Amaro - Site Inspection / Staff Surveillance Record

• Client / Contractor

• Site / Depot

• Inspection by

• Date & Time

  Date
• Location
  Address

• 

• Instructions
  
  1. Identify the Risk Factors by either "Satisfactory"; "Low"; "Low / Medium"; "Medium"; "Medium / High" or "High" for the questions below
  2. After identifying the risk factors, select Action that is applicable to each item.
  3. To add a notes, images or assign corrective actions, click on the paperclip icon then "Add Action"; provide a description, assign to a member, set priority and due date
  4. Complete audit by providing digital signature
  5. Share your report by exporting as PDF, Word, Excel or Web Link

• 

1. Site Documentation

• 1.1 Construction Phase Plan (Copy on site, signed off..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.2 Health & Safety Policy (Displayed, signed off)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.3 F10 (Displayed, up to date..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.4 Emergency Contact List

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.5 Insurance (ELI) (Displayed, In date..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.6 Law Poster (Displayed, sections completed)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.7 Risk Assessments

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.8 WPP / TB / MS

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.9 Permits (hot Works, C Form, Dig )

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.10 Inspection Registers ( Statutory Registers)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 1.11 Sub-Contractor documentation

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

2. Monitoring

• 2.1 Fire Control

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 2.2 First Aid

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 2.3 Tool Box Talks

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 2.4 Welfare Facilities

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 2.5 Competence

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 2.6 Induction

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

• 3.1 SSOW (Briefing, Protection arrangements, signed off etc)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.2 Sentinel Checks (Validity, Sponsor, Competence)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.3 WPP / TB (Briefing, compliance etc.)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.4 Access Points

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.5 COSS Performance (Briefing, work group control)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.6 ES Performance (COSS briefing..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.7 OLE / OTP / ALO / CC – MC

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.8 Emergency Arrangements

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 3.9 Life Saving Rules ( Communication, Compliance..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

4. Work Task Performance

• 4.1 PPE (Compliance)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.2 Work at Height (Access, Falls, Edge Protection..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.3 Housekeeping

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.4 COSHH (Hazardous / Flammable substances)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.5 Security

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.6 Buried / Overhead Services

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.7 Signage

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.8 Electricity (PA Test, Trailing Leads..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.9 Work Platforms (Towers, Scaffolds, MEWP’s..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.10 Noise / Vibration (safe use, assessment..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.11 Excavations (Guarded, exclusion zones, inspected)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.12 Access & Egress Routes (Signed, Clear of obstruction..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.13 Asbestos (Register, survey, training..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.14 Manual Handling (Assessment, technique..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.15 Abrasive Wheels (safe use, PPE, training..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.16 LOLER / Lifting (RAMS, lift plan, inspection, TE, competency..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.17 Confined Spaces (permits, RAMS, competency..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.18 Plant / Equipment (PUWER..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 4.19 Other – State: Foul weather clothing

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

5. Environmental / Ecology

• 5.1 WPP / TB / MS (Reference to Environment / Ecological performance)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 5.2 Waste (In accordance with WPP/TB/MS, segregation, skip ID..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 5.3 Ecology (Briefings, habitats, surveys..)

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

6. Management / Supervision

• 6.1 Is management structure clearly defined and understood?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 6.2 Is a management organogram displayed?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 6.3 Are on-site management meetings held and attended?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 6.4 Are statutory registers completed and supervisor inspections carried-out weekly?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

7. Surveillance

• 7.1 Does member of staff have the necessary competencies to work on the equipment in their area?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 7.2 Has all new work been carried-out / completed to the requirements of the appropriate standards?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 7.3 Have the correct tools / equipment been used to undertake the work?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• 7.4 Have all the records been completed and signed off correctly?

  Select Satisfactory Low Low / Medium Medium Medium / High High

  • Satisfactory
  • Low
  • Low / Medium
  • Medium
  • Medium / High
  • High

• Action

  Stop Work / Immediate Action

  Action Required

  No Action

• Comments

Inspection & Surveillance Completion

• Inspector's Name and Signature

  Sign