Form 995 653 F0157

Date 01Jul2005
Page 1 of 6

Audit Checklist

No. Audit Item N/A Rating Score Auditor’s Notes

5 4 3 2 1
1.0 PERSONAL PROTECTIVE EQUIPMENT
Safety helmets
Safety glasses with side shields
Mono-goggles –where applicable
Face visor/shield where applicable
Safety footwear – serviceable
Hearing protection – where applicable
Gloves where applicable
Respiratory protection – where applicable
Possible Score
Actual Score
2.0 HOUSEKEEPING
Materials correctly stored
Material stacked in a stable manner
Waste material correctly stored/piled up
Bins available for waste material
Vehicle access ways are clear
Barricading / signs in place where required
Correct types of fire extinguishers placed
Work areas are clean and tidy
Access & egress are clear of rubbish & debris
Possible Score
Actual Score
3.0 WELDING AND CUTTING
Cylinders secured & upright
Regulators/hoses/handsets condition
Flashback arrestor fitted to lines at both ends
Welding machine condition (inspection log)
Welding machine earthed and tagged
Welding leads (condition and position)
Protective screens (condition and position)
Fire retardant blankets (condition and position)
Fire extinguishers (condition and position)
Possible Score
Actual Score

Fluor Australia
Health, Safety & Environmental
 Form 995 653 F0157
Date 01Jul2005
Page 2 of 6

Audit Checklist

No. Audit Item N/A Rating Score Auditor’s Notes

5 4 3 2 1
4.0 HAZARDOUS MATERIALS
MSDSs available and filed in register
Containers labeled clearly
PPE provided (in accordance with MSDS)
Eye wash & shower station location known
Separation of reactive materials
Fire extinguishers (condition and position)
Flammable liquids
Electrical equipment explosive rating OK
Bunding – condition, height, depth, etc.
Tank vents
Signage
Clear of combustible waste
Possible Score
Actual Score
5.0 ELECTRICAL
RCD’s devices fitted and records verified
Portable electrical equipment tagged
Ext. leads (condition and position)
Generators (condition and position AS 2790)
Distribution boards locked/condition
Positive lockout & isolation in place correctly
Possible Score
Actual Score
6.0 SCAFFOLDING
SCAFFTAG affixed and complete
Base plates fitted and stable
Scaffold straight and square
Ladder access fitted correctly and anchored
Green Card clean, legible and serviceable
Name of certified person clear
Signature completed
Weight classification ticked
Possible Score
Actual Score

Fluor Australia
Health, Safety & Environmental
 Form 995 653 F0157
Date 01Jul2005
Page 3 of 6

Audit Checklist

No. Audit Item N/A Rating Score Auditor’s Notes

5 4 3 2 1
7.0 RIGGING GEAR
Chain Slings – wear, stretching, tagged, etc.
Wire rope slings (SWL, condition, tagged)
Flat webbing slings – condition, registered
Round slings – check for damage, registered
Chain blocks, turfors,. come-a-longs, etc.
Shackles – stamped, condition, registered
Inspection register maintained
Storage of rigging gear clean
Possible Score
Actual Score
8.0 CRANES
Pre-start inspection completed
Tyre & track condition sound
Rigging equipment inspection log & register
Counter weight swing radius barricaded
Crane located on level/stable ground
Outriggers extended where applicable
Operator trained & certified for crane
Dogman available and used where applicable
Personnel not under/between suspended load
Possible Score
Actual Score
9.0 FALL ARREST EQUIPMENT
Harness and lanyards worn correctly
Inspected, checked and registered in log book
Retractable lanyards and inertia reels correct
Anchor meets AS 1891.1-4 (1500 kg)
Angle of meets systems intent (pendulum etc.)
Ladder positioned correctly and anchored
Possible Score
Actual Score
10.0 AMENITIES
Lunch/dinner facilities are cleaned regularly
Food stuffs stored correctly

Fluor Australia
Health, Safety & Environmental
 Form 995 653 F0157
Date 01Jul2005
Page 4 of 6

Audit Checklist

No. Audit Item N/A Rating Score Auditor’s Notes

5 4 3 2 1
Water kegs filled, clean and labeled
Toilets clean and sanitary
Washing facilities are available and clean
Notices are displayed in prominent area
Possible Score
Actual Score
11.0 LIGHT VEHICLES
Pre start inspection completed and logged
Licenses or certifications as required
Clean and sanitary
Loads tied down and secure
Possible Score
Actual Score
12.0 MOBILE PLANT AND EQUIPMENT
Pre start inspection completed and logged
Operator competency and license
Spotter used when reversing
Operational radium clear and marked
Delineation of work area (barricaded, etc.)
Clean and sanitary
JHA, Pre Start Check List
Lift study where required
Fire extinguisher and first aid kit in good order
Communications radio working
Possible Score
Actual Score
13.0 CONFINED SPACE
JHA completed and signed off/authorised
Permit complete and authorised
Personnel are aware of the permit conditions
Personnel briefed on emergency procedure
Energy isolation/lock out implemented
Stand-by person is trained and certified
Entry register complete and up to date
Lighting and electrical tools used certified

Fluor Australia
Health, Safety & Environmental
 Form 995 653 F0157
Date 01Jul2005
Page 5 of 6

Audit Checklist

No. Audit Item N/A Rating Score Auditor’s Notes

5 4 3 2 1
Emergency equipment is available and usable
Atmospheric testing completed as required
Possible Score
Actual Score

Total Possible Score

AUDIT TOTAL
Total Actual Score
Percentage

Location: Date:
Inspector’s
Signature:
Name:
H&S Reps
Signature:
Name:
Supervisor’s
Signature:
Name

PROJECT MANAGER’S COMMENTS

SIGNATURE: DATE:

Fluor Australia
Health, Safety & Environmental
 Form 995 653 F0157
Date 01Jul2005
Page 6 of 6

Audit Checklist

OBSERVATIONS – FOLLOW-UP: Responsible Due Completed

Person Date

Note!!! This form is referenced in Procedure 995 653 8103.

Fluor Australia
Health, Safety & Environmental