Site Safety Assessment Form Template for New Zealand

A comprehensive document used in New Zealand workplaces to systematically identify, assess, and document potential hazards and safety risks at a specific work site. This form aligns with New Zealand's Health and Safety at Work Act 2015 and associated regulations, providing a structured approach to risk assessment and control measure implementation. It includes detailed sections covering various safety aspects, from general site hazards to specific risk areas, and serves as both a compliance document and a practical tool for ensuring workplace safety.

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What is a Site Safety Assessment Form?

The Site Safety Assessment Form is a crucial document required under New Zealand's workplace health and safety framework. It is designed to comply with the Health and Safety at Work Act 2015 and related regulations, serving as a systematic tool for identifying and managing workplace risks. This form should be completed before work commences at any new site, when significant changes occur in the workplace, or when new hazards are identified. The document includes comprehensive sections covering hazard identification, risk assessment, control measures, and emergency procedures. It requires input from qualified safety personnel and must be regularly reviewed and updated to maintain its effectiveness in ensuring workplace safety. The form is particularly critical in high-risk industries and must be readily available for inspection by WorkSafe NZ or other authorized parties.

What sections should be included in a Site Safety Assessment Form?

1. Site Identification Details: Basic information including site address, date of assessment, assessor details, and project reference

2. Emergency Information: Emergency contact numbers, assembly points, and location of emergency equipment

3. Hazard Identification: Systematic listing of all potential hazards present on site

4. Risk Assessment Matrix: Framework for evaluating likelihood and consequence of identified hazards

5. Control Measures: Existing and required control measures for identified risks

6. Environmental Conditions: Assessment of weather conditions and environmental factors affecting site safety

7. PPE Requirements: List of mandatory and situation-specific personal protective equipment

8. Access and Security: Site access points, security measures, and visitor control procedures

9. Sign-off Section: Signatures of assessor, site supervisor, and other relevant parties

What sections are optional to include in a Site Safety Assessment Form?

1. Hazardous Substances Assessment: Detailed assessment of hazardous materials present on site, required when chemicals or dangerous goods are present

2. Working at Heights: Specific assessment for sites requiring work at heights, including fall protection measures

3. Confined Spaces: Assessment specific to confined space work, needed when such spaces are present

4. Plant and Equipment: Detailed assessment of machinery and equipment risks, required for sites with heavy machinery

5. Noise Assessment: Evaluation of noise levels and control measures, needed for sites with high noise activities

6. Traffic Management: Assessment of vehicle and pedestrian movement risks, required for sites with significant vehicle traffic

7. Asbestos Management: Specific assessment for sites where asbestos may be present or disturbed

What schedules should be included in a Site Safety Assessment Form?

1. Appendix A - Site Layout Plan: Detailed site plan showing emergency exits, first aid stations, and key hazard areas

2. Appendix B - Risk Assessment Matrix Guide: Detailed guide for using the risk assessment matrix

3. Appendix C - Emergency Response Procedures: Detailed emergency procedures and evacuation plans

4. Appendix D - PPE Requirements Chart: Visual guide showing required PPE for different areas/activities

5. Appendix E - Incident Report Form: Template for reporting safety incidents and near misses

6. Appendix F - Safety Equipment Checklist: Checklist of required safety equipment and their locations

7. Appendix G - Relevant Safety Data Sheets: Collection of SDS for hazardous substances present on site

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

Jurisdiction

New Zealand

Publisher

Genie AI

Cost

Free to use

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