AIW-HSEQ-L4-FOR-RM-QA-000001 V4. Self Assurance Staff Surveillance F01 Site Surveillance F02

• Site

  Select

undefined

• Yes

  No

  N/A

• Name (of the individual carrying out the Site surveillance)

• Date (of the inspection)

  Yes

  No

  N/A

• Location (of the inspection)

  Yes

  No

  N/A

• Name of Person in Charge:

• Name of COSS

• Sentinel (of COSS/PIC)

• Number in Team:

• Sentinel No:

• (note – Detail of others on site can be taken from site briefing record (or attach copy)

• Photographs should be taken and submitted with the Site Surveillance to support the assurance activity

• Detail of Work being undertaken

Safety Arrangements in accordance with NR/L2/OHS/019

• Yes

  No

  N/A

• 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>

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• Is there a signed Safe Work Pack on site?

• Signed by the PIC and RM

  Yes

  No

  N/A

• Are all members of the working group signed onto the pack

  Yes

  No

  N/A

• Is the pack in date and suitable for location and type of work?

  Yes

  No

  N/A

• Was the Safe Work Pack dated for the works being carried out and state the correct location?

• Are Site arrangements consistent with those detailed in SWP?

  Yes

  No

  N/A

• ~Have the risks associated with the work been identified and controlled?

  Yes

  No

  N/A

• ~Have the team got the required Isolation forms, Permits associated with the work? is there sufficient First Aid, Fire, Welfare, Working at height etc?

  Yes

  No

  N/A

• Are appropriate Task Risk Control Sheets or Risk Assessments available?

  Yes

  No

  N/A

• ~Has the team conducting the work have a valid Risk Assessment or Task Risk Control sheet on site? Please state the reference number(s)

  Yes

  No

  N/A

• Are all staff using appropriate PPE?

  Yes

  No

  N/A

• The type and additional requirements available and being worn in line with the task specific Risk assessment?

  Yes

  No

  N/A

• Is the PPE Clean and in good Condition?

  Yes

  No

  N/A

• Is the PPE being worn in good condition, is it clean, is it adequate?

  Yes

  No

  N/A

• Have all members of the team have their sponsor on their PPE?

  Yes

  No

  N/A

• Work Content

  Yes

  No

  N/A

• Question

  Yes

  No

  N/A

• Guidance

  Yes

  No

  N/A

• Compliant / Non

  Compliant

  Non

  Compliant

  NA

• Does the team undertaking the task have the requisite competencies for the task?

  Yes

  No

  N/A

Can the team produce the necessary Sentinel competency or Authority to Work for the task being conducted

• Does the task involve substances or activities hazardous to health?

  Yes

  No

  N/A

~Such as HAVS, Dust, fumes etc

~Have the necessary Control measure been implemented and controlled in line with AIW Procedures?

• If there are any hazards to health, then are there suitable exposure monitoring arrangements in place?

  Yes

  No

  N/A

Are all HAVs activities being documented?

If not, the Task must be stopped!

• Are COSHH assessments available?

  Yes

  No

  N/A

are COSHH assessments available to the working group for all substances?

• Additional Observations

  Yes

  No

  N/A

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

• Maintenance completed to acceptable standard

  Yes

  No

  N/A

• Question

  Yes

  No

  N/A

• Guidance

  Yes

  No

  N/A

• Compliant / Non

  Compliant

  Non

  Compliant

  NA

• Is the access secure and in good condition?

  Yes

  No

  N/A

~Is the site access sufficient for plant delivery? ~Is the Access gate lockable with a functioning Lock & chain

• Is the equipment housing secure?

  Yes

  No

  N/A

if Appropriate

• Is there visible evidence of maintenance activity having been carried out?

  Yes

  No

  N/A

Cleaned, greased, refilled, tidy, signed for etc

• Are equipment maintenance records available, completed as necessary?

  Yes

  No

  N/A

Maintenance cards

• Is there evidence/record of adjustment?

  Yes

  No

  N/A

Where Necessary

• Is the standard of the maintenance consistence with the last maintenance date?

  Date

• Last Maintenance by (if Known)?

  Yes

  No

  N/A

ATW Evidence

• Equipment / Site Conditions

  Yes

  No

  N/A

• Question

  Yes

  No

  N/A

• Guidance

  Yes

  No

  N/A

• Compliant / Non

  Compliant

  Non

  Compliant

  NA

• Is the general condition of Equipment/Site Conditions

  Yes

  No

  N/A

~Is there an sign of malfunction, cracks or damage to the equipment

• Are diagrams and/or documentation required on site?

Does the equipment have the necessary diagrams such as lift charts, HAVs record sheets etc to support the equipment?

• Has the necessary housekeeping of site been completed?

  Yes

  No

  N/A

De-veg for access, floor clean for REB etc

• Are any spares on site stored correctly and secured as necessary?

  Yes

  No

  N/A

• Environmental

  Yes

  No

  N/A

• Question

  Yes

  No

  N/A

• Guidance

  Yes

  No

  N/A

• Pre-Work Information / Task Briefing(s)

  Yes

  No

  N/A

Environmental requirements considered and briefed out?

• Emergency Response

  Yes

  No

  N/A

• Emergency response plan for works in place and available to enact if required?

  Yes

  No

  N/A

• Ecology

  Yes

  No

  N/A

Are conditions of EPTW, EPS Licence conditions being met? Tree Root Protection areas marked out?

• Ground and Surface Water

  Yes

  No

  N/A

Controls around surface water and silt management in place? Compliance to FRAP if required?

• INNS Management

  Yes

  No

  N/A

INNS Location(s) demarcated and INNS Management Plan / JKN PAN being adhered to if required?

• Material Management

  Yes

  No

  N/A

Is material storage effective and secure to reduce wastage and environmental risk? Stockpiles sealed and away from watercourses / sensitive ecological receptors?

• Noise and Vibration

  Yes

  No

  N/A

Approach to Section 61 agreements agreed? Noise and vibration levels controlled and permitted?

• Carbon Reduction

  Yes

  No

  N/A

Evidence of low/zero carbon solutions being utilised on worksite(s)?

• Pollution Prevention

  Yes

  No

  N/A

Plant refuelling nappy satisfactory and spill kits measures in place? Chemicals and fuel storage bunded / secure?

• Waste Management

  Yes

  No

  N/A

Arrangements in place to reduce / segregate waste and Waste Licences/Permits/Transfer Notes in order? Housekeeping to satisfactory level?

• Unsafe conditions or acts

  Yes

  No

  N/A

• Question

  Yes

  No

  N/A

• Guidance

  Yes

  No

  N/A

• Action open or closed

  Yes

  No

  N/A

• Did you observe/note any unsafe act?

  Yes

  No

  N/A

If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action

• Did you observe/note any unsafe act?

  Yes

  No

  N/A

If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action

• Did you observe/note any unsafe act?

  Yes

  No

  N/A

If so, provide details. Has the unsafe act(s) been corrected? If not, stop the act and raise an action

• ACTIONS

  Yes

  No

  N/A

• Detail of action to be taken

• By Who

• Date

  Date

• Signed

  Yes

  No

  N/A

• (Print Name)