  No

  N/A

• DANGER notice attached and clearly visible to operator?

  Yes

  No

  N/A

• CAUTION notice attached and clearly visible to operator?

  Yes

  No

  N/A

• Is there safe access onto or into the vehicle? (steps, ladder, etc.)

  Yes

  No

  N/A

• Has Log book for Truck Mounted Crane been completed for the day?

  Yes

  No

  N/A

• Is the work area of the vehicle clean and tidy and equipment stored correctly?

  Yes

  No

  N/A

• Does this plant tow a compressor/Trailer?

  Yes

  No

  N/A

• Registration Number

• Visual inspection of plant. Do the following elements seem to be in good condition?

• Tyres

  Yes

  No

  N/A

• Indicators

  Yes

  No

  N/A

• Tail lights

  Yes

  No

  N/A

• Brake lights

  Yes

  No

  N/A

• Towing mechanism secure

  Yes

  No

  N/A

• Comments

Comment

• Comment

• Hard hats worn correctly at all times (and within 3 years from date of manufacture)?

  Yes

  No

  N/A

• Appropriate safety glasses or face shields worn when necessary?

  Yes

  No

  N/A

• Are the appropriate respirators/filters being used when necessary?

  Yes

  No

  N/A

• Gloves worn when required?

  Yes

  No

  N/A

• Correct safety footwear worn – steel capped boots?

  Yes

  No

  N/A

• Earmuffs or ear plugs worn when required?

  Yes

  No

  N/A

• Safety vest / High visibility shirts worn and in good condition?

  Yes

  No

  N/A

• Comments

Comment

• Comment

• Has a daily risk and hazard assessment been completed prior to starting work (HIdRA)?

  Yes

  No

  N/A

• Have all employees or visitors signed the daily risk and hazards assessment sheet (HIdRA)?

  Yes

  No

  N/A

• Has the daily risk and hazard sheet been completed correctly?

  Yes

  No

  N/A

• Overhead hazards identified and managed?

  Yes

  No

  N/A

• Traffic Conditions managed?

  Yes

  No

  N/A

• Location specific hazards managed? (school, shopping centre, steep incline)

  Yes

  No

  N/A

• Are bush fire safety measure in place?

  Yes

  No

  N/A

• Site specific environmental issues identified?

  Yes

  No

  N/A

• Is there a controlled, approved and current copy of the Safety Management Plan on site (in the PMP)?

  Yes

  No

  N/A

• Is there a controlled and current copy of Safe Work Method Statements relevant to the process on site?

  Yes

  No

  N/A

• Are there any issues on this site that are not identified in the Safe Work Method Statements?

  Yes

  No

  N/A
Issue

• Issue Name

• Action Required?

• Action to be completed by

  Date

• Responsible

• Action completed

  Yes

  No

• Are there Material Safety Data Sheets for all chemicals on site?

  Yes

  No

  N/A

• Name of MSDS

MSDS

• Name of MSDS

• Are all Material Safety Data Sheets within 5 years of issue date?

  Yes

  No

  N/A

• Name of MSDS

MSDS

• Name of MSDS

• Date of issue

  Date

• Do any of the Material Safety Data Sheet need to be reissued? List below:

  Yes

  No

  N/A

• Name of MSDS

MSDS

• Name of MSDS

• Are all personnel inducted to this Contract?

  Yes

  No

  N/A

• Are personnel carrying identification tags which are in reasonable condition?

  Yes

  No

  N/A

• First aid kits readily available, fully stocked and replenished within the last 12 months?

  Yes

  No

  N/A
First aid kit

• Date of last replenishment (must be within last 12 months)

  Date

• Is there a fire extinguish on vehicle and is it operational and within tagged service date?

  Yes

  No

  N/A
Fire Extinguisher

• Fire Extinguisher

• Tagged service date

  Date

• Is the security pin in the fire extinguisher secured?

  Yes

  No

  N/A

• Suitable access to extinguisher around work site?

  Yes

  No

  N/A

• Is there adequate lighting around the work site?

  Yes

  No

  N/A

• Are hand tools in good condition?

  Yes

  No

  N/A

• Are air hoses in good condition i.e. free of ruptures or damage?

  Yes

  No

  N/A

• Are the air hose connections secured with safety pins?

  Yes

  No

  N/A

• Are all hoses clear of roadways/foot paths?

  Yes

  No

  N/A

• If hoses are running across the roadway is there a person monitoring the hose?

  Yes

  No

  N/A

• Are Fuel containers labelled appropriately according to their contents?

  Yes

  No

  N/A

• Are fuel containers stored in the appropriate container (150% of Volume)?

  Yes

  No

  N/A

• Are the fibreglass push rods in satisfactory condition?

