Title Page

  • Permit Reference

  • Conducted on

  • Prepared by

  • Location

Live Site

Site Documentation

  • SSRA/RAMS/Permit docs available?

  • Up to date construction drawings?

  • NRSWA accredited operative on site?

  • Permit board displayed, correct number and in date?

  • Permit conditions being met?

SLG

  • Does TM and ped provision match permit?

  • Is TM and ped provision appropriate for site and safe, red book compliant?

  • Is there clear signage and barricading?

  • Is the area free from trip hazards?

  • Are storage areas being clearly identified and all materials stored within?

  • Is the work clean and tidy?

  • Are entry and egress routes being maintained?

  • Is lighting appropriate

Excavation, Backfill, Reinstatement

  • Is correct equipment on site?

  • Are correct materials being used, and are they stored correctly?

  • Have corrected construction layers and compaction been used?

  • Current type and length of excavation and reinstatement?

Health and Safety

  • Is there a first aid kit and associated records available?

  • Correct PPE being worn?

  • Welfare units available, or workers aware where closest is?

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.