• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work Requisition#

  • Work Requisition Number Here

Team Members & Team Leaders

  • List names here

Site Safety & Traffic Management

  • 1.1 Worksite clearly identifiable before reaching site

  • 1.2 Work signs erected & traffic management in position

  • 1.3 Pedestrian access & safety maintained correctly

2. Documents

  • 2.1 Task specific authorisation cards available on request (e.g NAC, blue/white card, high risk & traffic management).

  • 2.2 ESSP, Work Practice and Safety Manual available

  • 2.3 JRA complete with all site hazards identified & signed by everyone on site.

3. Personal & Height Safety

  • 3.1 Appropriate approved PPE & PPC worn for task being undertaken

  • 3.2 EWP within test date

  • 3.3 Safety Observer appointed and present when the EWP is in use

  • 3.4 Approved safety harness, lanyard/pole strap used correctly & within test date & in good condition

  • 3.5 First aid kit available on site (easy to access in an emergency)

  • 3.6 Fire extinguishers available, charged and within date

4. Electrical

  • 4.1HV minimum approach distances maintained

  • 4.2 Low voltage neutral position indentified & tagged

  • 4.3 Approved LV Covers/Barriers used & applied to all second points of contact

5. Equipment

  • 5.1 Tools and equipment in use are appropriate for the task

  • 5.2 Ladders/Step ladders are in good condition & within test date

6. Environment

  • 6.1 Worksite left in a safe condition with all rubbish/materials removed

  • 6.2 Public property respected and un damaged

7. Service Connection & Testing

  • 7.1 Metrel tester & electrical equipment in good condition & within test date.

  • 7.2 Current Service Connection Test sheet procedure being followed

  • 7.3 Witness present when carrying out SCT (prep & commissioning) & communicating with the tester

8. General

  • 8.1 Safety Lifesavers ( State 3 relevant to task)

  • 8.2 Any environmentally sensitive areas clearly identified

  • 8.3 Soil erosion & disturbance of Flora/fauna controlled

Site Drawing /Site Photo

  • Add a Site Drawing Here

  • Add site photo here

Follow up Actions by Who and When !

  • Action to be undertaken

General Comments and Team Feedback

  • Add Comments Here!

Sign Offs

  • Person in control of the worksite

  • Person conducting the assessment

  • Select date

Note* This is an IPad version of form DM#8237490

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.