Document Number

DABULAMANZI CIVIL WORKS & IRRIGATION

Revision Number / Date
MANAGEMENT SYSTEM 00
DAILY SAFETY TASK INSTRUCTION (DSTI) Page Number
CHECKLIST BEFORE WORK COMMENCES Page 1 of 2

AREA:
DATE: / /
TO STANDARD
DESCRIPTION CORRECTIVE MEASURES DATE
YES NO
Safe access to work area – clean & tidy
Sufficient / correct barricading erected
Electrical equipment in good condition
Machine guarding adequate
All tools / equipment pre-inspected
Safe access & egress available and used
Scaffolding tagged accordingly
Gas cutting equipment & hoses
Correct P.P.E (Utilised & available & safe)
Safe working platforms for elevated work
Safe Lifting & Rigging equipment
SMI board up to date
Correct PERMITS for application
PERMITS VALID
LOCK –OUT REQUIRED AND IN PLACE?
CORRECT TOOLS & EQUIPMENT
AVAILABLE
NO OVERHEAD WORK ALLOWED
The above list does not exclude and or wave any other checklist and or legal requirements!
TASK
CURRENT JOB STEPS OF TASK WHAT ARE THE HAZARDS LIST CONTROLS REQUIRED

• If tasks change, this list must be revised before proceeding with new/changed task.
• A signed attendance register must be attached to this list.
I certify that the above items were checked and all workers under my supervision received a safe task instruction:
Responsible Person:
(Foreman/Supervisor) Print Name ______________________ Signature: ________________________

Safety Officer (Contractor) Print Name _______________________ Signature: _________________________

TOOLBOX TALKS AND SIGNATRIES OVER LEAF

DSTI/ TOOLBOX TALK ACKNOWLEDGEMENT
 Document Number
DABULAMANZI CIVIL WORKS & IRRIGATION
Revision Number / Date
MANAGEMENT SYSTEM 00
DAILY SAFETY TASK INSTRUCTION (DSTI) Page Number
CHECKLIST BEFORE WORK COMMENCES Page 2 of 2

I, THE UNDERSIGNED ACKNOWLEDGE HAVING BEEN INFORMED OF THE TASK HAZARDS AND CONTROLS
THAT MUST BE IMPLEMENTED BY MYSELF AND MY FELLOW WORKERS AND AGREE TO WORK ACCORDING
TO THE CONTROLS LISTED ON THE DSTI

TOOLBOX TALK TOPICS: 1____________________________________

2. ___________________________________
PRESENTER: _________________________

DATE NAME SURNAME BADGE NO. SIGNATURE

DSTI CLOSE-OUT
(CHECKLIST – AT END OF SHIFT)

NO DESCRIPTION YES NO N/A ACTION REQUIRED

1 Are safe access to work area reinstated

2 Sufficient and correct barricading erected where required – no
floor openings
3 No tools and equipment left at workplace
4 Hot work inspection no fire hazards identified
5 Scaffolding tagged accordingly?
6 Housekeeping done and up to standard
7 Material neatly and safely stacked
8 All electrical equipment switched off, unplugged
9 Lifting & Rigging equipment correctly stored
10 Any environmental spillage during shift
11 Lockouts applied to all mobile plant and equipment left at work
area
12 Area safe / access to high-risk areas restricted
13 Applicable permits signed off
14 All incidents reported before end of shift
REMARKS:

I hereby certify that the above items were checked in my area/s of responsibility and the area/s is safe and free of any uncontrolled
hazards.
Responsible Person: _________________________ _______________________
(Foreman/Supervisor) Print Name Signature: