Section Two
OHSE Management Plan

OHSE Management Plan

PROJECT NAME		
ORGANISATION NAME		
ADDRESS		
PHONE		
FAX		
EMAIL		
ACN/ABN		

			

Contents	
OHSE 001–Document controL
OHSE 002–Project details and introduction
OHSE 003–Occupational health safety and environment policy
OHSE 004–Hazard identification, risk assessment and control
OHSE 005–Hazard categories
OHSE 006–Risk matrix
OHSE 007–Safe work method statement
OHSE 008–Objectives and targets
OHSE 009–Personal Protective Equipment (PPE) 
OHSE 010–Roles And responsibilities
OHSE 011–Training and competency register
OHSE 012–Consultation
OHSE 013–Toolbox / pre-start talks
OHSE 014–Workplace Inspection checklist
OHSE 015–Plant and equipment
OHSE 016–Plant and equipment register
OHSE 017–Plant and equipment pre-start checklist
OHSE 018–Plant and Equipment regular checklist
OHSE 019–Hazardous substances / dangerous goods
OHSE 020–Hazardous substances / dangerous good register
OHSE 021–Electrical equipment
OHSE 022–Electrical equipment register
OHSE 023–Hazard reporting
OHSE 024–Hazard report
OHSE 025–Injury and incident investigation
OHSE 026–Register of injuries
OHSE 027–Incident investigation report
OHSE 028–OHSE management plan checklist
OHSE 029–Injury management and return-to-work

OHSE 001–Document control 
INSERT ORGANISATION :

•	Maintains an up to date version of this OHSE Management Plan. 

•	Retains all obsolete pages of the Plan for a minimum of 7 years to demonstrate a record of OHSE management practices.

•	Provides a copy of the current version of the Plan to INSERT PRINCIPAL CONTRACTOR NAME.                  

•	Reviews the Plan on a INSERT TIME PERIOD basis

•	Ensures all amendments to the Plan are recorded in the Register of Amendments.  

Register of Amendments	
Date	Page/Form No.	Version No.	Description of Amendments	Prepared by	Approved by	

						

						

						

Distribution Register	
Version No.	Date of Issue	Name of Recipient	Position / Organisation	

				

				

OHSE 002–Project details and introduction 
Organisation Details	
Business/Trading name		
ACN/ABN		
Contract Job Number		
Director/Manager		
Address		
Phone		
Fax		
Mobile		
Email		

The following table sets out a brief description of the work to be carried out by INSERT ORGANISATION      during the course of the INSERT TRADE/ACTIVITY       contract/agreed works on the INSERT SITE NAME      project managed by INSERT PRINCIPAL CONTRACTOR NAME     .

Date	Description of Works	No of Employees
(inc subcontractors)	

The table below identifies the designated person on site responsible for the management of occupational health safety and environment.
Name	Contact Details	

INSERT ORGANISATION DOES/DOES NOT intend to subcontract all or part of the works. 
If engaged, the sub-subcontractors intended to be used on this site are:
Business	Contact Details	

INSERT ORGANISATION will ensure that the above mentioned subcontractors provide a SWMS for their specialised work, and that INSERT ORGANISATION shall review the SWMS, and append the SWMS to this Plan. If they are an employer, INSERT ORGANISATION will also ensure that evidence relating to a current workers compensation policy is provided.

Director / Manager______________________________		Date____/____/____				

OHSE 003–Occupational health safety and environment policy 

At INSERT ORGANISATION, a commitment to occupational health, safety and the environment is part of the business. 

This is achieved through:

•	complying with statutory requirements, codes, standards and guidelines;

•	setting up objectives and targets with the aim of eliminating work related incidents in relation to our activities, products and services; and

•	defining roles and responsibilities for occupational health, safety and environment.

Strategies will include:

•	ensuring occupational health, safety and environment management principles are included in all organisational planning activities;

•	providing ongoing education and training to all of our employees;

•	consulting with employees and other parties to improve decision-making on occupational health, safety and environment matters;

•	ensuring incidents are investigated and lessons are learnt within the organisation;

•	distributing occupational health, safety and environment information, including this policy, to all employees and interested parties;

•	providing enough resources to ensure occupational health, safety and environment is a central part of the organisation; and

•	ensuring effective injury management and rehabilitation is provided to all employees.

					
Director / Manager____________________________		Date____/____/____	

OHSE 004–Hazard identification, risk assessment and control 
 INSERT ORGANISATION will not commence construction work at a place of work unless: 

•	the principal contractor has provided INSERT ORGANISATION with a copy of the relevant parts of its workplace OHSE Management Plan (or equivalent); 

•	INSERT ORGANISATION has undertaken an assessment of the risks associated with the work activities and has provided to the principal contractor a written Safe Work Method Statement (SWMS); and

•	INSERT ORGANISATION has provided induction training to all employees.

INSERT ORGANISATION maintains and updates the SWMS, and provides the updated SWMS to the principal contractor.

INSERT ORGANISATION identifies the potential hazards of the proposed work activities, assess the risks involved and develops controls measures to eliminate, or minimise, the risks. The risk management process is carried out in consultation with employees.

