Information
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Client / Site
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Conducted on
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SITE ADDRESS AND AMBULANCE PICK UP POINT
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NAMES OF WORKERS USED FOR THIS TASK
- Mitch Batterham
- Mike CRAGG
- Jack Wagner
- Adam Hooper
- Garratt Hall
- Andrew Hooper
- Leon Reed
- Matt Dobson
- Matt Turner
- David Sims
- Allan Hall
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Names of workers not mentioned above
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NAME OF SUPERVISOR / LEADING HAND FOR THIS TASK
- Mitch Batterham
- Mike CRAGG
- Jack Wagner
- Adam Hooper
- Garratt Hall
- Andrew Hooper
- Leon Reed
- Matt Dobson
- Matt Turner
- David Sims
- Allan Hall
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NAME OF PERSON FILLING OUT THIS FORM
- Mitch Batterham
- Mike CRAGG
- Jack Wagner
- Adam Hooper
- Garratt Hall
- Andrew Hooper
- Leon Reed
- Matt Dobson
- Matt Turner
- David Sims
- Allan Hall
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CHOOSE OPTION FOR TASK BEING CARRIED OUT.
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ARE THERE ANY HAZARDS FOR REVIEW
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For hazards rated 5 and above choose best option
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Add photo of hazard here
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IS THERE ANY MAINTENANCE NEEDED
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Complete maintenance section of assessment
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TO BE COMPLETED FOR ALL WORK ON OUTDOOR ADVERTISING STRUCTURES. IF MORE THAN ONE SKIN IS TO BE INSTALLED AT A PARTICULAR SITE PLEASE TICK BOX HERE
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HAS EVERYONE READ, SIGNED AND UNDERSTOOD THE SWMS FOR THIS TASK
- YES
- NO
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CONSULT, READ AND SIGN SWMS IMMEDIATELY
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IS WEATHER SUITABLE FOR SAFE INSTALLATION?
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CAN USING EXTRA INSTALLERS ELIMINATE RISK
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IF ANSWER IS NO CHOOSE MOST SUITABLE OPTION
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DO YOU CONSIDER THE WORKPLACE IS SAFE TO WORK ON AND FROM
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IF RESPONSE IS NO DO NOT INSTALL
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INSERT PHOTO HERE
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CAN SKIN BE TRANSPORTED TO SITE SAFELY
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DO NOT INSTALL
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IS THERE SAFE PARKING AND ACCESS TO SITE?
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IF RESPONSE IS NO DO NOT INSTALL
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INSERT PHOTO OF ACCESS HAZARD HERE
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IS THE SITE COMPLETELY FREE FROM ELECTRICAL HAZARDS?
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IF ANSWER IS NO CHOOSE BEST OPTION TO ELIMINATE RISK
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INSERT ELECTRICAL HAZARD PHOTO HERE
FOR WORK WITH LADDERS
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CAN YOU PLACE LADDER ON EVEN GROUND
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IF ANSWER IS NO DO NOT INSTALL
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DO YOU USE FALL PROTECTION DEVICES?
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IF ANSWER IS NO DO NOT INSTALL
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ARE THERE LADDER LOCKS ON THE STRUCTURE?
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IF ANSWER IS NO PLEASE CHOOSE THE SAFEST OPTION
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CAN YOU MAINTAIN THREE POINTS OF ATTACHMENT AT ALL TIMES
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IF THE ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT
FOR WORK WITH EWP
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IS EWP OPERATOR LICENSED AND COMPETENT?
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IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT
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HAS EWP BEEN ASSESSED AND DEEMED SUITABLE FOR TASK?
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IF ANSWER IS NO DO NOT INSTALL AND REPORT TO MANAGEMENT
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IS EWP SETUP ON FIRM LEVEL GROUND?
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IF ANSWER IS NO CHOOSE BEST OPTION
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HAS EWP LOGBOOK BEEN FILLED OUT?
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FILL OUT LOGBOOK IMMEDIATELY
FOR WORK ON RAILWAYS
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DO ALL WORKERS HAVE TRACK ACCREDITATION?
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IS AN EXEMPTION IN PLACE FOR UNACCREDITED WORKER?
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IF UNACCREDITED WORKER DOES NOT HAVE A CURRENT EXEMPTION THEY MUST NOT ENTER RAIL RESERVE
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IS WPW15 PRESENT AND BOOKED ONTO TRACK
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IF ANSWER IS NO DO NOT ENTER RAIL RESERVE
MAINTENANCE
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CHOOSE TYPE OF MAINTENANCE NEEDED
- TRACKING REPLACE
- SWAGE TRACKING REPLACE
- RATCHET REPLACE
- BADGE REPLACE
- LANDSCAPING
- GRAFFITI
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OTHER MAINTENANCE
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ENTER MAINTENANCE PHOTO HERE
INSTALLER SIGN OFF
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ALL INSTALLERS TO ENTER PHOTO BELOW IN LIEU OF SIGNATURE. GROUP PHOTO IS ACCEPTABLE
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