  Yes

  No

  N/A

• Comments

Comment

• Enter comment

• Are Sub Contractors being used on this site?

Sub Contractor

• Sub Contractor Name

• Has the sub-contractor been approved to work on site?

  Yes

  No

  N/A

• Has the client been notified of the works via the daily forecast?

  Yes

  No

  N/A

• Does the subcontractor need an Authority to work permit?

  Yes

  No

  N/A

• Is the Authority to Work Permit on site?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• What is the Authority to Work Permit No

• Has gas monitor been response tested and recorded on the appropriate documentation?

  Yes

  No

  N/A

• Serial number of Gas Detector

• Calibration Due Date:

  Date

• YOU MAY NOT USE THE EQUIPMENT IF THE CALIBRATION DUE DATE HAS PASSED

• Has testing of maintenance hole been recorded on Confined Space Entry Permit (QF 053) or the Hazard Identification Risk Assessment (HIdRA)?

  Yes

  No

  N/A

• CREW MEMBERS MUST NOT ENTER A CONFINED SPACE WITHOUT A VALID, CURRENT CERTIFICATE

• Confined Space tickets for all crew members

Member

• Name

• Certificate No

• Expiry Date

  Date

• Standby person Confined Space trained?

  Yes

  No

  N/A

• Who is the nominated person for Confined Space Entry?

• Who is the nominated person for Standby Duties?

• Are correct confined space procedures being followed?

  Yes

  No

  N/A

• Has the Confined Space Entry Permit (QF 053) been completed?

  Yes

  No

  N/A

• Confined Space Entry Permit Number

• Are all chemicals used in confined spaces, listed on the Confined Space Entry Permit?

  Yes

  No

  N/A

• Are all applicable sections addressed by either a tick or N/A?

  Yes

  No

  N/A

• Has the responsible person signed off where required?

  Yes

  No

  N/A

• Name of responsible person

• Is there an approved tripod on site?

  Yes

  No

  N/A

• Is the Tripod engraved with an ID number?

  Yes

  No

  N/A

• Tripod ID No

• Is the tripod fully extended?

  Yes

  No

  N/A

• Is there an full parachute type harness on site?

Harness

• Is the harness in good condition?

  Yes

  No

  N/A

• Harness Serial No

• Is there an air rescuer on site and within its 10 year date?

Air Rescuer ID No

• Air Rescuer ID No

• Expiry Date

  Date

• Is there a grate covering unattended maintenance hole?

  Yes

  No

  N/A

• Is the “Confined Space Entry By Permit Only” sign displayed?

  Yes

  No

  N/A

• Comments

Comment

• Comment

CIVIL WORKS

• Are Civil works required?

  Yes

  No

  N/A

• Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• Is there Dial-Before-You-Dig information on site?

  Yes

  No

  N/A

• What is the Job number on the Dial Before You Dig Job caller confirmation sheet?

• Has a Dig/Cut Permit (QF 137) been completed?

  Yes

  No

  N/A

• Has a Trench Inspection and Authorisation Checklist (QF042) been completed and appropriate measures been implemented?

  Yes

  No

  N/A

• Has a Confined Space Entry Permit (QF053) been completed?

  Yes

  No

  N/A

• Have precautions been taken to positively identify and locate the position of any underground services, before excavation has started?

  Yes

  No

  N/A

• Has work area been barricaded, bollards placed and sign posted to warn resident or Pedestrians of potential hazards?

  Yes

  No

  N/A

• Barriers around the trench? (at least 1.2m in height)

  Yes

  No

  N/A

• Has trench/excavation been identified as a confined space?

  Yes

  No

  N/A

• Is there a escape/access route in place e.g. ladder?

  Yes

  No

  N/A

• Is there a gas monitor in position?

  Yes

  No

  N/A

• Is the self rescuer within reach?

  Yes

  No

  N/A

• Trenches 1.5m or more in depth - correctly shored or battered?

  Yes

  No

  N/A

• Edge of trench clear of spoil? (minimum 1000mm)

  Yes

  No

  N/A

• Correct techniques being used when lowering items into trench?

  Yes

  No

  N/A

• Persons in trench clear when items are being lowered?

  Yes

  No

  N/A

• Ladders used are adequate and in good condition?

  Yes

  No

  N/A

• Ladders in trench secured correctly, 900mm above trench lip and correct angle?

  Yes

  No

  N/A

• Comments

Comment

• Comment

EX WORKS

• Are EX works required?

  Yes

  No

  N/A

• Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• Has a Hot Work Permit been completed to work Instruction (WI012)?

  Yes

  No

  N/A

• Have employees been provided with and are wearing the appropriate PPE for this process?

