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WORKPLACE HEALTH, SAFETY and ENVIRONMENTAL CHECKLIST

PROJECT SITE: ___________________


CONDUCTED______________
BY:

_______________
DATE:

Indicate conditon with the one or these symbols:


(S) SATISFACTORY, (U) UNSATISFACTORY, (N) NOT APPLICABLE
ITEM
ITEM 1
Management

CRITERIA

ITEM

CRITERIA

Activity controlled by JHA

ITEM 10

Sufficient toilet facilities

Take 5 undertaken

Amenities

Toilet facilities clean & hygenic

Prestart meeting conducted

Facility for washing hands

Supervisor available at work location

Eating area clean & hygenic

ITEM 2

Workers understand the work procedure

Behaviour

Work processes compliant to the procedure

ITEM 11

Hazardous substances labelled

Workers using the correct PPE

Hazardous

Storage area secure

Actions of workers are safe

Substances

Stored correctly

Food waste disposal system

ITEM 3

Commissioning inspection performed

Store area correctly sign posted

Plant and

Reversing alarm operable

Fire extinguishers nearby

Equipment

Fire extinguisher in cab

Register of hazardous substances

Condition of the equipment

MSDS for all hazardous substances

Prestart inspection recorded

MSDS multi lingual

Evidence of operator competency

ITEM 12

Storage area well ventilated

ITEM 4

Government Registration

Compressed

Store area secure

Lifting

Commissioning inspection performed

Gas Storage

Oxygen and acetylene bottles

Equipment

Prestart inspection recorded

separated

Load chart in cab

Bottles secured against falling over

Load indicator operable

Empty and full bottles separated

Radius indicator operable

Store area signposted

Boom indicator operable

Fire extinguisher nearby

Fire extinguisher in cab

ITEM 13

Clear accessways maintained

Safety latch on hook

Access

Sufficient lighting maintained

Evidence of operator competency

Emergency lighting installed

ITEM 5

Proof tests certificates available

Rigging Gear

Rigging gear stored correctly

ITEM 14

ELCB / RCD fitted and tested

All lifting gear colour coded

Electrical

Electrical equipment condition

Condition of slings, shackles etc

Equipment

Inspection and testing up to date

Hand rails (where required)

Gear marked with SWL and unique number

Inspection tags colour coded (current)

ITEM 6

Permits available

ITEM 15

Condition of ladders

Hot Work

Correct PPE in use

Ladders

Ladders positioned correctly and

Welding shields in use

secured

No ignition sources close-by

Ladder inspected and register

Fire extinguisher nearby

maintained

Flash back arrestors in use at torch and reg

ITEM 16

Correct PPE in use

ITEM 7

Correct type of fire extinguishers in place

PPE

Maintenance of PPE

Fire

Extinguishers tested and tagged

Protection

Clearly signed posted

ITEM 17

Scaffolding erected to the standard

Area unobstructed

Scaffolding

Scaf-Tag displayed on all scaffolds

PPE meets the standard

ITEM 8

Correct signage displayed

Safe access to all working platforms

Signage

Signage well maintained

Guard rail, mid rail & toe board

Signage multi lingual

installed for height over 1.8 metres

ITEM 9

First Aid kit adequate

ITEM 18

Sides benched, battered or supported

First Aid

First Aid treatment recorded

Excavations

Safe access provided

13-Jul-2015

First Aider competent

Barricades erected

Sufficient first aid equipment available

Competent person appointed

MSDS available to first aider

Spoil heaps >1 metre from edge

Page 1 of 3

SRC-HSSE-F-02

WORKPLACE HEALTH, SAFETY and ENVIRONMENTAL CHECKLIST


PROJECT SITE: ___________________
CONDUCTED______________
BY:

_______________
DATE:

Indicate conditon with the one or these symbols:


(S) SATISFACTORY, (U) UNSATISFACTORY, (N) NOT APPLICABLE
ITEM

CRITERIA

ITEM

ITEM 19

General waste segregated

ITEM 25

WASTE

Waste bins colour coded

SITE SPECIFIC

MANAGEMENT Schedule waste stored separately


Schedule waste clearly labelled

CRITERIA

HEALTH &
SAFETY

Flammable waste stored separately


and labelled
Correct waste bins are being used
Food waste bins are covered
Effluent waste disposal system (sewage)
Liquid waste disposal system (wash out)
ITEM 20

Fuel and oil contained in bunded area

HYDRO

Bund volume > 110% of largest container

CARBON

Tanks and drums clearly labelled with

STORAGE

contents and volume

AND USE

Fuel and oil farm correctly sign posted for


flammable liquid
Fire fighting equipment available
Spill equipment available

ITEM 26

Drip trays for in-field refueling

SITE SPECIFIC

ITEM 21

Dust emissions controlled

ENVIRONMETAL

AIR QUALITY

Combustion engine emissions controlled


Air quality monitoring program in place
Air quality within the prescribed limits

ITEM 22

Drainage plan available

SURFACE

Oil separator in workshop area

WATER

provided and maintained

DRAINAGE

Sedimentation ponds adequate


and maintained
Water quality tested before release
to waterways
Water collected and re-used
Silt fencing in place
Slope protection erosion control

ITEM 23

Noise levels monitored

NOISE

Noise levels within prescribed limits


Mobile and static equipment maintained

ITEM 24

Native vegetation protected

FAUNA &

Native fauna protected

FLORA

Feral animals controlled.

13-Jul-2015

Page 2 of 3

SRC-HSSE-F-02

WORKPLACE HEALTH, SAFETY and ENVIRONMENT CHECKLIST


Indicate conditon with the one or these symbols:
(S) SATISFACTORY, (U) UNSATISFACTORY, (N) NOT APPLICABLE

13-Jul-2015

Page 3 of 3

SRC-HSSE-F-02

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