Title Page
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Conducted on
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Prepared by
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Site Entrance Location
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Photo of Site Name and Location Number Plate
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Sketch Layout of AGI and Location of Welfare, storage and Emergency Escapes.
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Date Required
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Is the work request for inside or outside the main compound?
- Inside
- Outside
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Stand Next to the item to be removed and add GPS Co-ordinates....
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Take Photo's of the Work Area, identifying height and width of the item to be cleared...
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How high (approx) is the item to be cleared?
- <3 Metres
- >3 Metres but <10 Metres
- >10 Metres
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How wide is the item to be cleared at its widest point?
- <3 Metres
- >3 Metres but <10 Metres
- >10 Metres
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Tick if you believe a lifting plan will be required.
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Can this work be done under a FOA or will a permit be required?
- Permit to Work (Via Risk)
- Form of Authority
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How close to the inlet/outlet Pipelines is the scrub clearance?
- <3 Metres
- >3 Metres but <10 Metres
- >10 Metres
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Please provide any information about Specific Site Hazards e.g. Site is on a fast Road, site is unsecure, Site is under an NRO etc etc
