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:
- Date
- Time
- Location
- Name of Personnel
- Key Steps Required
- Inherent Risk Score
- Operational Controls
- Hierarchy of Risk Control
- Residual Risk Score
- Person Responsible for Monitoring
- Authorised by All Personnel
-
What are the significant hazards that have been identified with the works?
- Electrical
- Mechanical
- Acoustic
- Physical
- Potential
- Ergonomic
- Fire / Explosion
- Environmental
- Biological
- Chemical
- Psychological
- Radiation
-
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?
- On or Near Energised Electrical Installations <500mm
- Movement of Plant
- RIsk of Fall >2m
- Disturbing Asbestos
- Confined Space
- Excavation Work >1.5m Depth
- Hazardous Atmospheres
- On or Near Roads <3m
- On or Near Water
- Extreme Temperatures
-
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:
- LV Rescue Bag
- Electrically Insulated Gloves
- Cotton Inners
- Leather Outers w/ Wrist Strap
- Fire Blanket
- Trauma Dressing
- Torch w/ Batteries
- Insulated Crook
- Isolate Here Tag
- Insulated LV Mat
- Arc Rated Face Shield
-
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:
- Silicone
- Butane
- Epoxy Resin
- Unleaded Petrol
- Conduit Glue
- CRC 2.26
- Spray Gal
- Aerosol Paint
- Blaze Brake
- Sikaflex
- Cable Lubricant
- Cold Gal
-
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:
- Safety Glasses Clear
- Safety Glasses Tinted
- Cut Resistant Gloves EN 388 4543
- Glove Clip
- Safety Boots
- High Visibility Shirt
- Hard Hat
- Hearing Protection
- Leather Riggers Gloves
- First Aid Kit
- Wide Brim Hat
- Wide Brim for Hard Hat
- Sunscreen
- Face Shield
- P2 Respirator
- Coveralls
- Lock Out Tag Out Kit
- Photo ID Danger Tag
-
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