Date
Time
Location
Conducted by
CLOSED OUT
FOCUS POINTS
COMPLIANT
OBSERVATIONS / FINDINGS
REMEDIAL ACTIONS (IF REQUIRED)
BY WHO
Y
Are haul roads and plant
routes authorised and
well defined including a
local traffic management
plan on display?
Are running surfaces in
good condition and free
of mud , ice ,excess
water etc.
Arrangements for
maintenance in place
(including dust
suppression, Gritting
etc)?
Are edges of haul routes
physically protected
(bunds and/or stop
blocks)?
Is the physical protection
of haul road edges
sufficient and adequate?
Are there any narrow /
choke points?
Are one-way systems
been prioritised?
N
N/A
(Written response must be included)
DATE
CLOSED OUT
FOCUS POINTS
COMPLIANT
OBSERVATIONS / FINDINGS
REMEDIAL ACTIONS (IF REQUIRED)
BY WHO
Y
Adverse camber or steep
gradients?
All signs visible, legible
& in good
condition.(Speed limits,
warning signs etc)
Plant / people interfaces
effectively managed?
Does plant have stable
working platforms?
Is protection of
excavations adequate
(face heights,
surcharging edges)
Are excavations
,stockpiles tis
etc.displaying signs of
slippage / loose materials
/ ingress of water?
Are water courses
identified, protected and
free of obstructions?
Are of GS6
arrangements sufficient
and in good condition.
N
N/A
DATE
CLOSED OUT
FOCUS POINTS
COMPLIANT
OBSERVATIONS / FINDINGS
REMEDIAL ACTIONS (IF REQUIRED)
BY WHO
Y
N
N/A
Sufficient lighting
available (General site &
task lighting)
Other risks
Does the working environment adversely affect the safe operation of plant?
Signed:
Print:
Time & Date:
DATE