Audit

General information

Client SAP Nr / reference

AMEY Order Nr / reference

MSN Order Nr / reference

Gang number

Grid reference X

Grid reference Y

Address

Postcode

County
Weather
Start date / time on site
Description of works

Any additional information available

Location of works

Works in highway

Has risk assessment MS03 signing and guarding in gang pack been read and understood ?

READ RISK ASSESSMENT AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

Road category (details from schedulers / TMA team)

Traffic management used

Is TMA a road closure

Duration of closure ?

Has diversion route been agreed with highway authority ?

Contact supervisor for guidance

Location of diversion route

Is the route suitable for the increased traffic volumes and size of vehicle ?

Contact supervisor for guidance

Are there site specifics ,eg school,bus stops,hospital,industrial estate,pedestrianised area,play park,etc. that will be affected by the increased traffic volume or type of vehicle using route

Contact supervisor for guidance

Impact of works on highway user

Risks to signing ,lighting and guarding
Weather
Traffic
Vandalism

Other factors

Is TMA remotely controlled STOP / GO board operation

Reason stop / go selected

1. Correct SLG available on site

2. Distance between stop / go boards is less than 200m

3. Daylight hours and good visibility?

4. Unobstructed view of both approaches ?

5. Operator is no more than 100m from each board ?

6. Traffic flow is less than 800 vehicles per hour ?

Are all answers 1. to 6. yes ?

Do not use boards . Contact supervisor

Is TMA manually controlled STOP / GO board operation

Reason manual stop / go selected

1. Correct SLG available on site

2. Distance between stop / go boards is less than 200m

3. Both boards are fully illuminated during hours of darkness ?

4. Where operators are not in direct line of sight, 2 way radios are in use ?

5. Operator is in a position of safety and not inside the safety zone ?

6. Are traffic flows less than maximum flows stated in table on page 60 of the red book ?

7. For a single operated stop / go board , the site is less than 20m in length?

Are all answers 1. to 7. yes ?

Do not use boards . Contact supervisor

Is TMA a footpath closure

Duration of closure ?

Location of works

Have all alternatives to closing the foot way been considered ?

Contact supervisor for guidance

Has the work been planned to avoid peak / traffic sensitive times ?

Contact supervisor for guidance

Describe control measures
Describe monitoring arrangements when site unattended

Impact of works on highway user

Are the works under a permit scheme ?

Are the permit conditions in place ?

Contact supervisor for guidance

Will the highway be temporarily obstructed for short periods

Control measures in place

Are there site specifics ,eg. Commuter route,school,bus stop,hospital,industrial estate,farm,pedestrians,play-park, etc.

Control measures in place

Will pedestrians,cyclists,horse riders be affected by the works? Do they have safe access through the works at all times ?

Control measures in place

Will the site layout change during the works ?

Risks during changeover

Control measures in place
Risks to signing ,lighting and guarding
Weather
Traffic
Vandalism

Other factors

Control measures frequency of site inspection / visit

Any additional information available

PTD Required before start on works

PTD Signed

DO NOT START WORKS CALL SUPERVISOR FEEDBACK WITH PHOTO TO PROVE ATTENDANCE

Daily risk assessment

Is this first job of working day

COMPLETE VAN CHECKS BEFORE MOVING ON

Items checked and in working order / fit for use

Are any items requiring attention

Items requiring attention

Details of requirements and actions taken

Is vehicle safe to operate

DO NOT USE VEHICLE CONTACT MANAGEMENT FOR GUIDANCE AND INSTRUCTION

Do works involve use of plant and tools ?

