CFH Health & Safety Site Assurance Audit

Document Reference Number

• OHSF-PR-08-01 Version 1 Revision 0 Dated 04/02/2021

• (Format:- City name - Job Pack / PN Number) E.g Aberdeen S12345 Always insert City name and Job Pack / PN number if known

• CityFibre Holdings Ltd, 15 Bedford St, London, WC2E 9HE

• Date and Time

  Date

Location

• Complete location on tracker
  Address

Contractor

• Who is the principle contractor?

  Select

• What is the name of the principle contractor?

• Please send an email to iAuditor.support@cityfibre.com detailing the contractor name and city.

• If unknown/other have you sent an email to iAuditor.support@cityfibre.com?

  Yes

  No

Reference materials (Streetworks Code of Practice etc.)

• Code of Practice (Red Book)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/safety-at-streetworks.pdf

• SROH/R (Reinstatement specification Highways/Road)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/SROF%20Scotland.pdf

• CDM Code of Practice
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/l153(1).pdf

• CityFibre Fibre Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SFI01%20-%20Fibre%20Specification.docx?d=wc41be78482c44d1eb56b968a21e799cf

• Code of Practice (Red Book)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/safety-at-streetworks.pdf

• Specification for Reinstatement
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/sroh.pdf

• CDM Code of Practice
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/l153(1).pdf

• CityFibre - Fibre Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SFI01%20-%20Fibre%20Specification.docx?d=wc41be78482c44d1eb56b968a21e799cf

• CityFibre Civils Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SCI01%20Civils%20Specification%20FINAL.DOCX?d=wd74a900ece7f4ea7a299ef8fe7e99a04

• Contractor Monitoring Risk Assessment
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/3.%20%20OHSM%20Risk%20Assessments/OHSF%E2%80%93PR-03-01-019%20RA%20Monitoring%20Contractor%20Work%20Sites.doc?d=wc53e3603bd7a41198b86334459838ff2

• CityFibre Civils Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SCI01%20Civils%20Specification%20FINAL.DOCX?d=wd74a900ece7f4ea7a299ef8fe7e99a04

• Contractor Monitoring Risk Assessment
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/3.%20%20OHSM%20Risk%20Assessments/OHSF%E2%80%93PR-03-01-019%20RA%20Monitoring%20Contractor%20Work%20Sites.doc?d=wc53e3603bd7a41198b86334459838ff2

• Please answer the following 3 questions based on your dynamic risk assessment on arrival at the site. If you answer 'No' to any of the following questions please explain this in the free text field which appears with a 'No' answer, take the appropriate action and, when safe to do so, continue the audit.

• Is it safe for you to conduct this audit?

  Yes

  No

• Please explain why and what action you have taken as a result.

• Is it safe for the construction workers to continue work?

  Yes

  No

• Please explain why and what action you have taken as a result.

• Is it safe for members of the public, in the areas surrounding the site, that they are able to access?

  Yes

  No

• Please explain why and what action you have taken as a result.

Site Walkthrough

Signing Lighting & Guarding

• Are CityFibre approved Permit/Courtesy Boards displayed and contain correct information? (0800 083 6160 Number)

  Yes

  No

  N/A

• please provide supporting evidence such as annotated photo’s and notes

• Are Advanced warnings signs in correct sequence, distance and suitably fixed to prevent being blown down or out of position?

  Yes

  No

  N/A

• Are all signs, cones, barriers (SLG) in good condition (no damage)?

  Yes

  No

  N/A

• Please add pictures of damaged elements.

  Media

• Is the lighting adequate for the works being carried out?

  Yes

  No

  N/A

• Is there temporary lighting (As in DRA)

  Yes

  No

Documentation

• Has site risk assessment been conducted and suitable for the current operations?

  Yes

  No

  N/A

• Have all operatives signed the Risk Assessment or evidence of briefing?

  Yes

  No

  N/A

• Are method statements in use and applicable?

  Yes

  No

  N/A

• Are COSHH Assessment and Safety Data Sheets available for all hazardous substances held on site?

