w CONSTRUCTION SITE CHECKLIST PowerServ een Seo ee aa ees Hazard reports are to be completed on SF-001 Job No: Site: Date: " - Tick Result Actions to Address: Task or Condition YES NO NA Miresuitis Ace include an Site Induction / Toolbox "Has a sile induction/toolbox talk been conducted o o oa and signed by all personnel involved in the task? 2 Daily Risk Assessment: (Please write document and Rev no) SF-012_ Rev. (Check Rev) {a tha Fisk Assessment available on site? (C1 Mandatory incident Report tor [=] Ho {it site specilic? {sit completed correctly for the worksite? | Has it bean signod & dated each day? ® | Does itaddress pedestrian salety? 1 | Does it address vehicle salety? 8 | Does it address plant safety? W Dangerous Goods are in use, are there adequate safoty canjrols in placo? 1 | Is the Supervisor nominated? | | ts tha First Aider nominated? Is the muster point nominated and Is it sultable? | | Ate environmental considerations addressed? 7 Mandatory incident Reopen fr [2] NO Mandatory neident Rpt fr [2] NO 3 Safe Work Method Statement (Please write document and Rev no) SF-050._ Rev.__ (Check Rev) m | Are all nominated controls in placa? onooono ooo ooO oO oOO bono ooOoO ooo ea oOo ooooooo 000000 1 | Are all nominated controls effective? '® Is there a SWMS available on site? oO oO F_ Mandatory incident Repan tor [=] no 6 Is it site specific? O QO O © Doss address alltacks Aassociatedhazards? (] [] 4 Have the non relevant steps bean crossed out? =) oOo oa @ Have the relevant legislalion/étandardsicodes of practice been highlighted? o Oo 0 Have the felevant work instructions/torms/risk: "assessments been idantilad? o.oo 0 Are the relevant work insiielonsionnslish 8 | assessments on site? oo oO | Does the workloice have the necessary wainng? =O OO 1 | Has plant and equipment been identified? oo oO 1 Have _emveanmenial corsidevalons been] Has the SWMS been Eigned by all personnal 7 | involved in the task? Oo oo a 1 Are all required controls in place? oO oO CK) Mandatory ineident Report tor [x] NO mm Ate all requited controls etfective? DC Mandatory ieitert Report for E2] NO ‘SF-0s7 Jul 2012 Rav 14 Pago talsCONSTRUCTION SITE CHECKLIST Tick Result Actions to Address Task or Condition Yes NO NA Oran ea is 4 Licences/Authorities | Are all plant operatots licensed ot authorised to « Soa beeen? O_O sr Rp no b [Ween personnel relevant State OHS o o o lory incident fi tor J wo Are Personnel Authorised = bythe» | © Authority/Client? o ao a 5 Forms/Documentation | O Qo € | Is tha job fle available on site? oO Oo al 4 [etebaccmencremomeigenmer | CC ¢ | Is there.a job Speciticatian on site? oOo 0 0O | Are the Authority's Salety Rules available? Oo oO oO 6 Work/Access Permits 8 (s.an appropriate permitonissuetorthiswork? =O OO Are all permit recipients authorised? o Oo C1 ttandatory incident Report tor [=] wo ‘Are OBYD's andior Excavation Permits completa y © and onsite and nave all overhead and = [] [J] —)_maandatory incidert Report tor [2] WO underground services been identified? | wt licable, is a State Roads permit onsite 1d @ [eae a Slate Roads permit oniie and ooo | op aka ‘eno . [some is @ council permil onsite 2D O_O tir ne ep or no 7 Manual Handling Have the manual handing hazards been ® identified? 4 o Q ao | o oOo 0O Are manual handling aids available? 