IDENTIFY HAZARDS:

INSERT ORGANISATION breakdowns specific work activities into job steps to assist in identifying all potential hazards. These work activities are detailed in a SWMS.  The SWMS is a list of job steps and other work related practices. 

For each of the work activities and associated job steps identified in the SWMS, INSERT ORGANISATION has identified potential hazards and their risks.

To assist in identifying hazards and risks, INSERT ORGANISATION has considered the use of resources such as codes and standards, industry publications (i.e. safety alerts; hazard profiles for specific trade groups), workplace experience and consultation (i.e. Toolbox Talks).

ASSESS RISKS:

INSERT ORGANISATION has identified a risk class/ranking for potential workplace hazards by referring to the categories ranging from high to low in a Risk Matrix.  

The Risk Matrix is used to determine the level of danger or seriousness (i.e. the consequence) of the risk, how likely it is that this risk will occur (i.e. likelihood/probability) and therefore how detailed control measures will need to be to eliminate or minimise the risk. 

OHSE 005–Hazard categories  
The following is a list of the hazards INSERT ORGANISATION has identified arising from the contracted/agreed work activities. These hazards are addressed within the Safe Work Method Statement(s).

Occupational Health and Safety	
	Access & egress		Confined/enclosed spaces	
	Coring/chasing		Dangerous Goods (Oxy/other)	
	Demolition/dismantling		Electricity (power tools/other)	
	Explosive/pneumatic power tools		Fatigue (shift work/hours of work)	
	Formwork erection/dismantling		Fire/explosion	
	Fumes/gas		Hazardous substances	
	Flying/falling objects/debris		Height & falls	
	Hazardous material		Hot/cold working environment	
	Hot work (cutting/welding/grinding)		Lasers	
	Lighting		Manual handling (lifting or twisting)	
	Machine/equipment guarding		Moving plant/traffic	
	Materials handling (crane/forklift/other)		Plant & equipment operation	
	Noise (hearing)		Structural alterations/support	
	Public (pedestrians/other)		Services (underground/overhead) 	
	Subsidence		Ultra Violet Light (sunlight)	
	Trenching/excavation		Other………………………….	
	Work near/over water		Other………………………….	
	Young workers/unskilled labour		Other………………………….	
	Biological/bacteria		Other………………………….	

Environment	
	Air quality (dust/emissions)		Bulk excavation/spoil 	
	Concrete or paint wastes		Contaminated soil/water	
	Dewatering/pump out		Habitats (protected flora/fauna)	
	Heritage  & Archaeology		Noise or vibration	
	Noisy work (neighbourhood)		Spills & response	
	Slurry or other discharges 		Traffic & parking	
	Waste hazardous (paint sludge, synthetic min fibre, asbestos/other		Dangerous Goods/Hazardous Substances (use/storage/spills)	
	Stormwater/sediment control		Other………………………….	
	Waste disposal		Other………………………….	

OHSE 006–Risk matrix
INSERT ORGANISATION has identified a risk class/ranking for potential workplace hazards by referring to the categories in the matrix below.  

Step 1: 	The organisation identifies the consequence for each potential risk by using the table below. Note: If a combination of harm, loss or damage could occur the worst case consequence is selected.

Level	Description of Consequence	
High (1)
(High level of harm)	Potential death, permanent disability or major structural failure/damage. Off-site environmental discharge/release not contained and significant long-term environmental harm.	
Medium (2)
(Medium level of harm)	Potential temporary disability or minor structural failure/damage.
On-site environmental discharge/release contained, minor remediation required, short-term environmental harm.	
Low (3) 
(Low level of harm)	Incident that has the potential to cause persons to require first aid.
On-site environmental discharge/release immediately contained, minor level clean up with no short-term environmental harm.	

Step 2: 	Using the following table, the organisation determines how likely it is that the risk will occur and result in the consequence identified above.

Level	Likelihood / Probability	
Likely 	Could happen frequently	
Moderate	Could happen occasionally	
Unlikely	May occur only in exceptional circumstances.	

Step 3:  Using the risk matrix below, the organisation identifies the risk class/ranking.

Consequence	Likelihood / Probability	
	Likely	Moderate	Unlikely	
High (1)	1	1	2	
Medium (2)	1	2	3	
Low (3)	2	3	3	

Class/Ranking	Description / Requirements	
1	Will require detailed pre-planning. 
Actions will be recorded on a Safe Work Method Statement	
2	Will require operational planning. 
Actions will be recorded on a Safe Work Method Statement	
3	Will require localised control measures	

OHSE 007–Safe Work Method Statement (SWMS)
Organisation Details	
Organisation Name:		Contact Name::		
ACN/ABN		Contact Position:		
Address:		Contract Phone No:		
Project Details:	
Project: 		Area:		
Activity:		This SWMS has been developed in consultation with:

