Ajara Water Alliance JSC

Occupational Health and Safety Management Plan

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AWA – Occupational Health and Safety Management Plan
Approved:

___________________________________ __________________
Director Date

# Document Version Prepared Checked Authorized Approval Signature

Name by by by Date

1 Occupational rev0 Harald Ranjin Matthias 23.08.2022

Health and Valdix, Fernando Hitzel
Safety
Management
Plan

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AWA – Occupational Health and Safety Management Plan
 Table of Contents

0 Context, purpose and organization..........................................................................................7

1 Policy........................................................................................................................................7
1.1 Health and safety goals.....................................................................................................8
1.2 AWA’s commitments........................................................................................................8
1.3 Update of this management plan.....................................................................................8
1.4 AWA Health and Safety Policy..........................................................................................9
2 Legal requirements.................................................................................................................11
3 Hazards identification.............................................................................................................11
3.1 Risk assessment..............................................................................................................12
3.2 Hazard and risk identification reviews............................................................................13
4 Roles and responsibilities.......................................................................................................13
4.1 AWA management..........................................................................................................13
4.2 Utilities............................................................................................................................13
4.3 Employees.......................................................................................................................13
4.4 Contractors......................................................................................................................14
4.5 Occupational safety specialist.........................................................................................14
4.6 Visitors.............................................................................................................................14
5 Training and awareness..........................................................................................................14
6 Reporting and documentation...............................................................................................15
7 Communication......................................................................................................................15
8 Operational control................................................................................................................16
8.1 General hazard prevention.............................................................................................16
8.2 Task specific hazard prevention......................................................................................17
9 Procurement...........................................................................................................................18
10 Emergency preparedness and response............................................................................19
11 Performance measurement and monitoring......................................................................19
11.1 Health Surveillance.........................................................................................................19
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AWA – Occupational Health and Safety Management Plan
 11.2 Internal Audits.................................................................................................................19
11.3 Workplace Monitoring....................................................................................................19
12 Accidents, non-conformances and corrective and preventive action................................20
13 Records and records management.....................................................................................20
14 Auditing, review and update..............................................................................................21
15 Management review...........................................................................................................21

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AWA – Occupational Health and Safety Management Plan
 ABBREVIATIONS

AWA Ajara Water Alliance JSC

OHS Occupational Health and Safety

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AWA – Occupational Health and Safety Management Plan
0 Context, purpose and organization

Ajara Water Alliance JSC (AWA) is committed to protecting the safety and health of our employees and
contractors, and the communities in which we operate. This Occupational Health and Safety
Management Plan (OHSMP) aims to implement the policies and is based on the principle of continuous
improvement.
AWA`s Occupational Health and Safety Management Plan is in place to control health and safety risks of
company activities. This plan contains the following elements:
• Policy;
• Legal Requirements;
• Hazard identification and Risk Assessment;
• Roles and Responsibilities;
• Training and Awareness;
• Reporting and Documentation;
• Communication;
• Operational Control;
• Procurement
• Emergency Preparedness and Response;
• Performance Measurement and Monitoring;
• Accidents, Non-Conformance, and Corrective/Preventive Actions;
• Records and Records Management;
• Audits and Assurance;
• Management Review.

1 Policy
AWA is committed to leadership and continuous improvement in environmental, health, and safety
practices for the benefit of employees, contractors, and communities. This will be accomplished by:
• Providing a safe and healthy workplace;
• Integrating environmentally sound practices into all processes;
• Complying with applicable laws, regulations, policies, and standards;
• Conserving natural resources and energy;
• Providing necessary resources to support environment, health, and safety goals and objectives;
and
• Integrating environmental, health, and safety goals and objectives with an overall business
strategy.

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AWA – Occupational Health and Safety Management Plan
1.1 Health and safety goals
AWA’s goals are to achieve:
• An accident / incident free-culture; and
• A sustainable and competitive business advantage through leadership and excellence in
environmental, health, and safety.

AWA is focused on everyone’s safety. AWA’s objective is to implement processes and systems for safety
excellence and integrate them in everyday activities to develop safe behaviour and ensure a safe place
for employees. Environmental, health, and safety excellence requires a daily commitment by all
employees.

