Pre-Site Checklist

1
Date
Date
Day
Month
Year
2
Person completing the submission:
First Name
Last Name
3
Site Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Do I have the required skills and knowledge to complete the task safely?* This field is required.
YESNO
5
Do I fully understand all aspects of the work?* This field is required.
YESNO
6
Am I fit for work, competent and authorised to perform the task?* This field is required.
YESNO
7
Am I aware of the emergency procedures and do I have the means to activate them if needed? (i.e. mobile phone or radio* This field is required.
YESNO
8
Have I ensured that the task will not impact on the environment/community? (i.e. dust, spills and noise)* This field is required.
YESNO
9
I have identified and isolated all sources of energy?* This field is required.
YESNO
10
Are my tools and equipment suitable for the task and in a safe operating condition?* This field is required.
YESNO
11
Is my PPE suitable for the task, do I know how to use it and is it in good condition?* This field is required.
YESNO
12
Am I aware of other people and equipment in my work area and have I communicated with them?* This field is required.
YESNO
13
Am I aware of other people and equipment in my work area and have I communicated with them?* This field is required.
YESNO
14
Site Hazards identified:* This field is required.
Electrical
Slips / Trips
Public
Hot Works
Power / Hands tools
Hazard manual tasks
Working at heights
Mobile Plant
Dangerous Animals
Atmospheric contaminants
Lighting
Young workers/ Apprentices
Access and egress to site
Lifting / Suspending equipment
Scaffold erection / Dismantle
Flammable & combustible substances
Dangerous goods / Hazardous substances
Other
15
Are all identified hazards covered by the SWMS?*
Yes
No
16
Control Measures:

1. Use of proper PPE i.e. hats, sunscreen, gloves, sunglasses, long sleeve shirts, ear plugs and covered footwear.
2. Water available on site.
3. Test equipment checked for correct operation before use.
4. Ladder secured.
5. Harness checked in date, and set up correctly.
6. Exclusion zones set up.
7. Correct lifting techniques at all times.
8. Proper supervision for apprentices, apprentices not to complete testing or verification.
9. Material data sheets available at all times.
17
Signature
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18
Contractor Email for PDF copy of report
example@example.com
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