Section 1: Site Induction / Toolbox
1. 1. Has a site induction/toolbox talk been conducted and signed by all personnel involved in the task?
Yes
No
N/A
Section 2: Daily Risk Assessment
1. 1. Is the Risk Assessment available on site?
Yes
No
N/A
2. 2. Is it site specific?
Yes
No
N/A
3. 3. Is it completed correctly for the worksite?
Yes
No
N/A
4. 4. Has it been signed & dated each day?
Yes
No
N/A
5. 5. Does it address pedestrian safety?
Yes
No
N/A
6. 6. Does it address vehicle safety?
Yes
No
N/A
7. 7. Does it address plant safety?
Yes
No
N/A
8. 8. If Dangerous Goods are in use, are there adequate safety controls in place?
Yes
No
N/A
9. 9. Is the Supervisor nominated?
Yes
No
N/A
10. 10. Is the First Aider nominated?
Yes
No
N/A
11. 11. Is the muster point nominated and is it suitable?
Yes
No
N/A
12. 12. Are environmental considerations addressed?
Yes
No
N/A
13. 13. Are all nominated controls in place?
Yes
No
N/A
14. 14. Are all nominated controls effective?
Yes
No
N/A
Section 3: Safe Work Method Statement
1. 1. Is there a SWMS available on site?
Yes
No
N/A
2. 2. Is it site specific?
Yes
No
N/A
3. 3. Does it address all tasks & associated hazards?
Yes
No
N/A
4. 4. Have the non relevant steps been crossed out?
Yes
No
N/A
5. 5. Have the relevant legislation/standards/codes of practice been highlighted?
Yes
No
N/A
6. 6. Have the relevant work instructions/forms/risk assessments been identified?
Yes
No
N/A
7. 7. Are the relevant work instructions/forms/risk assessments on site?
Yes
No
N/A
8. 8. Does the workforce have the necessary training?
Yes
No
N/A
9. 9. Has plant and equipment been identified?
Yes
No
N/A
10. 10. Have environmental considerations been addressed?
Yes
No
N/A
11. 11. Has the SWMS been signed by all personnel involved in the task?
Yes
No
N/A
12. 12. Are all required controls in place?
Yes
No
N/A
13. 13. Are all required controls effective?
Yes
No
N/A
Section 4: Licences/Authorities
1. 1. Are all plant operators licensed or authorised to operate the equipment?
Yes
No
N/A
2. 2. Have all personnel relevant State OHS Induction?
Yes
No
N/A
3. 3. Are Personnel Authorised by the Authority/Client?
Yes
No
N/A
Section 5: Forms/Documentation
1. 1. Is there a copy of the Management plan on site?
Yes
No
N/A
2. 2. Is a PowerServe contact details sign displayed?
Yes
No
N/A
3. 3. Is the job file available on site?
Yes
No
N/A
4. 4. Is there a certified/current Drawing on site?
Yes
No
N/A
5. 5. Is there a job Specification on site?
Yes
No
N/A
6. 6. Are the Authority’s Safety Rules available?
Yes
No
N/A
Section 6: Work/Access Permits
1. 1. Is an appropriate permit on issue for this work?
Yes
No
N/A
2. 2. Are all permit recipients authorised?
Yes
No
N/A
3. 3. Are DBYD’s and/or Excavation Permits complete and on-site and have all overhead and underground services been identified?
Yes
No
N/A
4. 4. If applicable, is a State Roads permit onsite and current?
Yes
No
N/A
5. 5. If applicable, is a council permit onsite and current?
Yes
No
N/A
Section 7: Manual Handling
1. 1. Have the manual handling hazards been identified?
Yes
No
N/A
2. 2. Are manual handling aids available?
Yes
No
N/A
Section 8: Personal Protective Equipment (PPE)
1. 1. PPE as per Daily Risk Assessment
Yes
No
N/A
2. 2. Are all safety harnesses & lanyards within their test date range? (Every 3 Months) and tagged. (Red – Jan to Mar, Green – Apr to Jun, Blue – Jul to Sep, Yellow - Oct to Dec Power only)
Yes
No
N/A
3. 3. Is other safety apparel in good condition?
Yes
No
N/A
Section 9: Tools/Equipment
1. 1. Are all electrical tools within their test date range and tagged? (As per state requirements)
Yes
No
N/A
2. 2. Check the following Equipment for condition, compliance and tagging:- Ladders (every 3 mths)
Yes
No
N/A
3. 3. Calibrated Test equipment within test date?