1.2 AWA’s commitments

AWA provides adequate resources to implement and maintain the OHS Management System, including
the necessary human, material, and financial resources.

1.3 Update of this management plan

The Health and Safety Management Plan will be regularly updated based on management reviews,
incident investigations, regulatory changes, or other Project-related changes. For the construction stage
of the project, contractor will assume leadership of the Health and Safety Management Plan for all
construction-related activities. AWA will perform regular audits of the contractor’s Health and Safety
Management Plan to ensure that it complies with AWA’s OHS Policy, safety goals and objectives.

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AWA – Occupational Health and Safety Management Plan
1.4 AWA Health and Safety Policy
AWA is committed to the reduction and prevention of on-the-job accidents and illnesses. This policy
demonstrates AWA’s commitment to providing a safe and healthy environment for work in accordance
with the relevant national and local laws and standards.

HEALTH AND SAFETY POLICY

AWA values the physical and psychosocial health, wellbeing and safety of all persons and aims to
prevent all work-related injuries and occupational illnesses when delivering its services and activities.
AWA is committed to achieving a high level of occupational safety and health performance through the
continual improvement of its occupational safety and health management system.

AWA will:

- conducts its activities in a transparent manner that as a minimum, complies with the
requirements of applicable legislation, regulation, codes and standards;
- ensures safety and health considerations are included into all aspects of its decision-making
process and water and wastewater facilities operation;
- measures, monitors and reports overall occupational safety and health management
performance through the establishment of key indicators, objectives and targets that promote
continual improvement opportunities;
- provides adequate training to employees, ensure they competent to do their task and make
them accountable for preventing work-related injuries and illness;
- develops and maintains an occupational health and safety management plan that ensures
continuous improvement through the process of risk assessment and risk minimization;
- provides and maintain safe plants, facilities and equipment’s;
- ensures safe handling and use of substances and chemicals;
- communicates openly with stakeholders on safety and health issues.

The Director of AWA has overall responsibility for implementation of this policy.

------------------------------------------- -----------------------------------------------

Director of AWA Chairman of AWA

Date approved:

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AWA – Occupational Health and Safety Management Plan
2 Legal requirements
Specific knowledge of legal and other requirements and associated tasks are necessary to establish
objectives and targets as well as to develop adequate management plans and operational controls to
achieve the objectives and targets.
The significant current legislation governing occupational health and safety is as follows:
 Organic Law of Georgia on Occupational Health and Safety, No 2048 Consolidated versions
(30/11/2018 - 22/12/2018)

 Organic Law of Georgia on Labour Code No 729 of 12 June 2013 – Website, 04/07/2013
 Organic Law of Georgia on the Labour inspection service No. 7178 of 29/09/2020 Website,
05/10/2020

AWA OHS staff will continually monitor legislation for any amendments and implement compliance
programs and employee communication, with these changes, as required.
Prodigy has a written operational control to identify changes in activities, occupations, operations, and
facilities that might affect the application of legal and regulatory requirements as well as health and
safety risks. The operational control indicates who in management receives results of the report on
changes and includes a regular review of the control. Operational controls for identifying such changes
include workplace inspections and regular interviews with area supervisors on changes in their areas.

3 Hazards identification
The identification and communication of hazards is the responsibility of all personnel who access port-
controlled areas. Management must ensure that hazards with potential to harm personnel are
identified, risk assessed and controlled.
Knowledge of hazards and evaluation of associated risks are necessary requirements for establishing
health and safety objectives and targets, and for setting priorities to control the identified risks to
employees and others on an ongoing basis. All contractors and subcontractors involved in the
exploration, construction, and operation of the Project are required to carry out hazard identification.