Reviewed by: ________________________

Position: __________________ Date: _ / __ /	
Resources / Trades Involved: 		
Equipment Used:		
Maintenance checks: 		
Materials Used:		
Occupational Health Safety or Environmental Legislation:		Codes or Standards applicable to the works:		
Level	Description of Consequence or Impact	Consequence	Likelihood / Probability	
			L
Likely	M
Moderate	U
Unlikely	
H (1)
(High level of harm)	Potential death, permanent disability or major structural failure/damage. Off-site environmental discharge/release not contained and significant long-term environmental harm.	H (1)
(High)	1	1	2	
M (2)
(Medium level of harm)	Potential temporary disability or minor structural failure/damage.
On-site environmental discharge/release contained, minor remediation required, short-term environmental harm.	M (2)
(Medium)	1	2	3	
L (3)
(Low level of harm)	Incident that has the potential to cause persons to require first aid.
On-site environmental discharge/release immediately contained, minor level clean up with no short-term environmental harm.	L (3)
(Low)	2	3	3	
Level	Likelihood / Probability	
Likely	Could happen frequently	
Moderate	Could happen occasionally	
Unlikely	May occur only in exceptional circumstances	

Item	
Job steps	
Hazards	Risk
Class/
Ranking	
Controls	Name of persons responsible for work	

						

						

Qualifications and experience required to complete the task	Personnel, Duties and Responsibilities
(Supervisory staff and others)	Training Required to Complete Work	

			

			

			

			
Engineering Details / Certificates / WorkCover Approvals:	

	

This SWMS has been developed through consultation with our employees and has been read, understood and signed by all employees undertaking the works:	
Print Names:	Signatures:	Dates:	

			

			

			

Review No	01	02	03	04	05	06	07	08	09	
Initial:										
Date:										

OHSE 008–Objectives and targets 
INSERT ORGANISATION has established the following objectives and targets to support and maintain the effectiveness of the OHSE Management Plan.  

Planning 	
Objective:
Employees are provided with regular and up-to-date information on OHSE for the duration of the contracted/agreed works.

Target:
Review the content of the OHSE Management Plan at maximum 3 month intervals (or more frequent as required) to maintain the currency of information provided to employees and others.	

Risk Management	
Objective:
Employees are familiar with hazards and risks associated with the contracted/agreed works that are assessed as a medium to high risk.

Target:
Safe Work Method Statement(s) or the equivalent list as a minimum those hazards and risks associated with the contracted/agreed works that are assessed as a medium to high risk.	

Consultation	
Objective:
Employees are regularly consulted on matters that affect OHSE. 

Target:
Toolbox/Pre-start or other agreed methods of consultation are undertaken on a regularly basis.	

Training	
Objective:
Employees are provided with training to enable work practices to be undertaken that are safe and minimise risk to the environment.

Target:
All employees involved with the contracted/agreed work have undertaken as a minimum the three levels of induction training, i.e. general industry (safety awareness) training, site specific training and work activity training as noted in the Safe Work Method Statement(s) specific to the contracted/agreed works.	

Other	
Objective:

Target:	

OHSE 009–Personal Protective Equipment (PPE)  
INSERT ORGANISATION maintains the following register of all PPE supplied to employees where such PPE is specified as a control measure in the Safe Work Method Statement.  INSERT ORGANISATION ensures all items of PPE are manufactured, used and maintained in accordance with the relevant Standard.  Proof of Standard compliance will be provided, e.g. labelling.  

Each employee has been instructed and trained in the correct use of the PPE issued. 

Employee name	Date of Issue/ replacement	Item supplied	Signature of recipient	
			I have received the listed PPE with appropriate instruction/training in its correct use.	

				

				

				

OHSE 010–Roles and responsibilities 
INSERT ORGANISATION provides the following key trained and competent personnel on site.  

Organisation
INSERT NAME______________________                                               

Works Manager
INSERT NAME__________________

Works Supervisor
INSERT NAME_________________

OHSE Coordinator
INSERT NAME__________________

Employees

Injury Management Coordinator
INSERT NAME__________________

	

ROLES AND RESPONSIBILITIES DEFINED

The roles and responsibilities of employees within INSERT ORGANISATION regarding OHSE are below.  

WORKS MANAGER

INSERT NAME is responsible for OHSE at the workplace and duties include: 

•	implementing the OHSE Management Plan;
•	using the Hierarchy of Controls in all design, fabrication and construct activities to minimise OHSE risks;
•	communicating with the principal contractor to reduce risks; 
•	being a part of the planning and design stages of trade activities;
•	deciding when training on OHSE is required;
•	leading by example and promoting sound OHSE practices at every opportunity;
•	ensuring safe equipment and plant is provided and maintained;
•	reviewing OHSE reports and inspections, and following up on recommendations;
•	coordinating incident investigations and reporting to the controller of the workplace and relevant authorities, as required;
•	coordinating OHSE meetings and programs;
•	monitoring compliance with the OHSE Management Plan, including Safe Work Method Statement; and
•	assisting injured employees to return to their pre-injury duties as soon as practicable after a work-related injury.

Signed by: ______________________	Date: ___ / ___ / ___

WORKS SUPERVISOR

INSERT NAME is responsible for OHSE at the workplace and duties include:

•	implementing the OHSE Management Plan;
•	observing all OHSE rules and regulations;
•	making sure that work activities are carried out in a safe and environmentally sound manner;
•	planning to do all work safely including any interface with other work activities;
•	providing advice and assistance on OHSE matters to employees;
•	being part of the planning and design stages of trade activities;
•	deciding when training on OHSE is required;
•	actioning OHSE reports and carrying out workplace inspections;
•	setting up OHSE meetings and programs;
•	helping to prepare Safe Work Method Statements for the organisation’s work activities;
•	investigating hazard reports and ensuring that they are completed and corrective actions undertaken;
•	carrying out project inductions, Toolbox Talks and team meetings;
•	being a part of incident investigations;
•	leading by example and promoting sound OHSE practices at every opportunity;
•	undertaking inspection of the contracted or planned works to ensure that OHSE control measures are implemented and effective; and
•	other OHSE duties as directed by the Works Manager.