  Yes

  No

  N/A

• Leather gloves?

  Yes

  No

  N/A

• Eye protection?

  Yes

  No

  N/A

• Leather Arm Guards and Boot Covers?

  Yes

  No

  N/A

• Dust mask/respirator?

  Yes

  No

  N/A

• Is there a current boiler inspection certificate on the truck?

  Yes

  No

  N/A

• Certificate expiry date

  Date

• Does the stand pipe have a backflow prevention device attached?

  Yes

  No

  N/A

• Is there a current certificate for the backflow prevention device

  Yes

  No

  N/A

• Backflow prevention device certificate expiry date

  Date

• Are steam hoses in satisfactory condition?

  Yes

  No

  N/A

• Winch Truck?

  Yes

  No

  N/A

• Tray greased?

  Yes

  No

  N/A

• Truck crane free of leaks?

  Yes

  No

  N/A
Comments

• Comment

TIGER TEES/PATCHING

• Are you installing Tiger Tees or Patching?

  Yes

  No

  N/A

• Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• Persons been instructed on the work instructions for this process?

  Yes

  No

  N/A

• Are employees or the public protected from the winch when it is able to start?

  Yes

  No

  N/A

• Have employees been provided with the appropriate P.P.E for this process?

  Yes

  No

  N/A

• Respirator mask?

  Yes

  No

  N/A

• Inorganic filters A1, B1, E1, P3 survivor?

  Yes

  No

  N/A

• Full face shield?

  Yes

  No

  N/A

• Rubber apron?

  Yes

  No

  N/A

• Are resin containers correctly labelled?

  Yes

  No

  N/A

• Is quality QF063 Camera Ipex, Equipment Gas recording register being completed?

  Yes

  No

  N/A

• Comments

Comment

CCTV/JETTING

• Are you operating CCTV or undertaking Jetting work?

  Yes

  No

  N/A

• Have the Safe Work Method Statements been identified for this process?

  Yes

  No

  N/A

• Have employees been instructed into Work Instruction WI 034 High Pressure Water Jetting Mainlines?

  Yes

  No

  N/A

• And Safe Work Method Statement WMS 003 Clean & CCTV sewer Conduit?

  Yes

  No

  N/A

• Is the jetter hose in good condition?

  Yes

  No

  N/A

• Access to the vehicle acceptable?

  Yes

  No

  N/A

• Is there a 110mm gap to prevent backflow from the jetter reservoir?

  Yes

  No

  N/A

• Is there a backflow prevention device on the Stand pipe?

  Yes

  No

  N/A

• Is there a current certificate for the backflow prevention device?

  Yes

  No

  N/A

• Certificate expiry date

  Date

• Is quality QF063 Camera Ipex, Equipment Gas recording register being completed?

  Yes

  No

  N/A

• Comments

Comment

• Comment

• Is Traffic Control necessary?

  Yes

  No

  N/A

• Is there an approved traffic control plan in use?

  Yes

  No

  N/A

• Traffic Control Plan number

• Are advisory signs as per Traffic Control Plan selected?

  Yes

  No

  N/A

• Is there a requirement for traffic controllers?

  Yes

  No

  N/A

• Does the traffic controller have a current traffic controllers certificate?

  Yes

  No

  N/A

• Name of person with Traffic Control Certificate

• Certificate expiry date

  Date

• Is there a requirement for an External certified Traffic Control agency?

  Yes

  No

  N/A

• Does the certified traffic control agency have an approved traffic management plan approved by the NSW/QLD/VIC Roads or Council on site?

  Yes

  No

  N/A

• Has a representative of Abergeldie Watertech sighted the traffic control plan?

  Yes

  No

  N/A

• Sufficient advisory signs used and correctly placed?

  Yes

  No

  N/A

• Is the access around the worksite, safe for the public?

  Yes

  No

  N/A

• Is there a NSW/QLD/VIC card holder on site (RIIOHS302A Implement Traffic Management Plan or Apply)?

  Yes

  No

  N/A

• Name

• Card No

• Is there a NSW/QLD/VIC card holder on site to Control Traffic with stop-slow bat)?

  Yes

  No

  N/A

• Name

• Card No

• Is there a current NSW/QLD/VIC Roads ROL on site?

  Yes

  No

  N/A

• ROL No

• Is there a current Speed Reduction in place?

  Yes

  No

  N/A

• Speed Reduction Certificate No

• Is there a current Council Permit or written Authorisation on site?

  Yes

  No

  N/A

• Is there a current approved Police Permit on site?

  Yes

  No

  N/A

• Are all Traffic Controllers correctly situated?

  Yes

  No

  N/A

• Are Traffic Controllers wearing high vis vest or night overalls?