For all phases of the Project, AWA will have knowledge of potential hazards through such sources as:
• Legal and regulatory requirements;
• Company sustainable development policy and supporting policies;
• Records of incidents, accidents and non-conformances;
• Company OHS audits;
• Communications from employees and others;
• Information from health and safety consultations;
• Information on best practices, typical hazards for the industry, and incidents and accidents in
other organizations;
• Details of changes in occupations, facilities and activities;
• Inventory of hazardous materials and the toxicology of the hazardous materials;
• Monitoring data;
• Existing administrative, engineering and personal protective equipment controls;
• Workplace knowledge and other data;
• Process hazard analysis;
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AWA – Occupational Health and Safety Management Plan
 • Management of change process.
Risk assessment, evaluation and control of occupational hazards will be undertaken in consideration of
the following broad hazard categories:
• chemical hazards – such as fumes and vapours;
• physical hazards – those related to heat, cold, noise, vibration, ionizing radiation, ultra-violet
light and workplace lighting;
• biological hazards – including mosquito borne viruses, potable water contaminants and other
water borne hazards such as legionella;
• ergonomic hazards – including manual handling hazards.

3.1 Risk assessment

Based on the Hazard Identification, Risk Assessment, and Controls Methodology, AWA will creates a list
of activities, occupations, and facilities and associated hazards with established priorities for risk control
and action.

Extract Organic Law of Georgia on Occupational Health and Safety, No 2048 Consolidated versions
(30/11/2018 - 22/12/2018):
“Article 6: Prevention
1. Employer at every stage of the work in order to reduce and eliminate the risk to the occupational
safety according to the size of the enterprise and the nature of the work should assess this risk,
according to the rules set by the administrative-legal act of the Minister, revise the risk assessment
document and take necessary steps based on the following general principles:
a. Make sure that the existing risks are avoided;
b. Evaluate those risks and threats, which cannot be avoided;
c. Make sure that the risks are reduced, including the elimination of their sources;
d. Within its capacities, according to the specifics of the work, replace the risk factors with safe or
less dangerous factors;
e. Elaborate a consistent policy of the preventive measures, which would consider the nature of the
workplace and work process;
f. Based on the subparagraph ‘e’ of this paragraph and on the analysis of the risk factors, elaborate a
written document, which should contain the measures aimed at reducing and eliminating risks
against the health of the persons at the workplace and other persons, which should be carried out
in the case of every type of work and at every level of enterprise management, also the time
frame for their implementation, as well as the budget for their implementation.”

3.2 Hazard and risk identification reviews

AWA determines and communicates appropriately a timeframe to complete written initial hazard
identification and risk assessment of identified occupations, activities, and facilities that might present
health hazards.

AWA will has written operational controls to review hazard identification, risk assessment, and risk
control. Reviews will be conducted periodically and the review documented and made available for all
employees.
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AWA – Occupational Health and Safety Management Plan
4 Roles and responsibilities

AWA will regularly review and update any changes in roles, responsibilities, and accountabilities.

4.1 AWA management

AWA management has the greatest responsibilities with respect to health and safety in the workplace
and is responsible for taking every precaution reasonable in the circumstances for the protection of a
worker. AWA management is responsible for ensuring that responsibilities at each management level
are clearly described in the job description and is responsible for monitoring accountability.

4.2 Utilities
Utilities are responsible for making workers fully aware of the hazards that may be encountered on the
job or in the workplace; and ensuring that they work safely, responding to any of the hazards brought to
their attention, including taking every precaution reasonable in the circumstances for the protection of a
worker.

4.3 Employees
Employees responsibilities include: reporting hazards in the workplace; working safely and following
safe work practices; using the required personal protective equipment for the job at hand; and
participating in health and safety programs established for the workplace.

Employee involvement is essential. Involvement of employees at all levels is needed for effective
performance of OHS-related tasks. All employees are required to practice good housekeeping,
participate in training, report hazards and injuries, use personal protective equipment, and practice safe
work habits. It is necessary that roles, responsibilities, and accountabilities be defined, documented, and
communicated.

Each employee is expected to actively participate in, and take ownership of Environmental, Health, and
Safety Policy, goals, and objectives. Line management will be accountable for implementing this policy.
Senior management will be visibly committed and actively supportive of this policy.

