Beruflich Dokumente
Kultur Dokumente
Safety Plan
April 2016
prepared for
Site-Specific Safety Plan
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Plain Safe: A straight Site-Specific Health & Site Job Hazard & Task Analysis & Safe Hazardous Products &
talking guide to... Safety Agreement Risk Register Work Method Statement Substances Register
Everything you need to know on Agreement between businesses Live document for PCBU 2 to record Job-planning tool for notifiable Records products, substances and
how to complete a Site-Specific working on a specific site on how significant hazards that cannot be works or other higher-risk activities. materials with hazardous ingredients.
Safety Plan. health and safety will be managed. eliminated. Keep updated. Use pre-work and update. Use pre-work then update.
Read pre-start Complete pre-start Complete pre-start Complete pre-start Complete pre-start
Emergency Response On-site Training and Site Safety Briefing Site Incident & Site Inspection
Plan Competency Register Toolbox Meeting Minutes Injury Register checklist - generic
Work needing Task Analysis/Safe Records training, qualifications Records who was responsible for Records incidents that caused, or Tailored to meet specific
Work Method Statement or Permit and competencies of workers what and by when; proves that a could have caused, harm to people requirements of a job. Use pre-work
to Work. Use pre-work and update. on-site. Use pre-work and update. practice or hazard was discussed. on-site. For on-site reporting. and on-site as agreed by all parties.
Complete pre-start Complete pre-start After start After start After start
Type of business
Main contractor Client Principal Contractor Subcontractor Other
Type of business
Main contractor Client Principal Contractor Subcontractor Other
If yes, have you provided a copy of the notification (or receipt from WorkSafe)
with this agreement? Yes N/A
If yes, we agree to have the relevant safety data sheets available onsite. Yes N/A
Communication
How will you be
communicating health Type of communications Frequency
and safety information
and activities to your Toolbox talks Yes N/A
employees, subcontractors
and other PCBUs?
Project pre-start briefings Yes N/A
Other
Damage to plant/equipment/
Immediately Within 24hrs
machinery (serious)
We will report these
Our own system or paperwork PCBU 1s system and paperwork
incidents using
Other inspection
Training/experience/competency
We agree that every worker under our control on site will hold a current site
safety card. Yes N/A
We agree that every worker under our control on site will be given a job-specific
safety induction. Yes N/A
We agree that every worker under our control on site will be appropriately
qualified, competent, or fully supervised. Yes N/A
For the agreed activities set out on page two of this agreement, we will provide
PCBU1 with evidence of competency (on-site training and competency register)
Yes N/A
for any workers participating in those activity types of activities (list below).
Environmental
Is there an environmental plan required for this site? Yes N/A
Is a resource consent required for any of the activities you will undertake
Yes N/A
on this site?
Will your activity potentially cause dirty water or wash-down runoff, silt or other Yes N/A
contaminants to be released?
2. Explain how potential for fire and explosion during refuelling will be controlled?
Subcontractors to PCBU2
Subcontractors working on this site and not covered by this SSSP Agreement Yes N/A
must supply their own agreement.
Emergencies
We agree that we will respond to any emergencies as outlined in PCBU1 induction
Yes N/A
and emergency response plan.
If N/A, we agree to provide our own emergency response plan for this site. Yes N/A
PCBU 2 (Subcontractor)
We agree to act according to the content of the Site-Specific Safety Plan as outlined above.
Signed (If signing electronically please type your name here) Date
Identified hazard or harm What is the initial risk Controls Level of control What is the residual risk For discussion at
e.g. Trip hazard on top step assessment? e.g. Build a ramp Use hierarchy of assessment? a toolbox talk/
Use risk assessment matrix controls table Use risk assessment matrix safety meeting?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Catastrophic
(e.g fatal)
Moderate Moderate High Critical Critical
Consider the severity of injury/illness
Major
(e.g Permanent Disability)
Low Moderate Moderate High Critical
Moderate
(e.g Hospitalisation/Short or Long Low Moderate Moderate Moderate High
Term Disability)
Minor
(e.g First Aid)
Very Low Low Moderate Moderate Moderate
Superficial
(e.g No Treatment Required)
Very Low Very Low Low Low Moderate
Hierarchy of controls
Most Effective ELIMINATE:
1 Eliminate the hazard - remove it completely from your workplace. If this isnt reasonably practicable, then...
MINIMISE:
2 Substitute the hazard - with a safer alternative. If this isnt reasonably practicable, then...
3 Isolate the hazard - as much as possible away from the workers. If this isnt reasonably practicable, then...
4 Use engineering controls - adapt tools or equipment to reduce the risk. If this isnt reasonably practicable, then...
5 Use administrative controls - change work practices and organisation. If this isnt reasonably practicable, then...
Least Effective 6 Use personal protective equipment (PPE) - this is the last option after
you have considered all the other options for your workplace.
