Carriageway

• CPA works number

• Site address

• Conducted on

  Date

• Supervisor

• Location
  Address

• Gang & Charge-hand Name

• Site Photo

  Media

Safety Observations

• Housekeeping

  Safe

  At Risk

  N/A

• Service avoidance (under and overhead) use of CAT

  Safe

  At Risk

  N/A

• PPE

  Safe

  At Risk

  N/A

• Ladders/cherry picker

  Safe

  At Risk

  N/A

• Cutting & Grinding

  Safe

  At Risk

  N/A

• Noise/dust

  Safe

  At Risk

  N/A

• Manual Handling (reduced where possible)

  Safe

  At Risk

  N/A

• Fire protection and First Aid

  Yes

  No

  N/A

• COSHH being used correctly? Labelled containers etc

  Safe

  At Risk

  N/A

• Lifting equipment in test

  Safe

  At Risk

  N/A

• HAV's

  Yes

  No

  N/A

Traffic management

• Has the diversion route been posted?

  Yes

  No

  N/A

• Have ramps been installed at cuts and iron work?

  Yes

  No

  N/A

• Correct signage posted? Ie Iron works raised, loose chippings?

  Yes

  No

  N/A

Quality

• Are materials correct to job

  Yes

  No

  N/A

• Are Plant & vehicle correct to the job?

  Yes

  No

  N/A

• Are works following design?(CVI)

  Yes

  No

  N/A

• Expected Progress

  Yes

  No

  N/A

Patching

• Patching

  Off

  On

• Are patches planed to correct depth?

  Yes

  No

  N/A

• Has bond coat been applied? Including vertical edges

  Yes

  No

  N/A

• Has the material temp been checked before laying?

  Yes

  No

  N/A

• Has the material temp been checked before laying?

  Yes

  No

  N/A

• Are patches compacted satisfactorily?

  Yes

  No

  N/A

Resurfacing

• Resurfacing

  Off

  On

• Are weather conditions correct for laying blacktop?

  Yes

  No

  N/A

• Is carriageway planed to correct depth?

  Yes

  No

  N/A

• Has ironwork been adjusted to correct level?

  Yes

  No

  N/A

• Has bond coat been applied? Including vertical edges

  Yes

  No

  N/A

• Has the material temp been checked before laying?

  Yes

  No

  N/A

• Has the material been adequately rolled?

  Yes

  No

  N/A

Surface dressing

• Surface Dressing

  Off

  On

• Has the site been correctly patched?

  Yes

  No

  N/A

• Is the ploughing and cleaning complete?

  Yes

  No

  N/A

• Is the iron work masked and the site swept?

  Yes

  No

  N/A

• Is the air temperature correct and road surface free from moisture?

  Yes

  No

  N/A

• Is the binder spread rate correct?

  Yes

  No

  N/A

• Are the correct chipping being applied?

  Yes

  No

  N/A

• Are the Chipping's being rolled correctly with rubber coated rollers?

  Yes

  No

  N/A

Roadmarkings

• Is line of the required quality?

  Yes

  No

  N/A

Acknowledgement

• Chargehand signature

  Sign

• Supervisor Signature

  Sign