Free NZ Site Specific Safety Plan (SSSP)
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Health & Safety Documentation
Site Specific Safety Plan
Complete all sections before work commences. Provide to the Principal / Client Representative prior to site mobilisation.
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1
Cover Information
2
Project Information & Scope of Works
Scope of Works
Subcontractors
A copy of each subcontractor's SSSP must be obtained and retained before they commence work on site.
| Subcontractor Company Name | Scope / Trade | SSSP Received | Notes |
|---|---|---|---|
3
General HSE Requirements
Mandatory PPE – Required at all times on Site
| ✓ | PPE Item | Standard / Notes |
|---|---|---|
| Hard Hat | ||
| Safety Footwear | ||
| High-Visibility Vest / Jacket | ||
| Eye Protection | ||
| Hearing Protection | ||
| Gloves | ||
| Dust Mask / Respirator | ||
| UV Protection | ||
Notifiable Works & WorkSafe NZ Notifications
Notifiable Work requires notification to WorkSafe New Zealand at least 24 hours prior to work commencing.
Notifiable Activities (tick all that apply)
Significantly Hazardous Activities
Tick all applicable activities. Each ticked item must be recorded in the Hazard & Risk Register with a Safe Work Plan.
4
Hazard & Risk Register
Record significant hazards only. Risk levels: Critical / High / Moderate / Low / Very Low. Controls: Eliminate > Substitute > Isolate > Engineering > Administrative > PPE.
| Hazard / Risk | Potential Harm | Initial Risk | Control Measures | Residual Risk |
|---|---|---|---|---|
5
Hazardous Products & Substances Register
Complete for ALL potentially harmful products brought on site. A current SDS must be held on site for each item listed.
| Product / Substance Name | Form (L/S/G) | HSNO Classification | SDS Location | Storage Location | PPE Required |
|---|---|---|---|---|---|
6
Emergency Response Plan
Emergency Contacts
Emergency Services (All)
111
WorkSafe New Zealand
0800 030 040
National Poisons Centre
0800 764 766
Nearest Hospital / A&E
Nearest Medical Centre
Site Supervisor / Foreman
Project Manager
Principal / Client Contact
Trained First Aider
H&S Representative
Emergency Evacuation Procedure
High-Risk Activity Emergency Rescue / Response
Complete one row for each high-risk activity requiring a specific rescue response.
| Type of Emergency | Work Activity | Rescue Method | Responsible Person & Contact |
|---|---|---|---|
7
Site Communications, Consultation & Self Inspection
Onsite H&S Communications
| ✓ | Communication Method | Frequency / Details |
|---|---|---|
| Project Pre-Start Briefing (all PCBUs) | ||
| Daily Pre-Start Briefing | ||
| Weekly Toolbox Talk | ||
| Progress / Site Meetings (H&S agenda item) | ||
| Horizontal Consultation with other PCBUs | ||
| Incident / near miss debriefs |
Self-Inspection Schedule
| ✓ | Inspection Type | Frequency / Responsible Person |
|---|---|---|
| Pre-start site inspection | ||
| Weekly site safety inspection | ||
| Major plant & equipment inspection | ||
| Vehicle inspection | ||
| Scaffolding / MEWP / specialist equipment | ||
| Electrical equipment (RCD / tagged leads) |
8
Environmental Management
For each applicable item describe the mitigation measure. Mark N/A where not applicable.
| Environmental Consideration | Applicable (Y/N/NA) | Mitigation Method |
|---|---|---|
| Will vehicles or equipment be refuelled on site? | ||
| Will concrete or mortar be washed / cleaned on site? | ||
| Could site run-off enter a drain or waterway? | ||
| Could noise levels adversely affect those outside the site? | ||
| Will dust be generated affecting the public or neighbours? | ||
| Will fumes or smoke be generated affecting others? | ||
| Will waste materials or empty product containers be generated? | ||
| Is a sediment control plan required? | ||
| Is a spill kit required on site? | ||
| Are there resource consent conditions applicable to this work? |
9
Supporting Documents & Attachments
Tick whether each document is attached or mark N/A. All attached documents form part of this SSSP.
| ✓ | Supporting Document | Status | Comments / Reference |
|---|
10
Declaration & Sign-Off
They have read and understood the requirements of this SSSP.
They will carry out work in accordance with the controls listed in this SSSP and the Company HSE Policy.
They understand their obligations under the Health and Safety at Work Act 2015.
Any change to risk, change in scope, or incidents must be reported to the nominated Project Manager and this SSSP updated accordingly.
Work will be suspended if conditions arise that make it unsafe to proceed.
Contractor Preparation & Sign Off
| Name | Role | Date | Signature (type full name) |
|---|---|---|---|
Worker Sign-on
| Full Name | Company | Date | Signature (type full name) |
|---|---|---|---|
Principal / Client Representative Acceptance
Acceptance does not transfer any duty of care or responsibility from the Contractor to the Principal.
Revision History
| Version | Date | Revised By | Summary of Changes |
|---|---|---|---|
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