Signed by: ______________________	Date: ___ / ___ / ___

OCCUPATIONAL HEALTH AND SAFETY ENVIRONMENT COORDINATOR

INSERT NAME is responsible for OHSE at the workplace and duties include:

•	communicating OHSE performance to the Works Manager;
•	assisting the Works Supervisor to develop and implement the OHSE Plan; 
•	providing advice on OHSE to all employees;
•	being a part of planning and design in work activities;
•	determining OHSE legal requirements for the work activity or trade;
•	making sure OHSE work procedures are followed;
•	coordinating injury management / return to work for injured employees;
•	reviewing OHSE reports and inspections;
•	setting up and being a part of OHSE meetings and programs;
•	setting up Toolbox Talks on a regular basis;
•	insisting on sound OHSE practices at all times;
•	setting up and conducting OHSE inductions;
•	conducting incident investigations;
•	communicating with the Works Manager/Works Supervisor on OHSE matters;
•	making sure records are kept under these guidelines;
•	being part of inspections and ensuring recommendations are completed; and
•	other OHSE duties as directed by the Works Manager.

Signed by: ______________________	Date: ___ / ___ / ___

INJURY MANAGEMENT COORDINATOR 

INSERT NAME is responsible for the management of injuries at the workplace and duties include:

•	assisting injured employees to return to their pre-injury duties as soon as practicable after a work-related injury;
•	ensuring that, where appropriate, the injured employee is given access to occupational rehabilitation services; 
•	liaising with any parties involved in the occupational rehabilitation of, or provision of medical services, to the injured employee; 
•	monitoring the progress of the injured employee’s capacity to work; 
•	taking steps to prevent recurrence or aggravation of the relevant injury upon the injured employee's return to work; and 
•	providing assistance to meet all legal requirements regarding injury management and return to work. 

Signed by: ______________________	Date: ___ / ___ / ___

EMPLOYEES 

Are responsible for the following:

•	working in a safe manner without risk to themselves, others or the environment;
•	complying with the OHSE Management Plan including all Safe Work Method Statements;
•	reporting all incidents to the Works Supervisor;
•	reporting all injuries and illnesses to the designated First Aid Officer;
•	reporting any OHSE hazards to the Works Supervisor;
•	providing suggestion, through agreed consultation methods, on how to improve OHSE issues;
•	seeking assistance if unsure of OHSE rules;
•	reporting any faulty tools or plant to the Works Supervisor;
•	complying with site rules;
•	correctly using all personal protective equipment; and
•	complying with emergency and evacuation procedures.

Signed by: ______________________	Date: ___ / ___ / ___

OHSE 011–Training and competency register 
Having regard to the hazards and risks associated with the work activity, INSERT ORGANISATION has assured that all employees are trained and competent to perform all tasks in a way that is safe and does not adversely impact on themselves, others or the environment. 

The following register contains details of the skills and competencies of the organisation’s employees.

Employee Name	Work on this project	Skills / Competencies / Experience
(e.g. tickets / qualifications)	Card No. / 
Reg. No.	Date of Course	Duration	

						

						

						

						

OHSE 012–Consultation
INSERT ORGANISATION promotes the active participation of all employees in OHSE decisions.

Employees are consulted and given opportunity, encouragement and training to be proactively involved in OHSE matters affecting the organisation and their work activities.

Consultation occurs in reference to, but not limited to, the following subjects / topics:

•	hazard identification and risk assessment processes;
•	control measures for the management of hazards and risks;
•	changes to the organisation's policies and procedures or work routines which may affect OHSE;
•	make up of and representation on relevant committees; and
•	election of OHSE and employee representatives.

All workplace consultation is recorded and occurs on a INSERT PERIOD basis.

OHSE 013–Toolbox/pre-start talks

All Toolbox / Pre-start Talks undertaken on behalf of INSERT ORGANISATION are recorded on this form and signed by participants. 

All corrective actions noted on this form are implemented and signed by the nominated person. It is the responsibility of the Works Supervisor to ensure that all corrective actions are completed and reviewed for effectiveness.   

Toolbox / Pre-start Talks	
Workplace:		
Subject of Talk:		
Presented by:		
Duration:		Date:		

Persons Present	
Print Name:	Signature:	Print Name:	Signature:	

				

				

				

				

Points Raised / Comments:	

	

	

	

	

	
	
Corrective Action	Action by	Action Complete	
		Sign off	Date	

				

				

				

OHSE 014–Workplace inspection checklist
INSERT ORGANISATION inspects the work activity(s) and work area, and provide a completed Workplace Inspection Checklist each week to the principal contractor for the duration of the works.