4.4 Contractors
For all phases of the project, AWA and the contractor will work closely together. They will define,
document, and maintain a list of the roles, responsibilities, and accountabilities of the employees
(management) responsible for OHS performance in their areas. They will also review the
implementation of their respective OHS Management System, and the OHS personnel advising and
assisting management to meet their OHS Management System responsibilities.
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4.5 Occupational safety specialist
The occupational safety specialist possess relevant professional experience and qualification (skills and
technical habits, which is confirmed by the special document issues after the completion of the certified
course. OSH specialist should has attended a relevant accredited programme for the OSH specialists at
the relevant accredited institution.

4.6 Visitors
Visitors and other persons to also have responsibilities to abide by our workplace safety rules and
procedures. These responsibilities include to:
• take reasonable care for their own health and safety and for the health and safety of other
persons
• comply with, so far as they are reasonably able, all reasonable safety directions provided by staff
• report all safety related incidents to staff
• not enter any restricted area without authorisation or escort
• not wilfully or recklessly interfere with property.

5 Training and awareness

All employees need some level of training depending on whether they manage, perform, or verify
activities affecting health and safety risks or environmental aspects. A key factor is to match training
provided with training needed. Training and awareness needs are determined by:

• Results of the environmental aspects evaluation;

• Results of hazard identification, risk assessment, and risk control;
• Company sustainable development policy and supporting policies;
• Legal and regulatory requirements;
• Established objectives and targets;
• Management Plans.

AWA identifies and documents training needs and delivers appropriate training to all employees whose
work might affect risks to health and safety in the workplace and whose work might create a significant
environmental impact.
All AWA contractors are required to enforce these requirements of training within their own companies.

Contents of the trainings should be:

• Importance of conformance to requirements of the OHS Management System and OHS policies;
• Risk associated with work in a remote environment;
• Risk associated with work in extreme climatic conditions;
• Risk to the environment and to health and safety of their work activities;
• Risk to the environment and to health and safety of deviations from specified operational
controls;
• Benefits of a healthy and safe workplace; and

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AWA – Occupational Health and Safety Management Plan
 • Their specific roles and responsibilities in achieving compliance.
AWA regularly reviews and updates the training and awareness plan based on changes in training needs
related to OHS Management System awareness, occupation-specific training, and regulatory-required
training.

6 Reporting and documentation

Reporting and documentation requirements are outlined in AWA’s framework. During the construction
phase of the project, the contractor will be required to implement a reporting and documentation
system.

7 Communication
Open communication between workers and managers is important to ensuring a safe workplace.
Therefore, workers are encouraged to:
• ask questions relating to WHS
• bring up safety concerns
• make recommendations regarding WHS
• give regular feedback
• become involved in evaluation of safety issues
• participate in any WHS related problem solving process.

It is important that workers help shape decisions about OHS particularly when:
• identifying hazards and assessing risks
• making decisions about ways to eliminate or minimise those hazards or risks
• proposing business changes that may affect the health and safety of workers
• purchasing of new equipment or substances
• developing or changing job tasks or safety procedures.
All workers are encouraged to raise any work health and safety concerns they may have with their utility
manager and/or occupational safety specialist.

During the construction phase of the project, the contractor will be required to implement an OHS
communication plan.

8 Operational control

Operational controls include administrative, engineering, and personal protective equipment controls
and other protective measures (e.g., machine guarding, railing). Administrative controls include
programs, standard operating procedures, practices, guidelines, and instructions. Operational controls
are the significant means and actions to control health and safety hazards and risks, and environmental
aspects and significant impacts.

8.1 General hazard prevention

a) Manual Handling
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Where a manual handling task is required a risk assessment shall be completed to identify the hazards.
The risk of injury should be assessed for each hazard, and appropriate controls implemented, including
manual handling training as appropriate.
Management must ensure suitable powered mechanical plant or equipment and lifting aids are provided
to enable personnel to avoid heavy manual tasks.
Employees shall undertake manual handling training periodically.

b) Working Alone
Where personnel are required to work alone, the activities and conditions shall be risk assessed and a
safe system of work developed.

