Title Page

  • Site Location:
  • Date:

  • Auditor(s):

  • Role:

  • Project Manager:

  • Client:

  • Site Manager:

  • Number of Workers on Site:

  • undefined

Contract DOCS, Site File:

  • SSoW on site & Briefed:

  • SSoW review Date:

  • SSoW:

  • COSHH Assessments & MSDS on-site & Briefed (If Applicable):

  • Toolbox Talks on-site/Tablet & Briefed:

  • Toolbox Talks:

  • Point of Work Risk Assessment completed:

  • Point of Work Risk Assessment:

Welfare

  • Welfare Facilities are adequate and sufficient for numbers on site?

  • All Welfare Facilities are being cleaned sufficiently and regularly?

  • Drinking Water provided in the canteen and on site, are being cleaned sufficiently and regularly?

  • Eating Facilities, Breakout Area are being cleaned sufficiently and regularly?

  • Is food being dispensed from site, do they have specialist catering on site?

  • Waste containers provided?

  • Changing Rooms Facilities provided and are being cleaned sufficiently and regularly?

  • Welfare Facilities

First Aid and Fire

  • First Aid Kits Correct Number and Type for Task (10 or 20 Man):

  • Suitable Number of Fire Marshals:

  • Fire Extinguishers Service - Correct number and Type for Task:

  • Fire Signage Displayed - Correct number and Type for Task:

  • Provisions:

Manual Handling

  • All Workers trained in Manual Handling:

  • Any Repetitive manual handling:

  • Extent of Manual Handling Acceptable:

Working at Height

  • Any working at height:

  • Working at Height Risk Assessment Completed:

  • Have Workers been briefed on Working at Height Tasks:

  • Working At Height carried out safely:

  • Ladder Pre-Use Check:

  • Podium/Tower Pre-Use Check:

  • MEWP Pre-Use Check:

  • Pre-Use Check:

  • Equipment

  • Tool Tethers in use:

  • Are Workers Harnessed Trained:

  • Do workers have in-date IPAF/PASMA Training:

  • Rescue Plan in place:

Confined Space

  • Confined Space Working

  • Operatives Confined Space Working Trained:

  • Confined Space SSoW documented and Briefed:

  • Confined Space SSoW documented:

  • Equipment and Tools Intrinsically Safe:

  • Tools and Equipment suitable for task?

  • All Equipment undergone Pre-Use Checking and recorded?

  • Suitability of Persons to do the Work, are Operatives Confined Space

  • Rescue Team Available on site?

  • Has Testing the Air been undertaken, and findings recorded?

  • Gas Detector - Complies with EMC Directive 89/336/EEC?

  • Provision of Ventilation - Impact on the rate of oxygen usage and possible build-up of toxic atmospheres

  • Isolation of Equipment and Services been undertaken?

  • Radio Communications - Effective communications should be established in an emergency

  • Self-Rescue Emergency Escape Breathing Device (ISO23269-1:2008)

  • 10minute Air. Complies with EN1146:2005 and SOLAS standards

COSHH

  • COSHH Items being used/Stored on-site?

  • COSHH Assessment on-site, read and understood and Signed?

  • Correct PPE for the Task (Refer to the MSDS)?

  • COSHH

Permits

  • Confined Space Permit (PTW)

  • Restricted Space Permit

  • Hot Works Permit

  • Works Permit

  • Working at Height Permit

  • Electrical Working Permit

  • Isolation Permit

  • Key Permit

  • Other Type of Permit:

  • Permits

Occupational Health

  • Any Medical Issues?

  • HAVS Recorded?

  • Fatigue being monitored?

  • Staff/Operatives Face Fit Tested?

  • Asbestos present on site?

  • If So, is Asbestos Register available for review?

  • Occupational Health

PPE/RPE

  • Hard Hat - (EN397:2012 or EN12492:2012)

  • Hi-Viz Vest (tear away) or Jacket Orange in colour -(EN471:2013)

  • Sponsor provided on PPE

  • Hi-Viz Trousers Orange in colour - (EN471:2013)

  • Is the PPE Damaged - Tears/Rips/Faded/Fluorescent

  • Steel toes cap boots with steel mid sole - (ISO20345:2011 S3 WR SRA/SRC/SRB)

  • Gloves General Low-Level Works - (EN388:3131 Cut Level 1 - Visitor’s to Site Only)

  • Gloves Protective - (EN388:3141 Cut Level 2)

  • Gloves Protective - (EN388:4343 Cut Level 3)

  • Gloves Protective - (EN388:4443 Cut Level 4)

  • Gloves Protective - (EN388:4532 Cut Level 5 (With Dexterity)

  • Safety glasses - (EN166:1f)

  • Safety Goggles - (EN166:1b)

  • Ear protection - (EN352-2:2002 - Hearing protectors - Ear Plugs. Filters)

  • Ear protection - (EN 352-5:2002 - Hearing protectors - Active Noise Filters)

  • Ear protection - (EN 352-3:2002 - Hearing protectors - Ear muffs attached to Filters)

  • PPE

Work & Site Equipment

  • All in Good Working Order - Clean/Maintained etc…

  • All Equipment Calibrated/Serviced - Check Certificate

  • Barriers in place (Segregation)

  • Correct Signage Displayed

  • Correct Lighting/Task Lighting/Helmet Torches?

  • Equipment under PUWER - Inspected, Maintained, Serviced and Calibrated?

  • Equipment under LOLER - Inspected, Maintained, Serviced and Calibrated?

  • All Equipment complete - Mobile Towers - Horizontal Brace, Rung Ladder

  • Out Riggers/Stabiliser, Casters with Brakes

  • Frame, Kick/Toe Board, Platform Trap Door, Diagonal Brace, Span Frame,

  • Equipment HAVS Marked

  • PAT Testing Carried out on all relevant equipment?

  • Manufacturers instructions available?

  • Work & Site Equipment

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.