Date Prepared: Enter date Prepared by: Insert Name and Position Title Project Number: # TRIM Number: # Potential Items for consideration Potential design design issues issues during Comments / actions specific to the works occurring (how will it be built in a safe way, how will during operation it be used in a safe way) construction Site Layout Have overhead power/underground services been located? Yes No Yes No N/A Eg. Dial before you dig. Will materials and equipment be stored in a Yes No Yes No N/A convenient location? Are there any other specific site layout Yes No Yes No N/A issues that need to be considered? Heights Can anyone be injured by falling a distance of 1.8 meters from either an elevation or into The contractor to ensure that temporary fall prevention measures an excavation Yes No Yes No N/A have been installed while works are being undertaken, prior to Consider raised road surfaces and trenching permanent fall protection devices (ie. Guard rails) are installed. / excavations during construction and after practical completion. Can anyone be injured by objects falling from a height? Yes No Yes No N/A Eg. Work platforms, ladders. Timing
Date Prepared: Enter date Prepared by: Insert Name and Position Title Project Number: # TRIM Number: # Items for consideration (how will it be built in a safe way, how will it be used in a safe way) Potential design issues during construction Potential design issues during operation Comments / actions specific to the works occurring Site Layout Have overhead power/underground services been located? Eg. Dial before you dig. Yes No Yes No N/A Will materials and equipment be stored in a convenient location? Yes No Yes No N/A Are there any other specific site layout issues that need to be considered? Yes No Yes No N/A Heights Can anyone be injured by falling a distance of 1.8 meters from either an elevation or into an excavation Consider raised road surfaces and trenching / excavations during construction and after practical completion. Yes No Yes No N/A The contractor to ensure that temporary fall prevention measures have been installed while works are being undertaken, prior to permanent fall protection devices (ie. Guard rails) are installed. Can anyone be injured by objects falling from a height? Eg. Work platforms, ladders. Yes No Yes No N/A Timing