c) Ergonomics
All personnel will consider ergonomics when designing or arranging workstations, products and systems
so that they fit the personnel who use them.
Management shall ensure that where ergonomic hazards are identified and pose a threat to personal
safety, a risk assessment is completed by a competent person. Personnel shall be informed of the risks
and provided with the necessary equipment and information to reduce the risk.
Special consideration should be given to ergonomics in confined spaces, awkward or difficult to access
spaces, using heavy or awkward tools and equipment, and using repetitive or high force actions.

d) Hygiene and Sanitation

AWA management will supply suitable facilities for personnel including:
• Toilet facilities within a reasonable distance from each
• workspace;
• Sanitation and hygiene facilities that are properly maintained;
• Eating places that are dry, clean, well ventilated and have
• adequate seating, tables, hand washing and waste disposal
• facilities; and
• Potable water supplies available to all personnel.
Personnel must ensure their own hygiene at all times and must not intentionally pollute work areas or
misuse or damage any sanitation or hygiene facilities provided.

e) COVID-19
AWA management will developed a COVID-19 Infectious Disease Management Plan which describes
how AWA manages the risks of COVID-19.

f) Hazardous Substances
AWA management must ensure the safe control of hazardous substances and reduce the level of
exposure to personnel, property and the environment.
A risk assessment must be undertaken to assess the health risks to personnel. Health surveillance may
be required to monitor the health of personnel who are at significant risk of exposure to hazardous
substances.

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AWA – Occupational Health and Safety Management Plan
 g) Personal Protective Equipment (PPE)
AWA management must ensure that all personnel and visitors wear or use personal protective clothing
or equipment provided if it is necessary to protect them from harm. Personal protective clothing or
equipment must be properly fitted, and users instructed in their use.
All personal protective clothing and equipment supplied must conform to an applicable Standard, be
properly maintained and, if it becomes defective, replaced.
All personnel must wear or use personal protective clothing and equipment where a sign is displayed to
do so or as identified by risk assessment.

h) Alcohol and Drugs

Personnel must not commence work if they are not fit for duty or if they are impaired by alcohol, illicit
drugs or medication.
Any personnel taking medication, including prescription and over-the counter medications which may
cause impairment, must inform their supervisor of the potential effects that medication may cause.
Supervisors must monitor the person’s fitness for duty and assign alternate duties wherever
appropriate.

8.2 Task specific hazard prevention

a) High Risk Work
AWA management must identify High Risk Work and implement a procedure or risk assessment specific
to that task to ensure hierarchical controls are in place to eliminate, prevent or control the risk.
Management must ensure that personnel performing High Risk Work requiring a high risk work licence,
do hold a current licence in that particular class, and are competent in that particular High Risk Work.

b) Electrical Work
AWA management must ensure compliance with legislative requirements when undertaking electrical
work as outlined in relevant Georgian Standards.
All personnel required to carry out electrical work must be authorised to do so by a licence or permit
under the national regulations. Suitably qualified electrical supervisors must carry out their duties as
outlined in the national regulations.
An electrical log book must be kept at each operational site to record plans, work carried out and other
relevant information.
c) Confined Space
AWA management must ensure that existing and new infrastructure is inspected for the purpose of
identifying a confined space. A risk assessment and rescue plan must be completed prior to entry.
Management must ensure that personnel do not enter or work in a confined space unless another
person is present in the immediate vicinity outside the confined space, for the purpose of undertaking
the duties of a stand-by person.
Personnel entering or working in and around confined spaces, and the manager or supervisor
supervising and/or approving the tasks, must be competent.

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 d) Excavation and Earthworks
Management must ensure installation or provision of protective systems to protect employees from
earth collapse or ground movement while working in and around excavations.
Personnel conducting excavations and ground penetrations in greater depth need a permit. The permit
holder must ensure that the excavation and or related earth works are carried out in accordance with
national regulations:
Excavation, with consideration for identification for underground services, minimum benching
requirements and appropriate barricading and safety signage.

e) Concrete Work
All concrete works must be carried out in accordance with the national regulations and standards.
AWA management must ensure identification of all hazards associated with concrete work and
implement appropriate controls to manage risk.

