WH&S

• Document No.

• FSE Territory

• FSE Name And Code

• Conducted on

  Date
• Location
  Address

• Prepared by

1.0 ELECTRICAL

• 1.1 RCD (Residual Current Device) Available

  Yes

  No

  N/A

• 1.2 No Broken Plugs,Sockets or Damaged Leads

  Safe

  At Risk

  N/A

• 1.3 Testing and Tagging of Electrical Items

  Compliant

  Non-Compliant

  Needs Improvement

2.0 CHEMICALS

• 2.1 MSDS Register is Available and Up to Date

  Yes

  No

  N/A

• 2.2 Containers are Clearly and Accurately Labelled

  Yes

  No

  N/A

• 2.3 Unsuitable Storage Containers

  Safe

  At Risk

  N/A

3.0 FIRST AID KIT

• 3.1 First Aid Kit Adequately Stocked<br>

  Compliant

  Non-Compliant

  Needs Improvement

• 3.2 Easy Access to First Aid Kit

  Yes

  No

  N/A

• 3.3 No Contents Past Their Expiry Date

  Safe

  At Risk

  N/A

4.0 PERSONAL PROTECTIVE EQUIPMENT (PPE)

• 4.1 Safety Cones (min 3) Available

  Yes

  No

  N/A

• 4.2 Safety Gloves Available

  Yes

  No

  N/A

• 4.3 Dust mask /Respirator Available

  Yes

  No

  N/A

• 4.4 Safety goggles available

  Yes

  No

  N/A

• 4.5 Hearing protection available

  Yes

  No

  N/A

• 4.6 Safety shoes available (construction site only)

  Yes

  No

  N/A

• 4.7 Sunscreen

  Yes

  No

  N/A

• 4.8 Body Harness

  Yes

  No

  N/A

• 4.9 Safety Barriers/Signage

  Yes

  No

  N/A

5.0 Ladders

• 5.1 Are All Ladders Industrial Rated -150Kg

  Yes

  No

  N/A

• 5.2 Are All Ladders In Good Condition

  Yes

  No

  N/A

• 5.3 If Working Near Power Lines Are They Non Conductive (Wood/Fibreglass )

  Yes

  No

  N/A

• 5.4 Has FSE Completed Heights Training

  Yes

  No

  N/A

ADDITIONAL COMMENTS OR ACTIONS

• FSE Name & Code

  Sign

• FSO Name

  Sign