Workplace Inspection	
Workplace		Date		
Inspected By		Signature		

Item	Item Correct
Yes  No  n/a	Action Priority
1  2  3	Action By 	Close Out By	Close Out Date	
Access/Egress
Access paths clear
Access paths defined (signage tape, other)
Prohibited areas display warning signs and barricaded	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 				
Dust/Air Quality
Dust suppressed/watered down
Stock piles protected from wind
Plant & equipment maintained to minimise emissions	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 				
Electrical
Electrical equipment tested & tagged
Register of tagging current
Portable generator fitted RCD
Portable Residual Current Device (RCD) tested/ tagged	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
First Aid/Emergency/Injury
First aid kit provided
Kit stocks refreshed
First Aid Officer available
Evacuation procedure in place
Emergency contacts displayed
Fire extinguisher/equipment available	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Manual Handling
Trolleys/aids in use
SWMS followed
Training/job rotation undertaken	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 				
Hazardous Substances/Dangerous Goods
Register current
MSDS available
SWMS lists precautions for use
Storage area bunded
Refuelling SWMS followed	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Height work
Perimeter protection
Handrails in place
Penetrations covered
Fall restraint/arrest system in use
SWMS followed	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Housekeeping
Materials stacked
Work area lit
Bins available & in use
Signage in place
Leads suspended
Walkway/stairs/work area clear	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Noise
Plant & equipment maintained
Site hours observed
Noisy works identified
Hearing protection used (SWMS)	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Personal Protective Equipment
Used when required (SWMS)
Correctly used by employees	
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 				
Plant & Equipment
Plant register current
Maintenance records provided
Daily log book completed
Operator ticketed/competency verified
SWMS followed	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Public Protection
Work area secure from public
Overhead protection provided	
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 				
Stormwater/run off
Silt control fences in place
Stormwater inlets protected
Discharges contained, e.g. pump out, slurry/other	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 				
Training
All employees have:
  - General industry (safety awareness) training
  - Site specific induction training
  - Work activity (SWMS) training	

Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	

1   2   3 
1   2   3 
1   2   3 				
Vegetation
Fencing around drip line of retained trees
No material/equipment stored within drip line	
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 				
Waste Management
Waste reduction plan in place
Waste contractor records available
Bins for litter/cigarette butts/other provided  
Hazardous wastes captured & correct disposal, e.g. paint sludge/ contaminated soil/other	Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	1   2   3 
1   2   3 
1   2   3 
1   2   3 				
Other
……………………………
……………………………
……………………………
……………………………
……………………………
……………………………	
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a
Yes   No   n/a	
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 
1   2   3 				

All items noted for correction have been rectified	
Name 		Signed		
Date		Time		

OHSE 015–Plant and equipment
INSERT ORGANISATION carries out regular inspections and maintenance of all plant and equipment. 

INSERT ORGANISATION ensures plant and equipment is inspected and maintained in accordance with the relevant standard and manufacturer’s recommendations. 

The inspection and maintenance history of each item is documented. 

Certain items of plant and equipment will be ‘Item Registered’ and or ‘Design Registered’ by the Regulatory Authority where required by Legislation

INSERT ORGANISATION ensures control measures are implemented and documented for all plant and equipment, including its operation, deemed as high risk.  The effect of all plant and equipment on the workplace is considered and documented in the Safe Work Method Statement

Pre-start checks, schedule of maintenance and fault reports are notified to the Works Supervisor, documented in plant log books and made available to relevant parties on request.

Where plant and equipment is hired, the same requirements as above apply. 

OHSE 016–Plant and equipment register
The following register contains details of all plant and equipment to be used by INSERT ORGANISATION during the course of the work activities. Examples include lifting gear, fire fighting equipment, mobile plant, fall restraint equipment and other.

Plant Type	Serial No. / Registration No.	Make / Model	Registration with Authority Required? Y/N	Authority Registration Expiry Date
(if applicable)	Date last service or maintenance record available	Required Maintenance Frequency	Alteration Details 
Y / N / NA	Date On Site	Log Book Available	

										

										

										

OHSE 017–Plant and equipment pre-start checklist
INSERT ORGANISATION completes the following checklist prior to initial plant operation at the workplace.   

Item	Description	Check	
Risk assessment	A checklist should identify general hazards and associated risks relating to the use of the plant & equipment e.g. entanglement, crushing, striking, electrical or other.  The checklist should then detail control measures to eliminate or minimise risk.	Yes 	No 	
Log Book	A current log book recording daily safety Pre-start checks.  These are subject to random inspection.	Yes 	No 	
Maintenance Reports	Proof of ongoing maintenance, i.e. maintenance records.  The records should note the most recent inspection and who conducted that inspection.  It may also describe any repair work carried out on the plant.  Most importantly, there should be no outstanding items noted for repairs.	Yes 	No 	
Operator’s Manual 	An operator’s manual relevant to the item of plant and which is to be kept with the plant.	Yes 	No 	
Operator Certification 	Copy of operator’s certification or licence to operate the plant. Where no statutory certification is required, evidence of competence by the operator in the use of the plant.	Yes 	No 	

Plant Provider 	
Name		Signature 		Date		

Plant Inspected	
Plant Type/Make		
Serial No.		
Company		

Inspection Verified By	
Name		Signature 		Date		
OHSE 018–Plant and equipment regular checklist
The following checklist is completed by INSERT SERVICE PROVIDER OR INSERT ORGANISATION as a general and regular check on plant operation at the workplace.   

