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

  • 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

  • Location of manhole

  • Removal type

  • Is job a manhole construction

  • Manhole construction

  • Is job an internal repair

  • Repairs carried out

  • 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)

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