Title Page
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Conducted on
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Prepared by
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Location
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First name
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Last Name
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ActivateRail job number
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Client
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Type of works client is performing (e.g. NDD, Survey, Sleeper replacement)
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Date
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Role performed
- Lookout
- Handsignaller
- TFPC 3.1
- TFPC 3.2
- TFPC 3.3
- Permit to Work
- Track Certifier
- Client Supervisor
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Start time
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Starting location
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Finish time
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Enter additional information if additional shifts or multiple work sites attended
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LAFHA claimed ?
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Travel KMs are being claimed (mobilise to or demoblise from site)
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Between site KM's are being claimed
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Upload site documentation (RSWHA, Site Diaries, Pre Starts etc)
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Did you have any other Track people reporting into you (e.g. Lookouts, Handsignallers)?
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Name of 1st Person
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Role performed
- Lookout
- Handsignaller
- TFPC 3.1
- TFPC 3.2
- TFPC 3.3
- Permit to Work
- Track Certifier
- Client Supervisor
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Did you have any more?
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Name of 2nd person
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Role performed
- Lookout
- Handsignaller
- TFPC 3.1
- TFPC 3.2
- TFPC 3.3
- Permit to Work
- Track Certifier
- Client Supervisor
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Did you have another person?
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Name of 3rd person
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Role performed
- Lookout
- Handsignaller
- TFPC 3.1
- TFPC 3.2
- TFPC 3.3
- Permit to Work
- Track Certifier
- Client Supervisor
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Did you have another person?
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Name of 4th person
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Role performed
- Lookout
- Handsignaller
- TFPC 3.1
- TFPC 3.2
- TFPC 3.3
- Permit to Work
- Track Certifier
- Client Supervisor
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Please insert the time and expenses that each of the people working with you have worked and/or incurred.
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Client Representative signature
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Client representative role title
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ActivateRail employee signature