ARE ALL CREW MEMBERS FULLY AWARE OF RISK ASSESSMENTS AND METHOD STATEMENTS MS07,08,09,10,11,12,41,48,50,60,61,29 INCLUDED IN GANG PACK AS APPROPRIATE FOR EXCAVATORS,STIHL SAWS,FLOOR SAWS,HIABS,MINI EXCAVATORS,JACK HAMMERS,HYDRAULIC BREAKERS,SINGLE DRUM ROLLERS,POWER TOOLS,SOIL AIR PICK,TRAILERS AND COMPRESSORS

READ RISK ASSESSMENTS AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr
Plant used
Plant nr

Are any items defective in any way

Plant used
Plant nr

ISOLATE IN STORE CABIN , RAISE DEFECT WITH MANAGER AND COLLECT REPLACEMENT

Plant used
Plant nr

ISOLATE IN STORE CABIN , RAISE DEFECT WITH MANAGER AND COLLECT REPLACEMENT

Plant used
Plant nr

ISOLATE IN STORE CABIN , RAISE DEFECT WITH MANAGER AND COLLECT REPLACEMENT

Do works involve working at height

Control measures required

Do works involve excavation

HAVE YOU CONSULTED GANG PACK GENERIC METHOD STATEMENTS MS01 EXCAVATIONS , MS01 AVOIDING DANGER FROM UNDERGROUND SERVICES , MS05 AVOIDING DANGER FROM OVERHEAD SERVICES , MS16 SHORING OPERATIONS , MS47 WORKING IN DEEP EXCAVATIONS

READ RISK ASSESSMENTS AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

Control measures required Refer to generic risk assessment US-WTR-HS-RiskAssessment-MS-01
Pre excavation checklist

Risk assessments suitable for work

DO NOT START WORKS SPEAK TO SUPERVISOR

Public utility records available

DO NOT START WORKS SPEAK TO SUPERVISOR

Pre or construction drawings available

CAT and genny function check completed

DO NOT START WORKS SPEAK TO SUPERVISOR

CAT And genny in calibration

DO NOT START WORKS SPEAK TO SUPERVISOR

CAT and genny survey completed to mark services complete with photo to confirm

DO NOT START WORKS SPEAK TO SUPERVISOR

CAT SURVEY RECORD

Suitable insulated tools available

DO NOT START WORKS SPEAK TO SUPERVISOR

Are you aware that no mechanical excavation or the use of picks, bars / spikes should not be used within 500 mm of known services

DO NOT START WORKS SPEAK TO SUPERVISOR

PPE worn as per risk assessment

DO NOT START WORKS SPEAK TO SUPERVISOR

Signing / lighting / guarding to company standards

DO NOT START WORKS SPEAK TO SUPERVISOR

Are measures to protect public suitable

DO NOT START WORKS SPEAK TO SUPERVISOR

Permit to dig

CAT serial number

Genny serial number

Operatives trained and competent with use of CAT and genny

DO NOT START WORKS SPEAK TO SUPERVISOR

Can operatives read and understand service drawings

DO NOT START WORKS SPEAK TO SUPERVISOR

Are operatives aware of safe digging techniques

DO NOT START WORKS SPEAK TO SUPERVISOR

Has photographic record of CAT & GENNY survey been carried out

DO NOT START WORKS SPEAK TO SUPERVISOR

water mains present on utility plans

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Gas mains present

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Electric mains present

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Street lighting present

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Telecom cables / ducts present

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Other fibre optic cables / ducts present

Is it possible to mark utility location ?

Has utility been marked and location photographed

DO NOT START WORKS SPEAK TO SUPERVISOR

Overhead services / obstructions present

Are protection measures required

Protection measures required

Are protection measures in place

DO NOT START WORKS SPEAK TO SUPERVISOR

IF EXCAVATION OVER 1.2 m DEEP OR GROUND CONDITIONS DICTATE NON STANDARD APPROACH AND THE FOLLOWING ITEMS NOT IN PLACE OR CARRIED OUT NO WORKS TO PROCEED

1. Ensure excavation assessment / inspection report is completed as part of works records

2. Ensure adequate trench support or benching is in place

3. All excavation works to comply with generic risk assessment UD-WTR-HS-RiskAssessment-MS-01

3. Ensure adequate edge protection is in place

Excavation assessment / inspection report

Depth of excavation Less than 500 mm deep score 0 Low risk 500 - 1200 mm deep score 1 Medium risk 1200 - 1600 mm deep score 2 High risk 1700 - 3000 mm deep score 3 If depth needs to increase beyond that originally planned then excavation support must be reviewed

