Western Power OCSC PROJECT Work Practice/ Site Safety Assessment Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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

  Yes

  No

  N/A

• 1.2 Work signs erected & traffic management in position

  Yes

  No

  N/A

• 1.3 Pedestrian access & safety maintained correctly

  Yes

  No

  N/A

2. Documents

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

  Yes

  No

  N/A

• 2.2 ESSP, Work Practice and Safety Manual available

  Yes

  No

  N/A

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

  Yes

  No

  N/A

3. Personal & Height Safety

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

  Yes

  No

  N/A

• 3.2 EWP within test date

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 3.6 Fire extinguishers available, charged and within date

  Yes

  No

  N/A

4. Electrical

• 4.1HV minimum approach distances maintained

  Yes

  No

  N/A

• 4.2 Low voltage neutral position indentified & tagged

  Yes

  No

  N/A

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

  Yes

  No

  N/A

5. Equipment

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

6. Environment

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

  Yes

  No

  N/A

• 6.2 Public property respected and un damaged

  Yes

  No

  N/A

7. Service Connection & Testing

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

  Yes

  No

  N/A

• 7.2 Current Service Connection Test sheet procedure being followed

  Yes

  No

  N/A

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

  Yes

  No

  N/A

8. General

• 8.1 Safety Lifesavers ( State 3 relevant to task)

  Yes

  No

  N/A

• 8.2 Any environmentally sensitive areas clearly identified

  Yes

  No

  N/A

• 8.3 Soil erosion & disturbance of Flora/fauna controlled

  Yes

  No

  N/A

Site Drawing /Site Photo

• Add a Site Drawing Here

  Drawing

• Add site photo here

  Media

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

  Sign

• Person conducting the assessment

  Sign

• Select date

  Date

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