Yes
No
N/A
4. 4. Gas Bottles (10 Years)
Yes
No
N/A
5. 5. Lifting equipment (Slings & chains) (every 3 months) (Red – Jan to Mar, Green – Apr to Jun, Blue – Jul to Sep, Yellow - Oct to Dec Power only)
Yes
No
N/A
Section 10: First Aid And Emergency Contacts
1. 1. Is there a stocked First Aid kit available on site and is it in date and accessible?
Yes
No
N/A
2. 2. Are the First Aid requirements adequate?
Yes
No
N/A
3. 3. Are there emergency contact details available?
Yes
No
N/A
4. 4. Is there emergency communication available?
Yes
No
N/A
Section 11: Traffic/Pedestrian Management
1. 1. If required, is there a traffic management plan in use and a copy of the plan on site?
Yes
No
N/A
2. 2. Is the site set up as per Traffic Control Plan?
Yes
No
N/A
3. 3. Does the plan address pedestrian safety?
Yes
No
N/A
4. 4. Can vehicles/pedestrians pass the site safely?
Yes
No
N/A
5. 5. If in use do the following personnel have tickets in: Traffic Controller (Blue)
Yes
No
N/A
6. 6. Apply Traffic Control Plans (Yellow)
Yes
No
N/A
7. 7. Select/modify Traffic Control Plans (Red)
Yes
No
N/A
8. 8. Design & inspect Traffic Control Plans (Orange)
Yes
No
N/A
9. 9. If managing pedestrians is there a PMP in place?
Yes
No
N/A
10. 10. Is the site set up as per PMP?
Yes
No
N/A
Section 12: Vehicles & Plant
1. 1. Does all plant and high risk equipment have a current risk assessment?
Yes
No
N/A
2. 2. If required, is the prestart inspection completed?
Yes
No
N/A
3. 3. Are warning devices fitted and in working order? (flashing lights, reversing alarm, site flag, warning signage)
Yes
No
N/A
4. 4. Where required, has the operator completed a competency for the plant?
Yes
No
N/A
5. 5. If required, is an emergency stop fitted?
Yes
No
N/A
6. 6. Is all of the equipment carried adequately secured?
Yes
No
N/A
Section 13: Fire Hazards/Procedures/Bans
1. 1. Are hot work restrictions been complied with?
Yes
No
N/A
2. 2. If required, has the hot work permit been issued?
Yes
No
N/A
3. 3. Is there Fire Fighting equipment available, and is it accessible and adequate?
Yes
No
N/A
4. 4. Is it maintained? (serviced every 6 months)
Yes
No
N/A
5. 5. If operating within a fire ban period, is a permit/exemption on site?
Yes
No
N/A
Section 14: Hazardous Substances / Dangerous Goods
1. 1. If Hazardous Substances / Dangerous Goods are in use, is there an MSDS available?
Yes
No
N/A
2. 2. Are there adequate safety controls in place, as outline in the MSDS?
Yes
No
N/A
3. 3. Has a risk assessment been conducted for hazardous substances?
Yes
No
N/A
4. 4. If Dangerous Goods are in use, are there adequate safety controls in place?
Yes
No
N/A
Section 15: Excavations & Trenches
1. 1. Are all Excavations isolated to prevent accidental access?
Yes
No
N/A
2. 2. If the excavations are deeper than 1.5 metres is there shoring or benching in place?
Yes
No
N/A
3. 3. Is there safe means of access to & from?
Yes
No
N/A
4. 4. Is there adequate protection to personnel in the excavation from falling material?
Yes
No
N/A
Section 16: Environment
1. 1. Are there effective erosion controls in place?
Yes
No
N/A
2. 2. Is any existing flora protected from damage?
Yes
No
N/A
3. 3. Is any existing fauna protected from damage?
Yes
No
N/A
4. 4. Is effective waste/spoil management in place?
Yes
No
N/A
5. 5. Are liquids stored to prevent spillage?
Yes
No
N/A
6. 6. Is there a spill kit available and is it accessible and adequate?
Yes
No
N/A
7. 7. If required, is weed control in place?
Yes
No
N/A
8. 8. Are vehicles free of mud/dirt when leaving site?
Yes
No
N/A
9. 9. Have any issues with dust been addressed?
Yes
No
N/A
10. 10. Is the site in a clean and tidy state?
Yes
No
N/A
11. 11. Are bunds litter free and empty?
Yes
No
N/A
Section 17: Emergency Preparedness
1. 1. Select a member of the workgroup and confirm if they are aware of:- The nominated first aider?
Yes
No
N/A
2. 2. Select a member of the workgroup and confirm if they are aware of:-The emergency contact list and its location?
Yes
No
N/A
3. 3. Select a member of the workgroup and confirm if they are aware of:-The evacuation procedure and muster point?
Yes
No
N/A
4. 4. Select a member of the workgroup and confirm if they are aware of:- Location of spill kit?
Yes
No
N/A