CS Roofing Job Safety Analysis – B-Compliant Smart Forms

General Details

Name of Site: *

Job Type: *

Job Task *

Toolbox meeting frequency *

Meeting run by:

PPE:

Hard hats (not required for on roof work, unless deemed so by principal contractor) *

Hi Vis, Safety glasses, Gloves *

Safety footwear, Soft soled shoes for on roof work *

Comments or Action taken

Site Access

Site Sign displayed updated *

Updated daily with specific hazards identified *

Area to be cordoned off *

Comments or Action taken

Method of cordon:

Ladders

Can they be extended to at least 1m beyond the landing point? *

Does it meet the NZ Safety standards for Ladders *

Is it positioned in a 4 to 1 ratio *

Has it been tied off at the top and secured at the bottom *

Comments or Action taken

Edge Protection

Erected by

Edge Protection response *

Current certificate dated

Current certificate dated response *

Comments or Action taken

Scaffolding

Erected by

Internal access to scaffolding *

Adequate handrails planking and toe boards *

Scaffold access hatch - has bottom of hatch been sprayed with dazzle to warn when open *

If above 5m, safety tag confirming it has been checked within the last 7 days? *

Date checked

Comments or Action taken

Power operated work platforms

Who are the fully trained workers available to operate the equipment? *

Has the equipment certification card been checked? *

Is certification card current? *

Expiry date response *

Expiry date

Comments or Action taken

Re-roofs

Inspect existing structure for soundness *

Check underside for weakness of support structures and surface material? *

Comments or Action taken

Fragile roofing material

Asbestos *

Glass *

Plastic roof lights *

Other (please state type of material) *

Comments or Action taken

Overhead electrical wires

Are they within 4m of the work area? *

Is Orion consent held? *

Isolation method is used? *

Method of isolation used:

Comments or Action taken

[Test and Tag] and [Safety mesh/nets]

All electrical equipment has a current electrical certificate. *

Safety mesh/ Safety nets online form completed *

Comments or Action taken

Working with Harness Safety Requirement

Personal fall Restraint systems to be used *

Are all workers adequately trained in the use if the equipment? *

Harness Task Analysis MUST BE completed and e-mailed prior to start *

Comments or Action taken

Installer/s Declaration

Installer Name *

Signature *

Clear

Date *

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Recovery Plan

Nearest Medical Centre *

1. Fall under fall protection system applies to this site? *

2. Laceration applies to this site? *

3. Broken bones & Sprains applies to this site? *

4. Head Injury applies to this site? *

5. Chemical poisoning Swallowed, breathed in, in eyes, on skin, bites or stings applies to this site? *

6. Chemical spills applies to this site? *

7. Fire applies to this site? *

Report copied to:

Email Address

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