9 Procurement
During procurement processes consideration is given to the suppliers, bids or tenders that will yield the
least potential negative impact to the health and safety of personnel. Suppliers are required to conform
to the relevant provisions of Australian Standards for OHS Management Systems including but not
limited to:
• Evidence that they are systematically controlling risks associated with their products or services;
• Evidence that they have an acceptable OHS Policy and effective systems in place to manage OHS
risks; and
• Evidence that they have taken suitable steps to ensure the control of hazards/risks in relation to
their services.

10 Emergency preparedness and response

Emergencies that could result in an accident or incident causing injuries, illnesses, or environmental
impacts, or that could cause health and safety risks or environmental impacts, need to be considered in
the OHS Management System.

AWA will establishes and maintains operational controls to identify the potential for and responses to
accidents, incidents, and emergency situations, and to prevent and mitigate the likely associated injury,
illness, and adverse environmental impacts

AWA will regularly reviews its emergency preparedness and response plans and operational controls. In
addition, a timely review will be undertaken after accidents, incidents, or emergency situations.

11 Performance measurement and monitoring

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11.1 Health Surveillance
AWA management must ensure that health assessments are carried out in respect of all personnel who
engage in specific tasks with the potential for occupational exposure, if:
• an identifiable disease or other adverse effect on the health of the employee may be related to
the exposure;
• there is a reasonable likelihood that the disease or adverse effect may occur under the
particular conditions of work;
• there are recognised techniques for detecting indications of the disease or adverse effect.
• personnel are exposed, or likely to have been exposed, to a hazardous substance in excess of
the exposure standard for that hazardous substance.
Health Surveillance is carried out to monitor for possible health effects that may arise following
occupational exposures at concentrations above accepted exposure standards.

11.2 Internal Audits

Internal health and safety audits are conducted in accordance with the Health & Safety Internal Audit
Schedule, which is developed annually. Audit evidence is documented, and findings recorded in the
Health & Safety Audit Report Form.
Refer to Internal Audit Procedure for the scope, frequency and methodologies of OHS auditing activities,
and the competencies, responsibilities and requirements for conducting audits and reporting results.

11.3 Workplace Monitoring

a) Workplace Inspections
Management must ensure that each work area is inspected regularly to ensure the work area is safe in
accordance with the national regulations and OHS laws.
Workplace Inspections must be undertaken to identify and rectify hazards, communicate hazard types
and controls put in place, monitor the effectiveness of controls and identify means of eliminating or
reducing risks.
They shall be documented. The types and frequencies of workplace inspections are required according
national regulations.

b) Calibration of Equipment
AWA management must ensure that equipment is maintained, inspected and calibrated in accordance
with the manufacturer manuals, national standards and OHS laws.

12 Accidents, non-conformances and corrective and preventive action

Root or basic cause analysis is important for evaluating and investigating accidents, incidents and non-
conformance and for establishing objectives and targets for a successful corrective action program.
Through this process, the actions taken to address non-conformance can result in permanent and
positive changes in the EHS Management System and continuous improvement. It is important that
employees with health, safety, and environmental responsibility be part of this process to assist in
identifying actual and potential health and safety risks, and adverse environmental impacts.

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AWA will use operational controls for handling and investigating potential accidents, incidents, and
non-conformance that include:
• Tracking and recording details of accidents, incidents, and non-conformance;
• Root or basic cause analysis;
• Mitigating any health and safety risks and adverse environmental impacts that arise from
accidents, incidents, or other non-conformance, including corrective and preventive action;
• Where mitigation is necessary, conducting a health and safety risk assessment and significance
evaluation of the environmental aspects of the proposed corrective and preventive action(s) to
determine appropriateness and effectiveness; and
• Implementing, recording, and communicating changes arising from the corrective and
preventive action, e.g., changes in operational controls.

13 Records and records management

AWA maintains and preserves internal and external records that are critical to design and performance
of the EHS Management System. These records include:
• Employee training records;
• Inspection reports;
• Management of change checklists and outcomes;
• Consultation reports;
• Accident, incident, and non-conformance reports and follow-up corrective and preventive action
reports;
• Medical test reports (medical test reports and health surveillance reports might be considered
confidential);
• Health surveillance reports;
• Cases of occupational disease and compensation claims;
• Audits and assurances;
• Management reviews;
• Other reviews;
• Environmental aspect evaluations;
• Emissions measurements;
• Exposure measurement records;
• Hazard identification, risk assessment and risk control records;
• Government reports.