  Yes

  No

  N/A

• Do Traffic Controllers have escape routes?

  Yes

  No

  N/A

• Are there Night Wands on site if required?

  Yes

  No

  N/A

• Are pedestrians and cyclist considered and adequately managed?

  Yes

  No

  N/A

• Are pedestrian managers required at site?

  Yes

  No

  N/A

• Are beacons and arrow boards on Traffic Control vehicles functioning correctly?

  Yes

  No

  N/A

• Comments

Comment

• Comment https://app.safetyculture.io/#/iauditor/templates/template_fdd880fa1de644a0af0dea0abe4249f1

SIGNAGE

• Click here for examples of signs
  https://www.dropbox.com/s/bspkh2ikw5dj329/Signage180117.docx?dl=0

• Are Multi signs available?

  Yes

  No

  N/A

• What signs are erected on the multi signs?

• 2 X “Pedestrians Watch Your Step” signs?

  Yes

  No

  N/A

• 2 X “Part Road Closed” Signs?

  Yes

  No

  N/A

• 4 X "Dig Man Ahead" signs?

  Yes

  No

  N/A

• 2 X Chevron signs - Left & Right?

  Yes

  No

  N/A

• Is there a Clients information sign on site?

  Yes

  No

  N/A

• Is there a “Confined Space - Entry By Permit Only” sign?

  Yes

  No

  N/A

• Is signage in good condition?

  Yes

  No

  N/A

SCAFFOLDING

• Is scaffolding being used on this site?

Scaffold

• Location

• Is the scaffold under 4mtrs high?

  Yes

  No

  N/A

• Who erected the scaffolding?

• Certificate Number

• Is scaffold secure and stable

  Yes

  No

  N/A

• Are there the required top and mid handrails attached? (after 1.8 metres)

  Yes

  No

  N/A

• Is the working platform fully decked?

  Yes

  No

  N/A

• Are guard rails and toe boards fitted?

  Yes

  No

  N/A

• Comments

Comment

• Comment

SLINGS

• Are slings being used?

Sling

• Persons slinging loads competent?

  Yes

  No

  N/A

• Correct slings used and in good condition?

  Yes

  No

  N/A

• Is a lead rope used to control loads where necessary?

  Yes

  No

  N/A

• Comments

Comment

• Comment

HOUSKEEPING

• Work area tidy and materials stored properly?

  Yes

  No

  N/A

• Have steam hoses been checked for leaks?

  Yes

  No

  N/A

• Noise requirements being adhered to?

  Yes

  No

  N/A

• All rubbish and cigarette butts removed from site?

  Yes

  No

  N/A

• Are bins being used?

  Yes

  No

  N/A

• Are start times being adhered to? No work prior to 7:00am?

  Yes

  No

  N/A

• Are the steal fittings covered to eliminate burns?

  Yes

  No

  N/A

• Comments

Comment

• Comment

• Is there a controlled, approved and current copy of the Abergelide Watertech Construction Environmental Management Plan on site?

  Yes

  No

  N/A

• Are there adequate erosion and sediment controls in place?

  Yes

  No

  N/A

• Controls

Control

• Control

• Are the adequate controls to minimise contamination of surface water or uncontrolled discharges from sewer system?

  Yes

  No

  N/A

• Controls

Control

• Controls

• Are adequate controls in place to protect Flora, Fauna or communities?

  Yes

  No

  N/A

• Controls

Control

• Control

• Are there adequate air quality controls in place such as odours or dust that could impact on nearby residents?

  Yes

  No

  N/A

• Controls

Control

• Control

• Are there adequate controls to manage noise levels?

  Yes

  No

  N/A

• Controls

Control

• Control

• Has the site be inspected for potential indigenous and non indigenous heritage?

  Yes

  No

  N/A

• Are employees aware of what is required when during the work process if they discover any indigenous and non indigenous heritage items?

  Yes

  No

  N/A

• Are there controls in place to manage handling and storage of waste products?

  Yes

  No

  N/A

• Controls

Control

• Control

• Are chemicals on site contained within a suitable container that can hold 150% of the chemical or fuels?

  Yes

  No

  N/A

• Comments

Comment

• Comment

• Are there any issues?

Issue

• Issue Name

• Action required

• Responsible

• Action to be completed by

  Date

• Action Completed?

  Yes

  No

  N/A

• Have all non-compliances identified by this inspection been discussed with the person in charge?

  Yes

  No

  N/A

• Does the person in charge understand what must be done to correct the non-compliance?

  Yes

  No

• Click to add comments

Comment

• Inspector

  Sign

• Date & Time

  Date

• Person in charge

  Sign

• Date & Time

  Date