Plant and Equipment Checklist	
Service Provider name 		
Plant type / make		
Plant No.		Serial No:		
Description	Check	
Risk assessment	Yes 	No 	n/a 	
Operator’s manual	Yes 	No 	n/a 	
Maintenance reports	Yes 	No 	n/a 	
Log Book	Yes 	No 	n/a 	
Competency ticket/licence of operator                            	Yes 	No 	n/a 	
Fire extinguisher	Yes 	No 	n/a 	
Crack test reports	Yes 	No 	n/a 	
Chains tested and tagged	Yes 	No 	n/a 	
Regulatory Authority plant registration	Yes 	No 	n/a 	
Flashing light	Yes 	No 	n/a 	
Forward/reverse beeper	Yes 	No 	n/a 	
Tested and tagged electrically	Yes 	No 	n/a 	
Seat belt		Yes 	No 	n/a 	
Roll over Protection (ROPS)	Yes 	No 	n/a 	
Plant Provider 	
Name		Signature 		Date		
Inspection Verified By	
Name		Signature 		Date		

In undertaking regular checks of plant and equiplent, INSERT ORGANISATION includes consideration of relevant aspects as follows: 

Scissor Lifts / Boom Lifts	Excavators / Backhoes / Bob Cats 	
•	Risk Assessment
•	SWMS
•	Operators Manual
•	Maintenance Reports
•	Log Book
•	Certification/Competency of Operator
•	Safety Booklet
•	Company Name	•	Risk Assessment
•	SWMS
•	Operators Manual
•	Maintenance Reports
•	Log Book
•	Certification/Competency of Operator 
•	Fire Extinguisher
•	Seat Belt
•	Flashing Light
•	Forward & Reverse Beeper		
Fork Lifts / Manatou’s	Cranes	
•	Risk Assessment
•	SWMS
•	Operators Manual
•	Maintenance Reports
•	Log Book
•	Certification/Competency of Operator 
•	Fire Extinguisher
•	Seat Belt
•	Flashing Light
•	Forward & Reverse Beeper	•	Risk Assessment
•	SWMS
•	Operators Manual
•	Maintenance Reports
•	Log Book
•	Certification/Competency of Operator
•	Fire Extinguisher
•	Crack Test Report
•	Regulatory Authority Plant Registration
•	Chains Tested and Tagged	
Concrete Pumps	Other…	
•	Risk Assessment
•	SWMS
•	Operators Manual
•	Maintenance Reports
•	Log Book
•	Certification/Competency of Operator 
•	Fire Extinguisher
•	Crack Test Report
•	Line thickness Testing
•	Regulatory Authority Plant Registration	

OHSE 019–Hazardous substances/dangerous goods
INSERT ORGANISATION provides a current (within 5 years of the date of issue) MSDS to the principal Contractor for all products and substances to be used for the work activity.

Before a product or substance is used for the work activity, INSERT ORGANISATION reviews the Material Safety Data Sheet (MSDS) to determine if the product or substance is classified as hazardous.

All employees involved in the use of products classified as hazardous, are provided with information and training to allow safe completion of the required task.  

As a minimum standard, all safety and environmental precautions for use listed on the MSDS are followed when using the substance and are included in the Safe Work Method Statement.

No products or substances, including chemicals or fibrous materials, are brought to the workplace without a current MSDS.  

All products and substances to be brought to the workplace are be documented.

INSERT ORGANISATION considers the following when selecting chemicals and substances for use on site:

•	Flammability and exclusivity;
•	Toxicity (short and long term);
•	Carcinogenic classification if relevant; 
•	Chemical action and instability;
•	Corrosive properties;
•	Safe use and engineering controls;
•	Environmental hazards; and
•	Storage requirements.

All storage and use of hazardous substances and dangerous goods is in accordance with the MSDS and legislative requirements. 

All hazardous substances and dangerous goods are stored in their original containers with the label intact at all times. 

Hazardous substances and dangerous goods of any quantity are not stored in amenities, containers (unless properly constructed for the purpose), sheds or offices.

OHSE 020–Hazardous substances/dangerous good register 
The following hazardous substances exist in the work place. A copy of the MSDS has been forwarded to the person responsible for First Aid.

Product Name	Application	Quantity	Product labelled	MSDS	Classified as Hazardous in the MSDS	
			Yes 	No 	Yes 	No 	Yes 	No 		If YES:
The risks and control measures associated with the use of the product/ substance and the precautions for its use are outlined in the Safe Work Method Statement	
			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 	Yes 	No 	Yes 	No 			
			Yes 	No 	Yes 	No 	Yes 	No 			
			Yes 	No 	Yes 	No 	Yes 	No 			
			Yes 	No 	Yes 	No 	Yes 	No 			

OHSE 021–Electrical equipment 
INSERT ORGANISATION ensures that the use of electrical wiring, equipment, portable tools and extension leads is in accordance with applicable codes and standards including AS3012, Electrical Installations – Construction and Demolition Sites and AS3000, Wiring Rules.  

INSERT ORGANISATION ensures that all electrical equipment brought on site is listed in the Electrical Equipment Register.  The register is completed prior to commencement of the works and maintained for the duration of the works on site.