Depth of excavation risk score A

Nature of ground Low risk score 1 Good ground, no recent disturbance ,soil moist earth or drained clay,one soil type consistent throughout. Medium risk score 2 Good ground, well compacted but possibly disturbed recently, soil type gravelly,shingle or dry sand,one soil type consistent throughout High risk. score 3 Poor ground,not well compacted,soil type dry earth,gravel with sand,wet sand or wet clay,more than one soil type If not possible to determine the soil type assume worst case scenario

Nature of ground. B

Ground water presence Low risk score 1 Ground water level below planned excavation depth Medium risk score 2 Ground water level encroaching at bottom of excavation High risk. score 3 Ground water level higher than excavation depth In addition to ground water also need to consider other factors such as proximity of watercourses or heavy rains (especially where it can run off land or down roads)

Ground water presence. C

Surcharge (side loadings) Low risk. score 1 No side loads anything likely to impact trench is far enough away Medium risk. score 2 Some surcharge , but deemed acceptable for depth of dig High risk. score 3 Side loadings likely to affect integrity of excavation Traffic particularly HGV's,traffic volumes,plant and equipment and spoil affect surcharge CONSIDER INCREASING DISTANCE BETWEEN TRAFFIC AND SIDES OF EXCAVATION

Surcharge (side loading) possibility. D

Personnel entering the excavation Low risk. score 1 Personnel entering the excavation at thigh height Medium risk. score 2 Personnel entering the excavation at chest height High risk. score 3 Personnel entering the excavation above head height Where personnel are entering into excavation below 500 mm enter a zero score

Personnel entering excavation. E

Total risk score A + B + C + D + E

Total risk score range

Site team to review need for excavation support Monitor conditions as work progresses

Advice required from competent person on need for excavation support / benching Monitor conditions as works progress

Excavation support required Monitor conditions as works progress

Can works be carried out safely ( if NO then name person informed and any actions taken)

DO NOT START WORKS SPEAK TO SUPERVISOR

Responsible person
CAT SURVEY RECORD

Is it necessary to enter a confined space

HAVE ALL CREW MEMBERS READ AND UNDERSTOOD RISK ASSESSMENTS AND METHOD STATEMENTS MS31 NC 4 COMPETENCY HIGH RISK , MS32 NC 3 MEDIUM RISK , MS33 LOW RISK INCLUDED IN GANG PACK AND AWARE OF REQUIREMENTS OF ENTRY INTO CONFINED SPACE AT THIS LOCATION

READ RISK ASSESSMENTS AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

Confined space - permit to enter

Gas detector serial number and calibration date

Reason to enter
Known and potential hazards

Are all operatives confined space trained

DO NOT START WORKS SPEAK TO SUPERVISOR

Have all operatives and any subcontractors received pre entry briefing on specific hazards and control methods

DO NOT START WORKS SPEAK TO SUPERVISOR

Is a non entry rescue procedure in place

DO NOT START WORKS SPEAK TO SUPERVISOR

Entry date
Equipment requirement checklist
PPE Requirement checklist

Electrical isolation of work area required

Has isolation been completed

DO NOT START WORKS SPEAK TO SUPERVISOR

Are specialist communication systems required

Has communication been established

DO NOT START WORKS SPEAK TO SUPERVISOR

Is additional lighting required

Has lighting been established

DO NOT START WORKS SPEAK TO SUPERVISOR

Responsible person
Pre entry set up record

Are slips and trips possible

Control measures required

Are public in close proximity of works

Control measures required

Overhead services (including sheathed / protected cables)

Control measures required

Underground services

Control measures required

Works on the highway

Control measures required

Substance spillage

Control measures required

Use of hazardous substances

Control measures required

Works near water

Control measures required

Plant operation

Control measures required

Works on live electrical equipment

Control measures required

Does work involve use of gas burner or asphalt mixer

HOT WORK PERMIT CHECKLIST

All items must be in place
Ensure all items are in place

HAVE ALL OPERATIVES READ AND UNDERSTOOD RISK ASSESSMENT AND METHOD STATEMENT MS30 SAFE USE OF LPG GAS CYLINDERS

READ RISK ASSESSMENT AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

The following operatives have read , understand and agree to follow procedures of work detailed in this assessment