This Task Analysis (TA) has an Emergency Response Plan Yes N/A Site name
Subcontractor
company name Site address
Task Analysis (TA) and Safe Work Method Statement (SWMS) BACK TO TOP Page 11 of 15
Sequence of basic steps Potential hazards and risks Initial risk Control methods and level of control Residual risk
Describe each step in the activity most will Describe the key hazards and risks for each step there will normally assessment Describe the key/significant way to control the risk and then refer to the assessment
have 4-8 steps. Follow the flow of the product or be more than one per step. Number each hazard e.g 1a, 1b, 1c; 2a, Before the controls hierarchy of controls After all controls
process. 2b, 2c. are in place. are in place.
Refer to the risk Refer to the risk
assessment matrix. assessment
Control method Level matrix.
Step No.
Step No.
Task Analysis (TA) and Safe Work Method Statement (SWMS) BACK TO TOP Page 12 of 15
Sequence of basic steps Potential hazards and risks Initial risk Control methods and level of control Residual risk
Describe each step in the activity most will Describe the key hazards and risks for each step there will normally assessment Describe the key/significant way to control the risk and then refer to the assessment
have 4-8 steps. Follow the flow of the product or be more than one per step. Number each hazard e.g 1a, 1b, 1c; 2a, Before the controls hierarchy of controls After all controls
process. 2b, 2c. are in place. are in place.
Refer to the risk Refer to the risk
assessment matrix. assessment
Control method matrix.
Step No.
Step No.
Task Analysis (TA) and Safe Work Method Statement (SWMS) BACK TO TOP Page 13 of 15
Sequence of basic steps Potential hazards and risks Initial risk Control methods and level of control Residual risk
Describe each step in the activity most will Describe the key hazards and risks for each step there will normally assessment Describe the key/significant way to control the risk and then refer to the assessment
have 4-8 steps. Follow the flow of the product or be more than one per step. Number each hazard e.g 1a, 1b, 1c; 2a, Before the controls hierarchy of controls After all controls
process. 2b, 2c. are in place. are in place.
Refer to the risk Refer to the risk
assessment matrix. assessment
Control method matrix.
Step No.
Step No.
Task Analysis (TA) and Safe Work Method Statement (SWMS) BACK TO TOP Page 14 of 15
Sequence of basic steps Potential hazards and risks Initial risk Control methods and level of control Residual risk
Describe each step in the activity most will Describe the key hazards and risks for each step there will normally assessment Describe the key/significant way to control the risk and then refer to the assessment
have 4-8 steps. Follow the flow of the product or be more than one per step. Number each hazard e.g 1a, 1b, 1c; 2a, Before the controls hierarchy of controls After all controls
process. 2b, 2c. are in place. are in place.
Refer to the risk Refer to the risk
assessment matrix. assessment
Control method matrix.
Step No.
Step No.
Task Analysis (TA) and Safe Work Method Statement (SWMS) BACK TO TOP Page 15 of 15
Date: Company Site Name
Complete pre-start Onsite
Date Identified Product or Substance Are safety data What is the related harm? What is the initial risk Is personal protective What other measures are required? What is the residual risk
DD/MM/YY e.g. petrol sheets held? e.g. risk of explosion assessment? equipment required? e.g. store in a locked space away from any assessment?
Use risk assessment matrix ignition source Use risk assessment matrix
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Yes No Yes No
Catastrophic
(e.g fatal)
Moderate Moderate High Critical Critical
Consider the severity of injury/illness
Major
(e.g Permanent Disability)
Low Moderate Moderate High Critical
Moderate
(e.g Hospitalisation/Short or Long Low Moderate Moderate Moderate High
Term Disability)
Minor
(e.g First Aid)
Very Low Low Moderate Moderate Moderate
Superficial
(e.g No Treatment Required)
Very Low Very Low Low Low Moderate
Hierarchy of controls
Most Effective ELIMINATE:
1 Eliminate the hazard - remove it completely from your workplace. If this isnt reasonably practicable, then...
MINIMISE:
2 Substitute the hazard - with a safer alternative. If this isnt reasonably practicable, then...
3 Isolate the hazard - as much as possible away from the workers. If this isnt reasonably practicable, then...
4 Use engineering controls - adapt tools or equipment to reduce the risk. If this isnt reasonably practicable, then...
5 Use administrative controls - change work practices and organisation. If this isnt reasonably practicable, then...
Least Effective 6 Use personal protective equipment (PPE) - this is the last option after
you have considered all the other options for your workplace.
