Reference No.

: KFV-SR-055
NON-CONSTRUCTION
WORK APPROVAL Revision: 0 Page: 1 OF 5

CHECKLIST Associated
Procedure: KGA-073

NON-CONSTRUCTION WORK APPROVAL CHECKLIST

(THIS DOCUMENT MUST BE COMPLETED BY THE CONTRACTOR AND SIGNED BY CLIENT CONTRACT PROJECT MANAGER
AND ESKOM SAFETY RISK MANAGER BEFORE WORK COMMENCE)

PROJECT NAME

CLIENT

CONTRACTOR

PROJECT MANAGER

DATE

REFERENCE LEGAL APPOINTMENTS YES NO N/A COMMENTS

Have the following legal appointments been made and signed copies are available on the H&S file

OHSAct Sec 16(2) Section 16(2) appointee

OHSAct 7 Safety Policy

CR 5(1)(j) Valid letter of good standing

OHSAct 37(2) Mandatary agreement

OHSAct 37(2) Mandatary agreement between contractors

32-726 Client Baseline Risk Assessment

32-726 Client SHE Specification

Detailed method statement of the scope of work as

KGA-073
per the provided template

N/A Organogram as per legal appointments

List names of employees that will be working on

N/A
the project and ID copies of all employees

N/A Copy of drivers licence for vehicle operators

J:\FORMS\KFV\SR\AUTHORISED\KFV-SR-055 REV 0.DOC  ESKOM – 2017 TD & RM – KOEBERG

 Reference No.: KFV-SR-055
NON-CONSTRUCTION
WORK APPROVAL Revision: 0 Page: 2 OF 5

CHECKLIST Associated
Procedure: KGA-073
COMPLIANCE
REFERENCE REQUIREMENT COMMENTS
YES NO N/A

GMR 2(1) Competent Person for Machinery

Employee nominated Health & Safety

Section 17
Representative

GSR 3 First Aiders

GAR 9(2) Incident Investigator

Person responsible for conducting risk

OHSAct sec. (8)(2)(d)
assessments
Person responsible for the development and
CR 10(1)
maintenance of the Fall Protection Plan

CR 16(1) Scaffold Erector

DMR (18)(11) Lifting Machine Operator

GSR 8 Stacking & Storage Supervisor

Appointment of Competent Person responsible for

CR 29(h) all firefighting equipment and emergency
evacuation procedures

CR 29(l)(ii) Fire & Emergency Co-ordinator

CR 29(l) Fire Marshall

GSR 13(A) Ladder Inspector

OHSAct Sec 8 (2)(d) Hand Tool Inspector

HCS 3(3) HCS Co-ordinator

Medical Certificate of Fitness

All employees employed on site are in possession

CR 7(8) of a valid Medical Certificates of Fitness issued by
Occupational Health Professional

Induction Training (Staff & Visitors)

All employees employed on site received induction

OHSAct 13(a)
training and training records are kept on site

Appointment and Functioning of Health &

Safety Representatives

Health & Safety Representatives conduct regular

OHSAct. sec 18 inspections and inspection reports are available on
site
Health & Safety representatives are involved
GAR 9
during incidents investigations
A Health & Safety Committee has been
OHSAct sec. 19 established and minutes of meetings are kept on
site

Reporting and Investigation of Incidents

OHSAct. Sec. 14 All incidents reported by Employees

All incidents as per Section 24, 25 and General

OHSAct. Sec. 24&25 Administrative Regulation 8 have been reported to
the DoL

J:\FORMS\KFV\SR\AUTHORISED\KFV-SR-055 REV 0.DOC  ESKOM – 2017 TD & RM – KOEBERG

 Reference No.: KFV-SR-055
NON-CONSTRUCTION
WORK APPROVAL Revision: 0 Page: 3 OF 5

CHECKLIST Associated
Procedure: KGA-073
COMPLIANCE
REFERENCE REQUIREMENT COMMENTS
YES NO N/A
Health & Safety Plan and File