Have there been any visitors to site

All visitors to sign that they have read and understood the briefing

Visitor 1
Visitor 2
Visitor 3

Have there been any client instructions given

Instructions given

Pre start photos

Is this assessment a site start only

WORK FEEDBACK

DO ALL CREW MEMBERS FULLY UNDERSTAND REQUIREMENTS OF GENERIC RISK ASSESSMENTS MS02 FOR BACKFILL AND REINSTATEMENT OPERATIONS , MS13 CHAMBER CONSTRUCTION , MS17 WORKING WITH ASBESTOS CEMENT PIPES , DUCTS,SHEETS ETC, MS18 LIFTING ,MOVING AND LAYING OF PAVING SLABS , MS27 MANUAL HANDLING

READ RISK ASSESSMENTS AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

ARE ALL CREW MEMBERS AWARE OF COSHH DATA CONTAINED WITHIN GANG PACK AND THE RELEVANCE TO MATERIALS BEING USED ON SITE

READ COSHH ASSESSMENTS AND TAKE NOTE OF REQUIREMENTS BEFORE CONTINUING ANY FURTHER

Were any other utilities services encountered in excavation ?

Gas

Depth

Number

Water

Depth

Number

Electric LV

Depth

Number

Electric HV

Depth

Number

Street lighting

Depth

Number

Sewerage

Depth

Number

Telemetry

Depth

Number

BT

Depth

Number

Traffic signals

Depth

Number

Finish date / time
Crew on site

Are works on a transferred sewer , manhole or cover

Description of works

Is essential additional information available

Contact supervisor for guidance

Is job a manhole cover replacement

Type of damage
Manhole cover size

Size if not listed

Depth of cover

Work type

Manhole cover type

Is job a pipe or rising main repair

Cause of damage

Sewer type

Pipe size
Pipe material

Length of repair

Is job an interceptor removal

Cause of damage

Sewer type

Pipe size
Pipe material

Length of repair

Location of manhole

Removal type

Is job a manhole construction

Manhole construction

Is job an internal repair

Cause of damage

Sewer type

Pipe size
Pipe material

Length of repair

Repairs carried out

Location of manhole

Is job a flood mitigation job

Type of mitigation installed

Is job a schedule 13 item

Detail work type

Is job a subcontract priced contract

Detail work type

Is job a main contractor priced contract

Detail work type
Reinstatement details

Reinstatement type

Length of reinstatement

Width of reinstatement

Thickness of surfacing

Depth of repair carried out

Surfacing material
Customer satisfaction record

Is job on private

Is customer available to answer a few questions regarding works carried out

Was a pre start visit arranged ?

Were all appointments kept ?

Was the work completed on time

Was the work clearly explained ?

Were all staff polite and courteous at all times ?

Was the work carried out safely ?

Is all the area we have worked in left in good order ?

We're any complaints dealt with promptly ?

Would you recommend this company ?

How would you rate the overall performance where 1 is poor 10 is excellent

Any other comments you would like recording

I confirm that the afore mentioned works were carried out with our full agreement and to our satisfaction

Reason for not signing

Additional information

Waste disposal details

Was any waste disposed of offsite

Method of waste disposal

Tankering / Overpumping details

Was any Tankering or Overpumping carried out

Tanker type 1

Tanker size
Nr of tankers

Hrs used

Tanker type 2

Tanker size
Nr of tankers

Hrs used

Tanker type 3

Tanker size
Nr of tankers

Hrs used

Pump 1 type

Pump size

Nr of pumps

Hrs used

Pump 2 type

Pump size

Nr of pumps

Hrs used

Pump 3 type

Nr of pumps

Pump size

Hrs used

Location plan / photos / sketch ( as required)
Site address
Location and general feedback photos
Draw sketch plan (if needed)
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.