All electrical equipment including leads, portable power tools, junction boxes and earth leakage, or residual current, devices is inspected and tested by a suitably qualified person and labelled with a tag of currency before being used on site.  

OHSE 022–Electrical equipment register 
INSERT ORGANISATION records all electrical equipment brought on site in the Electrical Equipment Register.

Note: Testing and Tagging frequency is as required by State or Territory Legislation, codes and relevant standards.

Electrical Equipment	
Workplace		Date		

Equipment Description	Plant / Serial No.	Date of Inspection/ Test	Results and/or
trip current
(less 30mA) for
Earth Leakage Device	Date of next Inspection/Test	Electrician’s / qualified person’s
Signature	License/
Registration No.	

							

							

Electrical item	Frequency of inspection / test
(in accordance with relevant requirements)	
Tools & leads or electrical equipment		
Sub-board earth leakage device		

OHSE 023–Hazard reporting 
INSERT ORGANISATION encourages all employees to report hazards immediately to the Works supervisor. 

Where the hazard cannot be corrected immediately, INSERT ORGANISATION records the details of the hazard in the Hazard Register 

INSERT ORGANISATION investigates all reported hazards and implements control measures to eliminate and/or minimise the likelihood of an incident or injury. 

INSERT ORGANISATION identifies a risk class/ranking for all hazards by referring to the categories ranging from high to low in the Risk Matrix.  The Risk Matrix is used to determine the level of danger or seriousness (i.e. the consequence) of the risk, how likely it is that this risk will occur (i.e. likelihood/probability) and therefore how detailed control measures will need to be to eliminate or minimise the risk. 

INSERT ORGANISATION regularly reviews and evaluates the effectiveness of control measures until the hazard is addressed and/or all risks have been mitigated or reduced.

INSERT ORGANISATION will issue a copy of any completed Hazard Report form to the principal contractor, as required.

OHSE 024–Hazard report 
Where a hazard cannot be immediately corrected, INSERT ORGANISATION records the hazard in the Hazard Report. 

General	
Date		
Workplace		
Submitted By		Signature		
Submitted To		Signature		

Details of Hazard	
Location		
Work Activity	

Hazard identified
in relation to the 
work activity		

Details of Risk	
Risk Class	       High (1)               Medium (2)               Low (3)    	

Control Measures	
Corrective Action Required	
	
By Whom		
By Whom		When	Immediate
Within 24 hrs Within 7 Days		

Completion	
Corrective Action Completed By		Signature		
Time		Date		
Confirmed By		Signature		

OHSE 025–Injury and incident investigation 
INJURIES:

All injuries are reported to the desiganted First Aid Officer in the workplace.  

 INSERT ORGANISATION records all injuries on the Register of Injuries. 

Where the injury requires medical attention or off site treatment, INSERT ORGANISATION completes an Incident Investigation Report.

Copies of Incident Investigation Reports are provided to the principal contractor, as required.

INCIDENTS:

For all incidents involving near misses, property/plant damage or injury to the public or the environment, Insert Organisation investigates and records the details in an Incident Investigation Report. 

Copies of completed Incident Investigation Reports are provided to the principal contractor, as required.

NOTIFIABLE INCIDENTS:

Insert Organisation reports all notifiable incidents to the relevant Authority.

Where such an incident has occurred, Insert Organisation considers whether the site needs to be preserved for investigation by the relevant Authority. 

RECORD KEEPING:

Insert Organisation keeps records of incidents and injuies in accordance with Statutory requirements. 

OHSE 026–Register of injuries
INSERT ORGANISATION records all injuries in the following register.

General 	
Workplace Location		
Injured Persons Name		
Home Address		
Date of Birth		Male         Female     	
Occupation		
Employers Name		
Employers Address		
Details of Injury	
Date of Injury		Time of Injury		am   pm 	
Activity in which the person was engaged at the time of injury		
Exact location where injury occurred		
Nature of injury e.g. fracture, burn, sprain, foreign body in eye.		
Body location of injury                           e.g. ear, eye, face, neck		
Details of Treatment	
Treatment provided
by First Aid Officer 	Yes No	Remarks:		
Follow up 
treatment required	Yes No	If yes, an Incident Investigation Report must be completed with 24 hours	
Doctor/ Medical 
Centre attended		
Date attended		Medical Certificate Received	  Yes         No      	
Treatment                 i.e. x-ray, prescription		
Further consultation required	Yes No	Injury Management required	Yes   No    	If yes, notify the Return-to-Work Coordinator	
Name of Witness		
Address of Witness:		

Name of Person Providing First Aid		
Signature		Date		

OHSE 027–Incident investigation report
INSERT ORGANISATION completes an Incident Investigation Report in the event of any injury involving medical attention or off site treatment or in the event of any incidents involving a near miss, property/plant damage or injury to the public or the environment.

The principal contractor will be informed immediately in the event of the above.  Following discussions with the principal contractor, a decision will be made as to who will conduct the incident investigation.  The principal contractor will be provided with a copy of the completed Incident Investigation Report.

