Title Page
To be completed when undertaking site surveillance of work activity. Complete each section as applicable and sign and date at bottom. Use additional sheets if needed
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Name (of the individual carrying out the Site surveillance)
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Sentinel No:
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Date (of the inspection)
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Location (of the inspection)
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Name of Person in Charge:
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Name of COSS
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Sentinel No. (of COSS/PIC)
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Number in Team:
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(note – Detail of others on site can be taken from site briefing record (or attach copy)
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Photographs should be taken and submitted with the Site Surveillance to support the assurance activity
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Detail of Work being undertaken
Safety Arrangements in accordance with NR/L2/OHS/019
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Has a Site Brief been carried out?-Did the COSS/ES/PIC carry out the brief, has the information available to conduct the brief. <br>-Was the briefing of a good quality and adequate for the task and location<br>
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Was the briefing adequate for the location and type of Work? - Was the brief taken in a safe location? -Was the briefing detailed enough for the type of work that’s commencing?
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Is there a signed Safe Work Pack on site? - Signed by the PIC & RM, are all members of the working group signed onto the pack?
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Is the pack-in date suitable for the location and type of work? Was the Safe Work Pack dated for the works being carried out and state the correct location?
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Are Site arrangements consistent with those detailed in SWP? ~Have the risks associated with the work been identified and controlled?~Have the team got the required Isolation forms, Permits associated with the work? is there sufficient First Aid, Fire, Welfare, Working at height etc?
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Are appropriate Task Risk Control Sheets or Risk Assessments available? ~Has the team conducting the work have a valid Risk Assessment or Task Risk Control sheet on site? Please state the reference number(s)
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Are all staff using appropriate PPE? ~The type and additional requirements available and being worn in line with the task-specific Risk assessment? Is the PPE Clean and in good Condition? Is the PPE being worn in good condition, is it clean, and is it adequate? Have all members of the team have their sponsor on their PPE?
Work Content
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Does the team undertaking the task have the requisite competencies for the task? -Can the team produce the necessary Sentinel competency or Authority to Work for the task being conducted
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Does the task involve substances or activities hazardous to health?<br>~Such as HAVS, Dust, fumes etc. <br>~Have the necessary Control measure been implemented and controlled in line with AIW Procedures?<br>
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If there are any hazards to health, then are there suitable exposure monitoring arrangements in place?<br>-Are all HAVs activities being documented?<br>-If not, the Task must be stopped!
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Are COSHH assessments available? <br>-are COSHH assessments available to the working group for all substances?
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Additional Observations -This section is to provide additional information on the task or process the team are undertaking including any safety conversations had with the working group
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Maintenance completed to an acceptable standard
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Is the access secure and in good condition?<br>~Is the site access sufficient for plant delivery? ~Is the Access gate lockable with a functioning Lock & chain<br>
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Is the equipment housing secure?<br>-if Appropriate<br>
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Is there visible evidence of maintenance activity having been carried out? <br>-Cleaned, greased, refilled, tidy, signed for etc
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Are equipment maintenance records available, and completed as necessary?<br>-Maintenance cards<br>
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Is there evidence/record of adjustment? <br>-Where Necessary <br>
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Is the standard of maintenance consistency with the last maintenance date?
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Last Maintenance by (if Known)?<br>-ATW Evidence<br>
Equipment / Site Conditions
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Is the general condition of Equipment/Site Conditions<br>~Is there a sign of malfunction, cracks or damage to the equipment<br>
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Are diagrams and/or documentation required on site? <br>- Does the equipment have the necessary diagrams such as lift charts, HAVs record sheets etc to support the equipment?<br>
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Has the necessary housekeeping of site been completed?<br>-De-veg for access, floor clean for REB etc.<br>
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Are any spares on site stored correctly and secured as necessary?
Environmental
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Pre-Work Information / Task Briefing(s)<br>-Environmental requirements considered and briefed out?<br>
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Emergency Response<br>-Emergency response plan for works in place and available to enact if required?<br>
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Ecology<br>-Are conditions of EPTW, EPS Licence conditions being met? Tree Root Protection areas marked out?<br>
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Ground and Surface Water<br>-Controls around surface water and silt management in place? Compliance to FRAP if required?<br>
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INNS Management<br>-INNS Location(s) demarcated and INNS Management Plan / JKN PAN being adhered to if required?
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Material Management<br>-Is material storage effective and secure to reduce wastage and environmental risk? Stockpiles sealed and away from watercourses / sensitive ecological receptors?
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Noise and Vibration<br>-Approach to Section 61 agreements agreed? Are noise and vibration levels controlled and permitted?
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Carbon Reduction<br>Evidence of low/zero carbon solutions being utilised on worksite(s)?<br>
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Pollution Prevention<br>-Plant refuelling nappy satisfactory and spill kits measures in place? Chemicals and fuel storage bunded / secure?<br>
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Waste Management<br>-Arrangements in place to reduce/segregate waste and Waste Licences/Permits/Transfer Notes in order? Housekeeping to a satisfactory level?<br>
6. Unsafe conditions or acts
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Did you observe/note any unsafe acts?<br>-If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action (Was this raised on Maximo - please provide a Close Call number)
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Did any Safety conversations take place? What was the topic, overall content of the conversation and any actions from the conversation?
Overall Summary of Findings
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Please provide an overview of how the site visit and any findings/actions
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Authority to work - Competence Criteria Observed (add observed record and employee name and Applicable Criteria)