  Yes

  No

  N/A

• Are utility drawings onsite, available, legible and in date? (ordinarily 28 days from date of issue)

  Yes

  No

  N/A

• Is the F10 displayed/available on site? (Physical / Digital)

  Yes

  No

  N/A

• Site Comments (Documentation)

Noticing and Competence

• Are NRSWA Noticing / TTRO's in place and displayed?

  Yes

  No

  N/A

• Is the noticing valid for the current operations?

  Yes

  No

  N/A

• Have Streetworks personnel got the relevant NRSWA Cards and plant certificates in date, appropriate and available for inspection? (Original / Print / Digital)

  Yes

  No

  N/A

• List Names of operatives sampled

Click ADD for another

• Names of Operative

• Qualification Expiry Date

• Site Comments (Noticing)

Barriers and Work Area

• Are Traffic / Pedestrian Segregation Barriers fitted?

  Yes

  No

  N/A

• Are all Barriers set up correctly as per the Code of Practice (Red Book), including all gate entrances?

  Yes

  No

  N/A

• Are Barriers supported by suitable bases?

  Yes

  No

  N/A

• Are all barriers linked together with no gaps and suitably fixed to prevent being blown down or out of position? (including all gate entrances)

  Yes

  No

  N/A

• Photo evidence required

  Media

• Is all the working equipment contained within the barriered work area?

  Yes

  No

  N/A

• Is the site fully enclosed in compliance with the ‘Safety at Streetworks and Roadworks’ Code of Practice (The Red Book) or otherwise controlled following a robust written risk assessment?

  Yes

  No

• Is work area of a suitable size to operate safely?

  Yes

  No

  N/A

Footways

• Are alternative pedestrian arrangements required? (i.e. Pedestrian re-routing, narrowing of walkway, road crossing)

  Yes

  No

  N/A

• Are footway Covers / Ramps fitted, fixed and a correct loading for the task? (i.e. vehicle or pedestrian)

  Yes

  No

  N/A

• Are footway closed signs in use?

  Yes

  No

  N/A

• Are pedestrian diversion signs in place and correctly fitted? (is it immediately obvious what is happening and what is expected of me - pedestrians & traffic)

  Yes

  No

  N/A

• Is the pedestrian walkway the correct width? (At least 1.2m)

  Yes

  No

  N/A

• Is there a safe method for pedestrians to avoid the road / carriageway whilst passing works?

  Yes

  No

  N/A

• Please provide photographs of the walkway & signage.

  Media

• (Footways / Paths) - Site Comments

Environmental

• Is spoil stored and contained in appropriate, barriered off, area(s)? (Environmental considerations i.e. away from water courses, tree canopies & drainage, not covering a fire hydrant.)

  Yes

  No

  N/A

• Are drain/gully coverers in situ preventing contamination and blockage of drains if trenching past or working in the vicinity of aforementioned?

  Yes

  No

  N/A

• Have suitable measures been put in place to protect & prevent staining of the carriageway and footway? (Visqueen sheets/spoil boards/road sweeper/jet washer etc..)

  Yes

  No

  N/A

• Have all excavation works taken place as advised by the NJUG tree protection zone? SROH - NG1.10.1 <br>- Prohibited (no excavation) - within 1m of the tree trunk<br>- Precautionary (no mechanical excavation) - within 4x the circumference of the tree trunk<br>- Permitted (works as normal) - Outside of the precautionary zone

  Yes

  No

  N/A

• Is there a site appropriate spill kit available for any environmental issues, fuel leaks etc

  Yes

  No

  N/A

• Are materials for backfill stored correctly and segregated?

  Yes

  No

  N/A

Traffic Management

• Is Traffic Management required?

  Yes

  No

• Is Traffic Management suitable for location?

  Yes

  No

  N/A

• Is Traffic Management set up in accordance with plan and assessment?

  Yes

  No

  N/A

• Is there a relevant TTRO (Temporary Traffic Restriction Order) in place?

  Yes

  No

  N/A

• Photograph required

  Media

• Is traffic management equipment in good working condition? (ie traffic lights working)

  Yes

  No

  N/A

• Site Comments (Traffic Management)

House Keeping

• Please complete the following questions regarding housekeeping (tap ok to continue).

  Ok

• Are duct, and other materials stored safely and correctly?