8 Personal Protective Equipment (PPE) 8 | PPEas per Dally Risk Assessment o oOo oO Are all safety harnesses & lanyards within their” | 5 | lest dale range? (Every 3 Months) and tagged. ] | (Rec — Jan to Mar, Green — Apr to dun, Blue — Jul to |___ Sep, Yellen - Oct to Dee Power onty) Jo | (other safety apparel in good cerition? o oo oO @ | ToolsiEquipment Are all electrical loots within thelr test daterange | | and tagged? (As per stato requirements) | Check the following Equipment for condition, compliance and tagging- b Ladders (every 3 mths) O Oo QO © | Calibrated Test equipment within test date? oO oOo OO | Gas Batties (10 Years) oO oOo OQ | Diting “equipment (Slings & chains) (avery 3 | months) (Red — Jan io Mar, Groen — Apr 10 Jun, Bluo oO o Sop, Yellow - Oct 1o Dec Power only) 10 First Aid and Emergency Contacts (Is ther a slockad First Ald KI avalable onsite and is tin dato and accessible? Min. Typo “B™ SFO SS0006 wureor@ Rov 14 Page 204CONSTRUCTION SITE CHECKLIST Task or Condition YES NO Tick Result 5 Actions to Address nS (WC result is NO, then include an action), b Aro the First Aid requiremants adequate? © Are thore omergency contact details available? @ Is there emergency communication avaliable? 11 Traffic/Padostrian Managemant use and a copy of the pian on site? | Is the site sot up.as per Tratfic Control Pian? © | Dogs the plan address pedestrian satety? 9 | Gan vehicles /pedestrians pass the site safely? MW ‘in use do tha following personnel have iekets in. © Traltic Contrllor (Blue) 1 | Apply Traffic Control Plans (Yellow) 8 Select/modity Trattic Control Plans (Red) h | Design & inspect Tralfic Control Pians (Orange) vif pao pedestrians is there a PMP in | place’ 1 Is the site set up as per PMP 2 Vehicles & Plant joquired, i there a Wallic managemont pian in doloooo ooo oO} jojojo oo joo | Does all plant and Sor ae aaa a current risk assessment? 1 | Mrequired, isthe prastar inspection completed? € | (flashing lights, reversing alarm, site’ flag, ‘warning signage) a | Whote requirad, has the operaior completed a competency lor the plant. | required, is an emergency stop fitted? ‘1s all of the equipment carried adequately | seoured? 12 Fire Hazards/Procedures/Bans | Ate hol work restrictions been complied with? & | required, has, nen ate been issued? = i there Fire Fighting | iidcoessible and adequate? 4 | Is it maintained (serviced every 6 montis) I" cporating within a |_permit‘exemption on sito? 14 Hazardous Substances / Dangerous Goods ‘a | Hazardous Substances / Dangerous Goods are in use, is there an MSDS available? Are there adequate safely controls in place, as outline in the MSDS? | Has a tisk assessment been conducted lor hazardous substances? gl! Dangerous Goods are in use, ate there adequate safely controls in piace? poriod, is a Oo o o oO o Oo o o o oO oO o oo) oooooo joooo joo oooog |ooo)o o/o}o}o} jolojo} OO} 40) a) oo] ooo ooo) ogooooo joa Sow Rov 14 Jateoz Pago otCONSTRUCTION SITE CHECKLIST 48 Excavations & Trenches | Ate all Excavations isolated to pr | accidental access? | iithe excavations are deeper than 1.5 metres is | there shoring or benching In place? © Is thore safe means of access to is thefe adequate protection to personnel in the excavation from falling material? 16 Environ: 2 Ave there affective erosian controls in place? — | !5.any existing flora protected fra € | Is any existing fauna protected Irom damage? (6 effective waste/spoil management in place? © Ate liquids stored to prevent spillage? {ip there a spill kit available and is it nocessible "and adequate? 8 | I! required, is weed control in pla th | Ate\vehiclos (tea af mudiciit when leaving site? 1 | Have any issues with dust boon || Is the site in a clean and tidy state? | Are bunds titer tree anda event & trom? olojo;o m damage? an addressad? Mandatary incident Repant tar [x] NO ooo 0 o oO oO a Qa o g a ao oO} 17 Emergency Proparedness. Soleci a mamber of the ¢ Tha evacuation procedure and muster point? | Location ob spill kit? hg Oooo}; Ooo000 0000/00 oooodsqddocnojooco0oo00 joo. ) and cantirm if thay are aware of oooo Additional Comments/Findings: Signed: Subcontractor Reprasenialive: Subcontractor Company: "Signed: NOTE: Retain a copy of this form in the CEMP records folder sro Rev 14 argo Page dof &