CityFibre SHE Inspection Template (BP)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

City conducted:

• PN Number:

• Principle contractor:

• Sub contractor (if applicable):

• Please remember to provide photo evidence for all applicable questions

SLG

• Is advanced warning correct, correctly placed, in acceptable condition and weighted?

  Yes

  No

  N/A

• Are barriers erected, weighted appropriately, and securing site on all sides?

  Yes

  No

  N/A

• Are the correct sized cones used and placed correctly?

  Yes

  No

  N/A

• If Traffic Control is Required, is it correct and fit for purpose?

  Yes

  No

  N/A

• Is there clear instruction and information for pedestrians?

  Yes

  No

  N/A

• Is there a safe route around the works including any footway boards or T matting which must be appropriately fitted, in good condition and fit for purpose?

  Yes

  No

  N/A

• If there is a cycle lane within the works area, have diversion or 'please dismount' signage been provided and displayed?

  Yes

  No

  N/A

• Where used, are carriageway ramps or road plates fit for purpose, fixed appropriately and in good condition?

  Yes

  No

  N/A

• Has adequate allowance been made in site setup for a safe working area, including within the confines of any traffic management?

  Yes

  No

  N/A

• Are materials and equipment that are separate to the work area suitably contained within barriers or fencing?

  Yes

  No

  N/A

• Is a CityFibre site information board displayed appropriately, providing the full and correct permit number readable from the footway or safe location?

  Yes

  No

  N/A

• Are the permit conditions on site and accessible for all crew and adhered to?

  Yes

  No

  N/A

• Is the site set up so it does not cause obstruction (either physical or to visibility for road users or pedestrians crossing) and accounts for the local area? (i.e. Residential or business access, schools, emergency services, disabled parking bays)

  Yes

  No

  N/A

• Are there any other high risk failures on site or caused by the works?

  Yes

  No

  N/A

Documentation

• Have suitable Site Risk Assessments been conducted, recorded, signed by/briefed to all, for the current operations?

  Yes

  No

  N/A

• Are Method Statements/SSoW in use, briefed, and applicable?

  Yes

  No

  N/A

• Are utility drawings on site, in date, available, legible and understood?

  Yes

  No

  N/A

• Are emergency and environmental incident response processes available on site?

  Yes

  No

  N/A

Noticing & Competence

• Is there a Streetworks qualified supervisor on site or available?

  Yes

  No

  N/A

• Have Streetworks personnel got the relevant operative certificates available for inspection?

  Yes

  No

  N/A

• Are all operatives trained and competent for the task being undertaken? (SA002/CPCS/Abrasive wheels etc)

  Yes

  No

  N/A

Welfare

• Are suitable welfare arrangements in place and have locations been communicated?

  Yes

  No

  N/A

PPE

• Is PPE being worn correctly and appropriate for the works being conducted?

  Yes

  No

  N/A

HSG47

• Are utility markings suitable and clearly visible?

  Yes

  No

  N/A

• Is CAT and Genny equipment calibrated, in good working order and being used appropriately?

  Yes

  No

  N/A

• Are safe digging processes being followed?

  Yes

  No

  N/A

• Are works in proximity to trees following NJUG tree protection zone guidance?

  Yes

  No

  N/A

Other Plant & Equipment (excluding CAT and Genny)

• Is all plant and equipment checked as required?

  Yes

  No

  N/A

• Is dust suppression being used during cutting activities?

  Yes

  No

  N/A

• Is there sufficient protection to prevent falls from height or dropped objects? (including on vehicles where required)

  Yes

  No

  N/A

House Keeping

• Are tools, equipment and materials (including contaminated) stored safely and appropriately?

  Yes

  No

  N/A

• Are plant, fuelled tools and fuel cans being stored on suitable plant pads, trays or nappies (including when in use) with a spill kit available?

  Yes

  No

  N/A

• Are substances stored with appropriate labels and in approved containers?

  Yes

  No

  N/A

• Are noise levels on site being controlled/reduced? (PPE, Working hours, equipment choices)

  Yes

  No

  N/A

• Is the site swept and in general good order?

  Yes

  No

  N/A

Good Practice & Sign Off

• Are there any exceptionally good safety behaviours or standards of work being exhibited?

  Yes

  No

  N/A

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

• Sign Off

  Sign

• Auditor Signature

  Sign