Working In, On, Over or Adjacent to Water

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Can the work wait until the water level drops below 1.0m?

  Yes

  No

  N/A

• Is the water less than 1.0m deep?

  Yes

  No

  N/A

• There is safe access/egress to the water?

  Yes

  No

  N/A

• Workers will use the buddy system or be fully supervised?

  Yes

  No

  N/A

• The water is clear of submerged hazards i.e. rocks

  Yes

  No

  N/A

• The water temperature will not cause hypothermia?

  Yes

  No

  N/A

• Is there edge protection?

  Yes

  No

  N/A

• Have potential electrical hazards been removed from the work zone to eliminate possibility of electrocution?

  Yes

  No

  N/A

• For working over water has the fall risk been considered and appropriate fall protection systems used in combination with lifejackets or PFDs?

  Yes

  No

  N/A

• Are life jackets and PFDs have a current inspection / thorough examination by a competent person and recorded on the AF4?

  Yes

  No

  N/A

• Are life jackets correctly fitted?

  Yes

  No

  N/A

• There is no risk of working at heights?

  Yes

  No

  N/A

• The structure/bank/work platform is stable, sufficient for the task and not subject to erosion or collapse?

  Yes

  No

  N/A

• The work area does incorporate slopes greater than 1:4?

  Yes

  No

  N/A

• There are no trip hazards?

  Yes

  No

  N/A

• There is no risk that other people or works being completed in the area could affect the task being performed?

  Yes

  No

  N/A

• There is no risk of being pushed into the water?

  Yes

  No

  N/A

• There is a practical timeframe for completion of the task being performed?

  Yes

  No

  N/A

• The tools and equipment are appropriate and fit for purpose regarding their intended use?

  Yes

  No

  N/A

• The means for carrying tools, equipment and samples if both hands are required for access/egress has been appropriately addressed?

  Yes

  No

  N/A

• All special notifications and/or permits have been obtained?

  Yes

  No

  N/A

• All workers are wearing appropriate task specific PPE?

  Yes

  No

  N/A

• A PFD is being used by all personnel working with 1.5m of a water's edge?

  Yes

  No

  N/A

• Adequate lighting and communication devices agreed upon and fit for purpose?

  Yes

  No

  N/A

• Emergency rescue equipment is available. Possible devices included life rings, throw ropes, pole and hooks?

  Yes

  No

  N/A

• Weather conditions including wind and temperature have been considered?

  Yes

  No

  N/A

• The task is not affected by flowing water or mud depths likely to cause sinking or slippage?

  Yes

  No

  N/A

• There is no possibility of surging water or swift currents?

  Yes

  No

  N/A

• There is no possibility of a worker becoming stranded or marooned?

  Yes

  No

  N/A

• All workers required to perform the task on, in, over or adjacent to the water can swim?

  Yes

  No

  N/A

Inspection Team

• Inspection Team

• Signature

  Sign