Installation Form

Builder Name*

Work Detail

Address*

Order #*

Installation Date*

Items/Areas to be checked BEFORE commencement of the installation

General State of the Work Site is SAFE and tidyYesNo

Ceiling has no cracksYesNo

Floors clean and tidyYesNo

Lights in place & in working orderYesNo

A safe working environment existsYesNo

Is the Ceiling lining made of asbestos?YesNo

Check all areas of the ceiling, if the ceiling is asbestos or you are unsure of its composition you must assume it is ASBESTOS and follow Higgins Asbestos Management Plan)

Write comments here

Items/Areas to be checked AFTER completion of this installation:

General State of Work Site is SAFE and tidyYesNo

Ceiling has no cracks YesNo

Floors clean and tidyYesNo

Lights in place & in working orderYesNo

Insulation packaging removed from siteYesNo

Access Aperture cleanYesNo

Default Minimum clearance of insulation around all recessed lights And electrical equipment achieved as per AS/NZS 3000:2007YesNo

Upload Files

Upload at least 6 pictures including the site board

Job Safety Analysis (JSA) Worksheet

Electrocution

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Biohazards, Snakes and Spiders

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Heat

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Falls from Height

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Asbestos (lagging or loose fill insulation)

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Other Hazards

Hazard #6

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Hazard #7

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Hazard #8

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Hazard #9

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

Hazard #10

Probability

Consequence

Risk

Control Measure

Eliminate, Isolate, minimise to a safe level (state how)

Person

The person responsible to make this happen

If risks cannot be reduced to a safe level or eliminated, do not start the job.

Work site evaluated by

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Date

Signature

Builder's Confirmation

Please input builder or site supervisor's name

Date

Signature

Assessor's Name*