  Yes

  No

  N/A

• Is the site regularly swept clean and after completion?

  Yes

  No

  N/A

• Is all fuelled plant and equipment stored in a manner that prevents any chemical spillage to watercourses or the environment? (for example Stihl saw stored on plant nappy or other containment method)?

  Yes

  No

  N/A

• Are materials (reinstatement/excavated) stored within the confines of the site/compound?

  Yes

  No

  N/A

• Are tools stored safely? (Slip, trip & fall)

  Yes

  No

  N/A

• Are all excavated materials removed from the side of the excavation?

  Yes

  No

  N/A

• Are drains/gullies kept clear of excavated spoil?

  Yes

  No

  N/A

• House Keeping Comments

• House Keeping Media

  Media

Plant & Equipment

• Cat, Genny, GDU, Excavator, other plant, tools and equipment

• Are CAT & Genny required on site?

  Yes

  No

  N/A

• Is the model appropriate? (Add accepted models)

  Yes

  No

  N/A

• Calibration / Service due date

  Date

• Please add photographic evidence.

  Media

• Is other plant and equipment required on site at time of audit?

  Yes

  No

  N/A

• Are Plant / Equipment etc in good operational order, with beacons where required? (To include F91's)

  Yes

  No

  N/A

• Equipment Name / Type

• Calibration / Service due date

  Date
Click Add for more

• Equipment Name / Type

• Calibration / Service due date

  Date

• Photographic Evidence

  Media

• Site Comments (Plant & equipment)

Documentation / Welfare / PPE

Fire

• Are Fire Extinguishers held in vehicle or on site?

  Yes

  No

  N/A

• Is there an expiry date on the fire extinguisher? (Annual service record)

  Yes

  No

• What is the expiry date of Fire Extinguishers?

  Date

• Please provide photographic evidence

  Media

Welfare - For guidance see CDM Code of Practice Schedule 2

• Are drinking water and vessels made available to the operatives?

  Yes

  No

  N/A

• Are washing facilities (including warm water, sink, soap & hand towels) available within a 10 minute walk or journey using a readily available mode of transport?

  Yes

  No

  N/A

• Are toilet facilities within a ten minutes walking distance?

  Yes

  No

  N/A

• Are site First Aiders Qualified?

  Yes

  No

  N/A

• What is the expiry date of first aid certificate?

  Date

• Is First Aid Kit stocked suitably for the work being carried out and content in date? For guidance see INDG214, Q4

  Yes

  No

  N/A

• What is the expiry date of First Aid Stocks in First Aid Box

  Date

• Please provide photographic evidence

  Media

• Site Comment (Welfare)

PPE

• Please answer 'yes' for PPE items that are;
  - Being used correctly and appropriately OR
  - Readily available

• Full Hi-Vis (Long Sleeved & Trousers)

  Yes

  No

  N/A

• Safety Boots

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Dust Mask

  Yes

  No

  N/A

• Ear Defenders

  Yes

  No

  N/A

• Is the CityFibre logo on the contractors PPE? (N/A- if flame retardant PPE is required)

  Yes

  No

  N/A

• Is there suitable storage for PPE in the vehicles or welfare facility provided?

  Yes

  No

  N/A

• Site comment (PPE)

Defects

• Are there any Streetworks Defects / Issues that have not been rectified at the completion of Site Visit?

  Yes

  No

• Follow standard defect process.

All personnel conducting site audits and inspections must ensure that all findings are recognised by the Contactor lead person on site (They do not have to agree the findings but must acknowledge your audit)

• Contractor Signature of recognition of findings

  Sign

• Ensure all actions have been assigned and the senior contractor has provided signature recognising findings

  Yes

  No

  N/A

• Would you like to highlight any good practice?

  Yes

  No

• Who would you like to highlight?

  Contractor / Gang

  Individual

  Other

• If answer is other, please specify.

• Please name the group / individual you would like to highlight

• Which category best describes the good practice? Categories TBC

  Select

• Please describe the category of the work being recognised.

• Please give a description of the practice you have observed and would like recognised.

• Please provide the name of the Supervisor or Sub-Contractor.

• Please provide the name of the Gang Leader.

• Auditor Signature

  Sign