Title Page

  • Audit Title

  • Client / Site

  • Conducted on

  • Location
  • Prepared by

  • Personnel

Scope of Works

  • Current scope of works being performed:

  • ICP Project Number:

  • Customer Reference Number:

Operational Control

  • Has a documented Risk Assessment been conducted for the works undertaken?

  • Have all relevant team members had input into the risk assessment process?

  • Capture image of the Risk Assessment including sign on evidence

  • Does the risk assessment contain the following:

  • What are the significant hazards that have been identified with the works?

  • Detail any other additional hazards identified:

  • Has the Risk Assessment successfully identified all of the significant hazards associated with the works?

  • Detail 3 significant operational controls required to perform the task safely:

  • Can the auditee demonstrate effective implementation the the operational controls?

  • Have inherent and residual risk scores been calculated correctly?

Site Specific WHSEQ Plan

  • Is the value of the works in excess of $250,000 (Section 292 Work Health Regulation 2011)

  • Is Yes, is a Site Specific WHSEQ Plan available for inspection?

  • Have all Team Members onsite signed on the Site Specific WHSEQ Plan?

  • Have all Team Members completed all required inductions?

High Risk Construction Activities

  • Are any of the following High Risk Construction Activities being undertaken?

  • Are Safe Work Method Statements available for all High Risk Construction Activities?

  • Have all SWMS been authorised by the ICP Site Supervisor?

  • Have all Team Members signed onto the SWMS?

Electrical Safety

  • Is suitably calibrated electrical testing equipment available for use?

  • Capture image of calibration evidence

  • Is a fully stocked LV Rescue Kit available for use?

  • Nominate the following items available in the LV Rescue Kit:

  • Have any isolations been performed to complete the works

  • Does the isolation contain the following required elements:

  • Check 3 Electrical Cords for evidence of Testing & Tagging

  • Capture image of completed Test Tags

  • Have all required Electrical Tests been performed on the electrical installation / equipment?

  • Are test records available for inspection as evidence of completion of required testing?

  • Has a completed Certificate of Testing & Compliance been issued to the customer upon completion of works?<br>(verification that the works are electrically safe)<br>

Working at Heights Equipment

  • Is there evidence of inspection available for all working at height equipment? <br>(6 months re-test frequency)

  • Is unsuitable equipment clearly tagged "Out of Service"?

Hazardous Chemicals

  • Are any of the following Hazardous Chemicals being used onsite:

  • Additional Hazardous Chemicals:

  • Is a SDS available for inspection for all hazardous chemicals onsite?<br>(reviewed within 5 years)

  • Has a risk assessment been conducted for the use of the Hazardous Chemicals?

  • Are all Hazardous Chemicals stored appropriately?

Incident Reporting

  • Have there been any Near Misses onsite?

  • Have there been any Incidents onsite?

  • Have Incident Reports been completed where required?

  • Detail any corrective actions required to be undertaken in response to any incidents:

  • Is there evidence of the corrective actions being undertaken?

Environmental Impact

  • Is storm water contamination being effectively managed?

  • Has all recyclable waste been segregated apprpriately?

  • Are all noise generation restrictions being enforced correctly?

Public Protection

  • Is access to the site effectively controlled?

  • Is suitable barricading, signage and hoarding in place to deliniate work area?

  • Is the lighting in the work area adequate?

  • Are designated walkways free of obstruction?

Emergency Preparedness

  • Is there a first aid kit located as close as practicable to the work area?

  • Are all the items in the first aid kit in date?

  • Capture image of first aid kit expiration date:

  • Name of the Qualified First Aider onsite:

  • What is the location of the emergency evacuation point:

  • Do all personnel know the location of the emergency evacuation point?

Personal Protective Equipment

  • Nominate items of PPE available:

  • Do all Team Members have the required mandatory PPE items?

  • Is the PPE fit for purpose and in good condition?

  • Are any other addtional PPE items required?

Audit Report Authorisation

  • I agree that the findings raised in this report are factual, accurate, fair & reasonable:

  • Auditor

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