1234 checklist
Workplace visual inspection record form
What does this form include?
This form contains 23 sections:
Management Responsibilities
- Has the worksite been inspected previously?
- Have previous inspection items been auctioned?
- Is there a safety management plan for this job?
- Have subcontractors provided Risk Assessment / Job Safety Analysis (JSA) before commencing activities?
- Is there safe access / egress to and from the site?
Housekeeping
- Work area clean and tidy (adequate rubbish disposal facilities)?
- Leads not lying on or draped over walkways or mobile plant access ways?
- Access ways clear of debris, obstructions and trip hazards?
- Equipment / material stored safely?
- Hazardous locations / penetrations covered, sign posted and appropriately fenced?
- Are all signs on site unobstructed, clean and legible?
Electrical
- Portable electrical equipment and leads inspected and show current tags?
- Electrical leads supported above the ground with hooks or stands?
- Temporary power boards are weatherproof?
- Electrical testing register maintained on site?
- Electrical equipment in good condition (no frayed leads, damaged plugs/connections/leads?
- Are residual current devices / earth leakage protection systems used for all electrical connections, checked and operational?
- Are personnel undertaking electrical work appropriately trained and qualified?
- Are isolations completed (lock-out procedures / permits to work in place?
- Are fiberglass or aluminum ladders used rather than metal ladders?
Mobile Plant and Equipment
- Plant and equipment is in good working condition?
- Are roll over protective systems on all earth moving equipment?
- Where applicable are reverse and visual alarm operating and audible?
- Are elevated work platforms (EWP) and crane logbooks kept on the mobile plant?
- Daily inspections completed and recorded?
- Do only trained and licensed operators operate mobile plant and equipment?
- Are riggers and dogmen certified and recorded and used for crane operation?
- Are mobile plant and equipment used on firm level ground?
- Are all combustible type engines only operated outdoors or with extra ventilation (eg portable welders, generators)?
- Safe work limit of lifting or carrying equipment displayed, tested and recorded kept?
- Mobile plant keys removed and kept secure?
Machinery
- Is machinery clean and free from excess oil and grease?
- Is machinery guarding in place and operational?
- Are warning signs or instructions displayed?
- Are emergency stops clearly identifiable?
Hazardous Substances
- Are Safety Data Sheets available for all hazardous substances?
- Is a chemical / hazardous substance register kept on site and complete?
- Are site personnel aware of and understand SDSs?
- Is signage erected at storage areas?
- Are containers labeled and stored appropriately?
- Are chemical storage areas provided with appropriate containment areas (bunds and spill kits)?
- Required PPE supplied when using hazardous materials (as specified by SDS)?
- Emergency / first aid equipment available (showers, eye baths)?
- Ventilation / exhaust systems installed where necessary?
Hot Work (includes oxy - acetylene cutting and welding)
- Are personnel trained and competent?
- Are hot work permits used, signed by supervisors and kept on site?
- Are bottles secured in an upright position?
- Fire fighting equipment is located in work area?
- Are flash back arrestors fitted to both the hand piece and at the bottles?
- Correct PPE used as per SWMS or Job Safety Analysis?
- Are welding equipment, hoses and fittings in good condition?
- Are screens erected and ventilation provided?
Excavation and Trenching
- Are excavation permits used, signed by supervisors and kept on site?
- Are new and existing services identified on site and controls implemented to prevent accidental contact?
- Shoring in place and in sound condition for all trenches more than 1.5m?
- Is air quality testing carried out for identification of toxic gases?
- Is signage and barricading installed effectively?
- Are excavations battered or benched to prevent collapse?
- Has spoil materials and equipment been stored away from excavation edges?
- Are dust control measures in place?
- Are there seperate access and egress points from excavations?
Working at Height
- Are working at height permits used, signed by supervisors and kept on site?
- Are personnel trained in working at height?
- Is safe access and egress provided?
- Are harnesses inspected and inspection records kept?
- Are emergency protocols developed for retrieval of a fallen injured person?
- Are anchor points assessed by a person qualified engineer / competent person?
- Are barriers, barricades and signs erected to delineate restricted access?
- Are controls in place to minimise the risk of objects falling from height?
Stairs, Steps and Landings
- No worn or broken steps, rungs or styles?
- Handrails in good repair?
- Non-slip treatments / treads in good condition?
- Kick plates where required?
Ladders
- Are ladders in good condition?
- Are ladders secured?
- 4:1 Pitch and extended 1 meter above top landing?
Scaffolding
- Are standards on solid foundations with adequate soul plates?
- Is there adequate branching and bracing in all directions?
- Are scaffolds complete, ladders, handrails, kickboards, ties, brackets mesh, hop ups?
- Are there access to and from all working platforms?
- Are ladders of an industrial grade?
- Are ladders secured top and bottom and exceeding platform 1 meter at a 4:1 pitch?
- Are scaffold boards secured to prevent uplift from winds?
- Is sign off received for completed scaffolding (scaffolds tagged with a Scaff tag system or similar)?
- Are signs or barriers erected for incomplete scaffolds?
- Are scaffolds regularly inspected and records kept of details?
Personal Protection Equipment (PPE)
- Is mandatory and job specific PPE worn, suitable for task and in good condition?
- Is PPE readily available?
- Are regular maintenance checks performed on PPE?
- Are employees appropriately trained in the use of PPE?
- Are facilities provided for the maintenance and storage of PPE?
- Are signs displayed to identify the required PPE?
Confined Spaces
- Has a risk assessment been undertaken to a) determine if necessary to enter the confined space and b) determine the control measures?
- Are personnel trained and certified to work in confined spaces?
- Are confined space entry permits used, signed by supervisors and kept on site?
- Is a adequate communication system utilised?
- Is there a need for gas monitoring?
- Are emergency procedures developed (including rescue plan and equipment)?
- Is safety equipment in good woking condition?
- All confined spaces identified and appropriately signposted?
Traffic Management
- Has a traffic management plan been developed and implemented?
- Are all road work signs and devices erected in accordance with the plan?
- Are safety barriers installed to segregate pedestrians?
- Are traffic controllers trained and qualifications sighted?
Lasers and non-destructive testing equipment
- Are operators trained and qualified?
- Is signage displayed to identify equipment?
Public Protection
- Is access to the site controlled and unauthorised entry restricted?
- Is a boundary fence / barricades in place and stable in all sections?
- Is site signage displayed?
- Are dust and noise controls in place?
Amenities
- Are amenities hygienic and tidy (washroom, toilet, lockers, meal rooms)?
- Are there notice boards in crib areas?
- Is there cool clean drinking water available at appropriate locations?
First Aid
- Are personnel aware of the first aid kit location and is it clearly identified?
- Is there a first aid kit located on site and adequately stocked?
- Is there an adequate number of personnel trained in first aid?
- Are records of treatment and supplies dispensed completed?
Lighting
- Is there adequate access and work activity lighting?
Emergency Response and Fire Control
- Fire extinguishers in place service / tagged and appropriate to the hazards?
- Are emergency response procedures developed and issued?
- Are emergency response personnel identified and trained in site emergency procedures?
- Is emergency evacuation information correct, prominently displayed and included in the induction process?
- Does the site have an emergency siren and equipment?
- Have trial evacuations been conducted?
Training and Consultation
- Is there a site induction?
- Are training records, certificates of competency and induction records maintained on site?
- Do supervisors conduct regular pre-work briefs?
- Are site personnel kept informed on hazards, incidents and committee meeting minutes at pre-work briefs?
- Do supervisors carry out risk assessments and incident reports?
- Is there a health and safety committee established on site and meetings held regularly?
Other Issues and Comments
Use this template