Class of Incident 	Reported	
 Injury                  Property/Plant Damage 
 
 Near Miss           Environmental 

 Other…………………….	Yes  No    Details:	
	Further Action Required	
	 Report to Authorities   Other:	

Details of Incident	
Date of Incident		Time of Incident 		am   pm 	
Witness Name		Witness Contact		
Nature of Incident 		
Location of Incident 		
Description of Incident 		
Details of damage to equipment/property?		

Injured Person/s (if applicable)	
Name		
Address		
Date of Birth		
Occupation		Employer		
Referred/transferred to		

Recommended Preventive Action	
Details		

Completed By	
Name		Position		
Signature		Date		

OHSE 028–OHSE management plan checklist
INSERT ORGANISATION reviews all OHSE policies and procedures on a INSERT TIME PERIOD to determine the effectiveness of the OHSE Management Plan in addressing OHSE in the workplace. 

General 	
Project Name		
Location		
Auditor		
Other Attendees		

Activities Reviewed	Conforms	
Changes and distribution of the OHSE Mgt Plan are recorded	Yes 	No 	
Project details / Description of works / Organisation details are current	Yes 	No 	
OHSE Policy signed and dated by Director/Manager	Yes 	No 	
Hazards are identified and risks are assessed 	Yes 	No 	
Controls for high risk activities are documented (Safe Work Method Statement(s)) 	Yes 	No 	
Training and Competency Register is current	Yes 	No 	
Site Specific Induction Training records are current	Yes 	No 	
SWMS Training is current	Yes 	No 	
Roles and responsibilities are allocated and signed	Yes 	No 	
Consultation arrangements (nature, topics, intervals) are documented	Yes 	No 	
Plant / Equipment Register is current	Yes 	No 	
Hazardous Substances / Dangerous Goods Register is current	Yes 	No 	
Personal Protective Equipment Register is current	Yes 	No 	
Periodic Workplace Inspection Checklists are completed	Yes 	No 	
Register of Injuries is current	Yes 	No 	
Incident Investigation Reports are completed 	Yes 	No 	
Hazard Reports are completed	Yes 	No 	
Electrical Equipment Register is current	Yes 	No 	
Injury Management and Return-to-Work Program is displayed	Yes 	No 	
Workers Compensation Information is current	Yes 	No 	
Other:	Yes 	No 	

Items Identified for Correction	

	

	

	

	
Outstanding Issues and Recommendations	

	

	

	

	
	
Follow up 
actions required 	Yes        No  	When		

Completed By	
Name		Position		
Signature		Date		

OHSE 029–Injury management and return-to-work
OUR COMMITMENT: 

INSERT ORGANISATION is committed to the return to work of injured employees.

As part of this commitment, we will:

•	prevent injury and illness by providing a safe and healthy working environment;

•	participate in the development of an injury management plan and ensure that injury management commences as soon as possible after an employee is injured;

•	support the injured employee and ensure that early return to work is a normal expectation;

•	provide suitable duties for an injured employee as soon as possible;

•	ensure that our injured employees (and anyone representing them) are aware of their rights and responsibilities – including the right to choose their own doctor and rehabilitation provider, and the responsibility to provide accurate information about the injury and its cause);

•	consult with our employees and, where applicable, unions to ensure that the return-to-work program operates as smoothly as possible;

•	maintain the confidentiality of injured employee’s records.

•	not dismiss an employee as a result of a work related injury within six months of becoming unfit for employment.

To support the above, INSERT ORGANISATION has established the following procedures. 

NOTIFICATION OF INJURIES:

•	All injuries must be notified to the supervisor as soon as possible.

•	All injuries will be recorded in the Register of Injuries.

•	Our Workers Compensation Scheme Agent will be notified of any injuries that may require compensation within 48 hours.

RECOVERY:

•	All injured employees will receive appropriate first aid or medical treatment as soon as possible.

•	The injured employee must nominate a treating doctor who will be responsible for the medical management of the injury and assist in planning return to work.

RETURN TO WORK:

•	A suitable person will be arranged to explain the return to work process to the injured employee.

•	The injured employee will be offered the assistance of a WorkCover-accredited rehabilitation provider if it becomes evident that they are not likely to resume their pre-injury duties, or cannot do so without changes to the workplace or work practices.

SUITABLE DUTIES:

•	An individual return to work plan will be developed when the injured employee, according to medical advice, is capable of returning to work.

•	The injured employee will be provided with suitable duties that are consistent with medical advice and are meaningful, productive and appropriate to the injured employee’s physical and psychological condition.

•	Depending on the individual circumstances of the injured employee, suitable duties may be at the same workplace or a different workplace, the same job with different hours or modified duties, a different job and may involve full-time or part-time hours.

DISPUTE RESOLUTION:

•	If disagreements about the return to work program or suitable duties arise, the organisation will work with the injured employee and any union representing them to try to resolve the issue.

•	If all parties are unable to resolve the dispute, the organization will seek to involve the Scheme Agent, an accredited rehabilitation provider, the treating doctor or an injury management consultant.

CONTACTS:

INSERT ORGANISATION‘s workplace contact for the return-to-work is:

Name	Organisation 	Contact Details	

INSERT ORGANISATION‘s preferred WorkCover-accredited rehabilitation providers are:

Name	Organisation 	Contact Details	

INSERT ORGANISATION‘s workers’ compensation Scheme Agent is:

Name	Organisation 	Contact Details