CONSTRUCTION SITE CHECKLIST jentity, review and correct any conditions or hazards that wv PowerServe may endanger personnel, contractors or members of the publ ieee Re ne eee ecu Sed) Job No: Site: Date: Teck or Gonal Tick Result Retions to Address ‘ask or Condition ves No wa | results Ho; non ine 1 | Site Induction / Toolbox Tas a site induelionfoolbox tak been conducied * | and signed by al personnel invovedinthetask? | OO O 2 | Dally Risk Assessment: (Please write document and Rev no) SF-012,___ Rev._ (Check Rev) « | Is the Risk Assessment available on site? Mandatory incident Report tor [X] NO » [ Isitsite specific? © | Is it completed correctly for the worksite? 4 | Has it been signed & dated each day? © | Does it address pedestrian safety? «| Does it address vehicle safety? 8 | Does itaddress plant safety? Tr Dangerous Goods are ih use, are there adequate safety controls in place? 1 | Is the Supervisor nominated? 1 | Is the First Aider nominated? i | Is the muster point nominated and is it suitable? 1 | Are environmental considerations addressed? 'm | Ate all nominated controls in place? Mandatory neldent Report for Dd] NO 1 | Are all nominated controls effective? OOO OOO O;O/O)O/O/0/0)0 OOO OOO O;O/O)O/O/0/0)0 Mandatory Incident Report tor [=] NO 3 | Safe Work Method Statement (Please write doct sument and Rev no) 050, Rev,__(Check Rev) 2 | Is there a SWMS available on site? Mandatory incident Report tor [X] NO b | Isitsite specific? © | Does it address all tasks & associated hazards? 4 | Have the non relevant steps been crossed out? Tiave the relevant legislation/standards/codes of practice been highlighted? OO OOOO) O/O) 00/0) 0/0) ¢/O/ O00 00) 0)o 00 0)0)0/0 Oo a | oO 0 oOo a oOo a 7 [Have the relevant. work Instructions Tormsiisk assessments been identified? oo ‘Are the relevant work insirucTonsTormeliak ® | assessments on site? oO oO 1 [ Does the workforce have the necessary vainng? | Cl OI 1 | Has plant and equipment been identified? o oa 1 [Rave _eqvionmencalcarsdeatins eer | Fy Fas the SWMS been signed by all personnel * | involved in the task? oO oO 1 [ Aco all roquired controls in place? oo Mandatory neldent Report for] NO wm | Are all required controls effective? o oO Mandatory incident Report or DX] NO Soa ar 20T Revt4 Page 1 of 4CONSTRUCTION SITE CHECKLIST Task or Condition Tick Result YES NO NIA ‘Actions to Address (it result is NO, then include an action) Licences/Authorities ‘re all plant operators licensed or authorised to ‘operate the equipment? Oo Oo Oo Mandatory incident Report tor [Z] NO Have all personnel relevant State OHS Induction? Oo Oo Oo Mandatory incident Report tor DX] NO ‘Are Personnel Authorised by the Authority/Cliont? Qa Qa Qa Forms/Documentation Is there a copy of the Management plan on site? (Requited forall Jobs »$250,000) Is a PowerServe contact details sign displayed? Is the job file available on site? Is there a cortiffedi/current Drawing on site? Is there a job Specification on site? ‘Are the Authority's Safety Rules available? Work/Access Permits Is an appropriate permit on issue for this work? Are all permit recipients authorised? Mandatory incident Report tor DX] NO ‘Are DBYD's andlor Excavation Pormits complete ‘and on-site and have all overhead and underground services been identified? Mandatory Incident Report tor [X] NO Tf applicable, 's a State Roads permit onsite and current? Tf applicable, is a counel permit onsite and current? O;O} 0 OO) joyojojo|o}o O;O} 0 OO) joyojojo|o}o O;O} 0 OO) joyojojo|o}o Manual Handling Fave the manual handing hazards been identified? ‘Are manual handling aids available? Personal Protective Equipment (PPE) PPE as por Dally Risk Assessment ‘Wee all safety hamesses & lanyards within ther test date range? (Every 3 Months) and tagged. (Red — Jan to Mar, Green — Apr to Jun, Blue — Jul to ‘Sep, Yellow - Oct to Dec Pewer only) Is other safety apparelin good condition? ToolsiEquipment Bre all electrical tools within the test date range and tagged? (As per slate requirements) QO; jo} Oo jo} jojo QO; jo} Oo jo} jojo QO; jo} Oo jo} jojo ‘Check the following Equipment for condition, compliance and tagging:- Ladders (every 3 mths) Calibrated Test equipment within test date? Gas Bottles (10 Years) Tiling equipment (Sings _& chains) (every & months) (Red - Jan to Mar, Green - Apr to Jun, Blue =u to Sep, Yellow - Oct io Dec Power only) oyooja oyooja oyooja 10 First Aid and Emergency Contacts Ts there a stocked First Aid kit available on site andis tin date and accessible? Min. Type "B Qa Qa Qa SF0G7 S806 Rev 14 Jul 2072 Page 2 ofCONSTRUCTION SITE CHECKLIST Tick Result ‘Actions to Address Task or Condition Yes NO WA | Wrtile No; then inde an » | Are the First Aid requirements adequate? oO oO 0 © | Are there emergency contact details available? | Ol OO 4 | Is there emergency communication available? | Ll LI LI 1 | Traffic/Pedestrian Management T required, is there a Waffie management plan in ® | use and a copy of the plan on site? oo 0 » [Is the site set up as per Traffic Control Plan? oOo 0 © | Does the plan address pedestrian safety? oO oO 4 @ | Can vehiclesipedestrians pass thesitesaiey? | O OO iin use do the following personnel have tickets in:- | Trattic Controller (Blue) oO oO 4 «| Apply Traffic Control Plans (Yellow) oO oO U 8 | Selectimodify Traffic Control Plans (Red) oO oO 0 fh | Design & inspect Tratfic Control Plans (Orange) | O OF OO Trmanaging pedesirans & trere @ PP in * | piace? oo 0 1 [isthe site set up as per PMP oo oO 12 | Vehicios & Plant 2 | bees all pant and Figh rk equipment Fave @] yy current risk assessment? » | Itrequired, is the prestart inspection completed? | O OF O Waring devices ited and In working order? © | flashing lights, reversing alarm, sto tag. O OF OF warning signage) Where required, has the operator completed @ 4 | competency fr he plant oo 0 ¢ | Hrrequired, is an emergency stop tited? oo oO Teall ofthe equipment carried adequately ' | secured? oo 0 18 | Fite Hazards/Procedures/Bans @ | Are hot work restrictions been complied with? oO u Oo ® | irequired, has the hot work permit beenissuea? | COO Ts there Fire Fighting equipment avalable, ands * | itaccessible and adequate? oo 0a 4 | Is it maintained (serviced every 6 months) oO oO 0 T operating witin @ {re ban porlod, Sa * | permitiexemption on site? oo 0 14 | Hazardous Substances / Dangerous Goods Hazardous Substances 7 Dangorous Goods * | are in use. is there an MSDS available? oo oO ‘Are there adequate safely controls in pIaCS, 8S ® | utine in the MSDS? o 0 0 Has a risk assessment been conducied Tor £ | hazardous substances? oo 0 TF Dangerous Goods are in use, are there * | adequate safety controls in place? oo oO SF-057 Ss0066 ar 20T Revita Page 3 of 4CONSTRUCTION SITE CHECKLIST 15 | Excavations & Trenches + | Areal Baravalons folated to prevent Ty _"J Mandatory incident Report tr [2] NO. *[tesstomobnanngae | O OO © [Is there sate means of access to & from? oo oO *[Sawinontigmea "| O OO 16 | Environment a | Are there effective erosion controls in place? oO oO 4 ® | Is any existing flora protected from damage? oOo oF oO © | Is any existing fauna protected from damage? | COO @ | Is effective waste/spoil management in place? oO oO 4 © | Are liquids stored to prevent spillage? oOo oF oO 1 [Eiaea gla aah meer] gg | It required, is weed control in place? oO oOo 2 h | Are vehicles free of mudidirt when leavingsite?’ | O OF O 1 | Have any issues with dust been addressed? oO oOo 2 1 | Is the site in a clean and tidy state? oO oO oO | Are bunds litter free and empty? oO oOo 2 17 | Emergency Preparedness. Select a member of the workgroup and contim ifthey are aware of | The nominated first aider? Oo ao 0 » | The emergency contact list and its location? oO oO oO | The evacuation procedure and muster point? oO oOo 2 4 | Location of spill kit? oO oO 2 ‘Additional Comments/Findings: Inspected By: (Print Name) Signed: Roviewed By: Print Name: Signed: Field Co-ordinatoriLeading Hand? Site Supervisor: Project Manager/Supervisor: ‘Subcontractor Representative ‘Subcontractor Company: NOTE: Retain a copy of this form in the CEMP records folder SF0G7 S80066 Rev 14 Jul 2072 Page 4 of &