A consolidated Health & Safety Plan has been

CR 7(1)(a)
submitted to the client by the Contractor

The Health & Safety Plan has been approved by

CR 5 (1)(l)
the Client

A Health & Safety File is being kept by the

CR 7(1)(b)
contractor and is available for inspection

The Health & Safety Plan is reviewed after

CR 7(1)(a)
incidents or when changes are made to the design

Fall Protection

Fall Protection Plan has been developed by a

competent person in accordance with unit
CR 10(1)
standard 229994 and contains all information as
per the legal requirement

CR 10(2)(c) Proof of working at heights training

Suitable fall arrest equipment available to staff for

CR 10(4)
use in areas where handrails cannot be fitted

Roof Work

CR 10(5) Roof work has been properly planned

No roof work is being performed during bad

CR 10(5)
weather

CR 10(5) Weak areas and openings on the roof are covered

Where possible hand rails are installed along the

CR 10(5)
side of the roof

Rope Access Work

All rope access staff members are properly

CR 18 (1)(c) registered and licensed for the task to be
performed
Rope access equipment used safe and in
CR 18 (2)(a)
compliance with safety standards

CR 18 (3) A rescue plan has been drafted and implemented

Use of Lifting Machines and Cranes

All lifting tackle inspected at intervals not

DMR 18 (10)(e)
exceeding 3 months and inspection registers kept
All lifting machines are thoroughly examined every
DMR 18(6)
6 months
All lifting machines to be load tested by LME and
DMR 18(5) LMI at intervals not exceeding 12 monthly and
inspection registers kept

J:\FORMS\KFV\SR\AUTHORISED\KFV-SR-055 REV 0.DOC  ESKOM – 2017 TD & RM – KOEBERG

 Reference No.: KFV-SR-055
NON-CONSTRUCTION
WORK APPROVAL Revision: 0 Page: 4 OF 5

CHECKLIST Associated
Procedure: KGA-073
COMPLIANCE
REFERENCE REQUIREMENT COMMENTS
YES NO N/A

Use of Scaffolding

All scaffolding erected and use complies with

SANS 10085
provisions of SANS 10085
All scaffolding inspected after erection and before
SANS 10085 use, weekly, after damage, after rain and before
demolition and an inspection register is kept

Electrical Equipment

Electrical Contractor register as an electrical

EIR 6(4)
contractor by the Chief Inspector
Certificate of Compliance issued for Electrical
EIR 9(4)
Installation
All portable electrical equipment inspected daily
EMR 9&10
and an inspection register kept

Use and Storage of Flammable Liquids

All flammable liquids are properly and safely

GSR 4(2)
stored

Work performed close to Water

CR 26 Fall prevention, fall arrest and or life jackets made

available to staff who perform work in close
proximity to water
Housekeeping and General Safeguarding of
site
Good housekeeping practices are maintained on
ERW 6(2)(c)(d)
the work site

Fire Prevention

Sufficient quantities and correct types of fire-

ERW 9(2)
fighting equipment available on site
Evacuation Plan has been drafted and
ERW 9
implemented

Toilets and Change Room Facilities

At least 1 shower available for every 15 staff

SANS 10400
members
SANS 10400 At least 1 toilet available for every 30 staff
members
SANS 10400 Change facilities available to all staff

SANS 10400 Sheltered dining areas available to all staff

OH&S must visit the project site before the

N/A
approval of this safety file

J:\FORMS\KFV\SR\AUTHORISED\KFV-SR-055 REV 0.DOC  ESKOM – 2017 TD & RM – KOEBERG

 Reference No.: KFV-SR-055
NON-CONSTRUCTION
WORK APPROVAL Revision: 0 Page: 5 OF 5

CHECKLIST Associated
Procedure: KGA-073

PHYSICAL SITE INSPECTION

NON-CONFORMANCES IDENTIFIED OR COMMENTS CORRECTIVE ACTION NEEDED

END-USER
SAFETY CONTRACTOR
OFFICER NAME AND SIGNATURE
NAME AND
SIGNATURE

ESKOM
PROJECT
MANAGER APPROVED YES NO DATE
NAME AND
SIGNATURE

ESKOM SAFETY
RISK MANAGER
APPROVED YES NO DATE
NAME AND
SIGNATURE

J:\FORMS\KFV\SR\AUTHORISED\KFV-SR-055 REV 0.DOC  ESKOM – 2017 TD & RM – KOEBERG