Information
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Job No.
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Client / Site
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Time and Date
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Prepared by
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Location
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Personnel
Housekeeping, Materials , Trade and Public Safety
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Is the site in a clean condition?
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Access to your work area is safe and clear ?
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Are all materials stacked safely ?
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Is there a toilet on site ?
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Are we safe from falling objects ?
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Have safety barrier / cone been set up ?
Electrical Equipment
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All my equipment has been tagged
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Residential current devices are in use
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Leads are away from water and over access ways
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Circuits to be isolated, tested & tagged
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All appliances have been maintained
Ladders
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Ladders are tied in
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Ladders are at the corrent angle (1:4)
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Ladders extend 900mm above area being accessed
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Ladders have been maintained
Personal Protective Equpiment
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Safety Helmets
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Safety Footwear
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Eye Protectuon
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Ear Protection
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Hi Vis workwear
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Sun hats, cream & sun glasses
Scaffolding / EWP / Cage
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Is there a completion certificate / log book?
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Are there kickboards in place?
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Are there ladders at all entries?
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Training and Qualification
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I have been inducted for this site?
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I have general induction training for construction?
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I am in possession of all required qualifications?
Additional Information
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Location:
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Hazard:
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Action/control measure:
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The above site has been inspected for possible hazards and it was found that our standard Safe Work Statement indicates the general risks and control measures required. Any other hazards and control measures specific to this site, as indicated indicated in the above check list or observed during our assessment, are as listed.
Assessed By
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Name:
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Date:
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Signed:
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I declare that we assessed this site in accordance with W.H.S requirements and deem the work safe to proceed and all hazards eliminated or controlled responsibly. All our employees or contractors have been involved in this assessment and advised of safe work procedures for this site. All employees or contractors have also signed.
Additional Workers
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Name:
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Date:
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Signed:
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Name:
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Date:
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Signed:
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Name:
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Date:
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Signed:
