INTERNAL SAFETY & COMPLIANCE INSPECTION
One form per inspection, per crew/vehicle
INSPECTOR
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INSPECTION DATE
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Day
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Month
Year
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Region
*
Please Select
Sunshine Coast
Noosa
SC Zone ID
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Please Select
Zone 1A
Zone 5
Zone 3
Zone 7T
Zone 7G
Zone 8
Zone CRN
Zone NRN
Location/Site of INSPECTION
*
Noosa Zone ID
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Please Select
Parks
Roads
Crew Lead
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Crew Members
*
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EVALUATION
APG Compliance
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Pass
Fail
NA
Comments
DAILY SITE CHEKLIST: Sheets completed correctly
CHEMICAL APPLICATION: All labels, procedures, and records being maintained correctly
HAND WASH stocked
FIRST AID KITS: Stocked with required items
RISK ASSESSMENTS/JSA: Crew understands when and how to complete
LICENSES & CERTIFICATIONS: All crew members have required certs & licenses.
TEAM LEAD QUALIFICATIONS: Team Lead has a current FA, TMI, and other required certs or licenses per contract.
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Traffic / Pedestrian Management
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Pass
Fail
NA
Notes
Traffic Management : is there an approved Traffic Management Plan?
Safe Worksite : is the worksite safe from oncoming traffic (40km speed reduction when working less than 1.2 metres from traffic)?
Signage : are signs clearly viable complying with current AS?
Pedestrian Safety : has public safety been jeopardised?
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Work Practices
*
Pass
Fail
NA
Notes
Professional Manner : are staff following safe work practices and conducting themselves in a professional manner?
Overhead Objects : are staff working safely around electrical cables, trees etc. exclusion zone established when working near power lines?
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Work Site Conditions
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Pass
Fail
NA
Notes
Steep incline/drop-offs : are staff using appropriate machinery around slopes and inclines?
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Environment
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Pass
Fail
NA
Notes
Dust / Gases / Odours : are at levels that will not be a threat to the environment and/or the public?
Noise levels : are noise levels within noise exposure levels?
Flora and Fauna : are there any visible effects on plant or animals?
Spills or potential for spills - Are spill kits readily available & in good order?
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Housekeeping
*
Pass
Fail
NA
Notes
Tidiness of work areas : are work areas free from trip hazards, debris, vegetation materials etc.?
Cabins and Storage : are these areas easily accessible and tidy, free of loose projectiles?
Is a first aid kit present?
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Plant and Machinery
*
Pass
Fail
NA
Notes
Conditions : is plant well presented and in reasonable condition e.g. free from sharp edges, oil leaks and
excessive carbon emissions?
Guards : are all guards in place and in working condition?
Maintenance : is there a record of periodic maintenance? Is machinery maintained on a regular basis?
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Personal Protectice Equipment
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Pass
Fail
NA
Notes
Use : is the appropriate eye, hearing protection, gloves, safety boots, respirator, high visibility long sleeve garments, broad rimmed hat, sunscreen etc. being worn?
Condition : is the PPE in good condition and ensuring the safety of the operator - Hi visiblity garments not
faded?
Sharps : is there a well maintained sharps container within the vehicle and is there a sharps handling
procedure?
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WHS Documentation
*
Pass
Fail
NA
Notes
Work Method Statements : are the crew carrying Work Method Statements which are readily available?
Risk Assessments : has a risk assessment been completed, particularly for hazardous sites?
Slopes : wet sites and sites affected by close vehicle traffic?
Is there a record of training and induction of all staff on site?
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Chemical Records
*
Pass
Fail
NA
Notes
Hazardous substances/Contaminated water - Are applicable MSDs readily available & chemicals stored in a safe manner?
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Fire Protection
*
Pass
Fail
NA
Notes
Fire Extinguishers - Are fire extinguishers present & are they in working order & are they in working order & have they been serviced within the last 6 months
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Hygiene
*
Pass
Fail
NA
Notes
Facility : are there adequate cleaning facilities readily available - detergent/clean water?
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FINAL COMMENTS
Did this crew Pass or Fail this inspection?
*
Pass
Fail
COMMENTS:
*
Signature
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