14 Auditing, review and update

AWA conducts internal audits to determine the degree of implementation and to verify performance of
the OHS Management System. Management and labour representatives may undertake audits. The
results of audit(s) and management review(s) form the basis for the annual written statement of
assurance by management on effectiveness of the OHS Management System.

15 Management review

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Management reviews the OHS Management System to determine its continued suitability, adequacy,
and effectiveness. Outcomes of a management review include recommendations to revise AWA’s
policies, to revise established objectives and targets, and to specify corrective actions for individual
management with target dates for completion.

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ESHS Checklist for small to medium Construction Sites
Project, Monitoring person, name of IC and PEA, Location/Sites, Time:

Before works start the following MUST be in place (tick if items are in place and if acceptable)

Permits Supervision & Qualified/ OHS Plan & First OHS induction/ Drinking Sanitation Changing/
ESMP insured workers Aid Provisions training water Canteen
SELECT SELECT Tick the box to identify if hazard or activity is identified. All controls identified below must be in place.
HAZARD OR CONTROL
ACTIVITY Tick the box to identify if controls are in place; Tick when controls are OK according to guidance text.

Shoring Ladder Access Exclusion

No undermining Chock Spoil back
zone Barriers
Excavations o >1.25m provide sloping the sides of the
Remarks: 1
excavation to an angle not steeper than 1 :1 or
2
provide shoring & ladder
o Keep excavated soil (spoils) and other materials at
least 0.6 meter from trench edges.
o Keep heavy equipment away from trench edges.

Scaffolding
working Edge protection Trestle Platform Open holes Nets/Bean
platform Safe Ladder Propping
Bags
Falls and o Ladders are fastened in place at the top and
Falling bottom.
Objects o Scaffolding have stable footing.
o Fixed guard rails are in place to prevent falls.
Remarks:
o Safety harnesses are worn and clipped on where a
fall could occur.
o Equipment is in good working order.
o Workers are being supervised and acting safety.
o Fall from objects is prevented

Road signage Traffic speed control Reverse warning devices Other

Liaison

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 o A traffic control plan for the movement of vehicles in
areas where there are also workers conducting other
tasks and when members of the community can be
Traffic impacted.
management o Traffic management plans are in place to manage traffic
movement.
Remarks:
o Vehicle and pedestrian walkways are segregated.
o Vehicles windscreens, mirrors and lights are clean and in
working condition.
o Workers wear high visibility jackets.
o Reversing is avoided where possible and one-way
systems are in place.
o Banksman or reversing assistant is used to assist when
reversing.

Fencing/Hoarding Barriers Traffic Dust-muck

Liaison Pedestrian control
Working routes Lightning
close to the o Public access to the site and equipment is
public restricted.
o Construction sites will generally adopt perimeter
security measures to control access, both for
Remarks:
safety purposes, and to prevent damage, theft of
vandalism.

Gene-
Other & rator Outside Confined space Tripod
Check cable Guards
Electric
Other
Works
o Avoiding uneven surfaces, obstacles, trailing
Remarks: cables, wet or slippery surfaces, changes in level.
o Avoid untidy workplaces
o Are confined spaces safe and is worker properly
secured (e.g. rope and tripod) and ventilation
installed if required?

Personal
Protective
Equipment
Remarks: Safety Respiratory Face Safety
Ear Dust Mask
helmet/Boo Eye Protection Safety Gloves Equipment Protection Harness
Protection
t/Hi-Vis
SELECT SELECT Tick the box to identify if hazard of activity is identified. All controls identified below must be in place.
HAZARD OR CONTROL
Tick the box to identify if hazards could occur; tick when hazards are under control.
ACTIVITY

Environm
ental and
Social
Aspects
Remarks: Bad working Unfair
Waste working
Leakages environment
managemt. Air pollution conditions Child labor

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 Other:
o Check ESIA and ESMP for risks and follow them up.

Further notes:

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