Name and ID No. Site Safe Key role or tasks Site induction Training/qualifications Experience Competence
First and last name card type date (Any Site Safe training, trade and skills training, formal qualifications - certificates, No. of years Level of competence
DD/MM/YY licences, unit standards, etc relevant to the key role or task). experience relating to in current job, see
the key role or task below
Name
Types of qualifications, certificates, licences, unit standards, other: 1 = Under direct supervision, is not competent (watch all the time); 2 = Under supervision, is partially
competent (line of sight); 3 = Indirect or occasional supervision, is partially competent (supervision nearby);
EWP (elevated work platform), PAT (powder actuated tool), FL (fork lift), FA (fall arrest), SCA (scaffold),
4 = Fully competent to work unsupervised; 5 = Competent to train.
DOG (dogman), LBP (Licensed Building Practitioner card type and number), CRA (crane specify type),
LULU - under supervision, is partially competent (line of ishgt); Indirect or occasional supervision, is
MP (mobile plant specify type), RELECT (registered electrical worker), ELTAG (electrical testing and tagging),
partially competent (upervision nearby); Fully competent to work unsupervised; Competent to train.
STMS (site traffic management supervisor), TC (traffic controller), EXP (explosives), NZQA (trade or safety units)
Competence designation:
Onsite training and competency register BACK TO TOP Page 19 of 20
Name and ID No. Site Safe Key role or tasks Site induction Training/qualifications Experience Competence
First and last name card type date (Any Site Safe training, trade and skills training, formal qualifications - certificates, No. of years Level of competence
DD/MM/YY licences, unit standards, etc relevant to the key role or task). experience relating to in current job, see
the key role or task below
Name
Type of emergency
e.g. Fall from height while
Location
wearing a harness
PCBU1 PCBU2
Describe work activity
e.g. Working from MEWP Supervisor Date
and fall off
Name each person involved in the rescue Their role or responsibility in the rescue is to: List the training required Provide contact details
First name and last name e.g. release the bleed valve e.g. competence using MEWP Phone number
Site-specific Briefing
Health and safety Issues raised from site safety inspection Actions By who and when
issues
Site activities/
safe work practices/
incident reports and
investigations discussed
Issues outstanding from previous briefings Actions By who and when
Day-to-day site
management issues/items
for discussion
Hazard board and signage up-to-date Proper lift assessment plan done Correctly stored
Environmental plan issues Crane certification current Safety Data Sheet (SDS) available
Toolbox talk last date / / Slings/chains certified Operators using PPE
Safety inductions for all on site Operator procedures in place
12. Tools
Safety notice board current Inspections being done
PAT tool WoF current and secure
Man cage available
2. Site facilities Staff trained in tool use (SWPS)
Emergency plan in place
Offices clean, adequate & good lighting PAT signage on site
Smoko sheds clean, potable water 7. Compressed air equipment
13. Scaffolding
Toilets clean, washing water In good condition
Notifiable weekly Scaftag/current
Tool/equipment sheds adequate Appropriate guards fitted
Handrails/mid-rails
Trained user
3. General site tidiness and accessways Toe boards
Clear, safe access to work areas 8. Excavations Platforms
Stairways and accessways clear Correctly shored Ladders/stairs
Hoardings/fence and gates secure Base sound
9. Welding/gas cutting
Loose materials secure from wind Work platforms clear
Hot work permits being issued
Platforms trip free
4. Personal safety equipment Fire extinguishers on hand
Planks tied down
Signage displayed and legible Operators using PPE
Headroom clear
Hardhats being worn
10. Electrical equipment Ties/bracing adequate
Correct footwear being worn
Main board lockable/weatherproof 14. Ladders
Glasses/ear muffs/vests/masks used
Current tagged and damage-free leads
Good condition
5. First aid/fire prevention Current tagged plant
Secured top and bottom
First aid box Available Current tagged lifeguards
Stays to step ladders
Accident register Leads safely placed
Working 2 steps down
Fire extinguishers Available Equipment in good condition
Current (12 mth) Appropriate guards on equipment 15. Fall hazards
Date and time Details Immediate action taken? Does this incident Should this incident be Is this incident the Signature and date
DD/MM/YY Name of person (injured or observer), description of require a WorkSafe investigated by your subject of a toolbox DD/MM/YY
accident/incident/near miss, type of injury/disease (if any). notification? company (PCBU 2)? talk?
How did it happen? (briefly).