Title Page
Job Details
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Type of Works
- 2way lights
- 3way lights
- 4way lights
- Ped crossings
- Road closure
- Lane Closure
- Priority
- AWS Install
- Give + Take
- Footway Closure / Barriers
- TO15
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Reason for Visit
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Operative Name
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Client
- Morrison Telecom Services
- Virgin Media
- NGE
- Magdelene
- Dr Stump
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Job Number
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Date
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Speed of Works
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Address
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MUS Card (Photo)
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Smart Awards Card (Photo)
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Lantra Card (Photo)
Activity (Marks Out Of 60)
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If any activities are N/A then please mark down as a 5.
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Pre Hire Report Done Prior to site Install
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Broom and Shovel on Vehicle
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First aid kit
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Van Cleanness inside and outside
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Full PPE
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Method Statements on site
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Risk assessment prior to install
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All safety zones / shuttle lane width compliant to red book
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Chapter 8 correct and fit for purpose
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Correct Yardage on site for Location
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All signs have C&L sticker
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Cone Lamps (60MPH)
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Safety Culture app completed
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Cone sleeves compliant
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Walkway or Civils Equipment compliant
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Stop go boards
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Correct permit board on site
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Are all signs 300mm of the ground
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Any additional comments
Site Photos
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Chapter photos
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Taper photos
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Permit Board
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Ped crossing (If Used)
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Cone run pictures
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Excavation / work area
Signature/Completion
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Operative Signature
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Auditor Signature