Title Page

  • JOB NUMBER

  • CONDUCTED ON

  • AUDITED BY

  • LOCATION
  • LEAD ENGINEER

GENERAL

  • CIV01.01 - At least one operative on site conversant with<br>English language?

  • CIV 01.02 - Is the site set up as per the agreed permit<br>conditions?

ROADWORKS GUARDING

  • CIV02.01 - Contractors Information Board displayed on site?

  • CIV02.02 - Correct size signs / barriers / cones for the speed of road and all plant and equipment placed within the barriers?

  • CIV02.03 - Sandbags used when weighting is necessary?

  • CIV02.04 - Are the safety zones and controls in place sufficient to prevent injury to operatives and members of the public from any activities being carried out?

  • CIV02.05 - Lead in / exit taper in place with correct number of cones and angle of taper

  • CIV02.06 - Minimum widths of carriageway maintained for<br>mode of traffic control employed?

  • CIV02.07 - Pedestrian Walkway meets / exceeds minimum<br>width requirements

  • CIV02.08 - Handrail and tapping rail in place, is the correct<br>height above the ground and meets the COP depth<br>requirements

  • CIV02.09 - Kerb ramps/footway boards/road plates used when necessary

  • CIV02.10 - Signs illuminated when required as per the Code of Practice?

  • CIV02.11 - Where required, are suitable physical pedestrian<br>barriers in place around excavations ?

  • CIV02.12 - Traffic control option meets criteria within the Code of Practice?

  • CIV02.13 - Code of Practice “Safety at Street Works and Road Works” available on site?

  • CIV02.14 - Are all vehicles positioned safely as per the Code of Practice

  • CIV02.15 - Where COP cannot be applied, has an alternative<br>means of protecting pedestrians been recorded on the Site<br>Risk Assessment?

  • CIV02.16 - Are vehicles and required plant fitted with fully<br>functional Amber Flashing Beacons?

SAFETY

  • CIV03.01 - Do operatives have Electricity Prints as per HSG47 requirements

  • CIV03.02 - Do operatives have Water prints on Site as per<br>HSG47 requirements

  • CIV03.03 - Do operatives have Gas prints on Site as per HSG47 requirements

  • CIV03.04 - Where excavation is required is there at least one<br>operative on site trained and able to demonstrate competent use the Cable Avoidance Equipment

  • CIV03.05 - Evidence of tests for underground apparatus<br>location carried out on site correctly and marked out<br>accordingly?

  • CIV03.06 - Health & Safety File available on site?

  • CIV03.07 - Are Gas Bottles / Compressed Air Cylinders being<br>used / stored correctly?

  • CIV03.08 - Are effective site communications in place?

  • CIV03.09 - Where required is Personnel Protection Equipment on site as per confined spaces regulations (ie blowers / rescue equipment.)

  • CIV03.10 - Confined Space compliance (Qualifications &<br>equipment). Where required are all persons sufficiently<br>trained in accordance with confined space arrangements

  • CIV03.11 - Are mechanical lifters used when handling CW<br>covers where required

EXCAVATIONS

  • CIV04.01 - Method / Machinery suitable for the Site / Job?

  • CIV04.02 - Excavations in the vicinity of trees carried out in<br>line with correct specifications? (NJUG)

  • CIV04.03 - Excavation shored to prevent loss of ground where required?

  • CIV04.04 - Existing Ducts / Mains supported correctly?

  • CIV04.05 - Excavated Material stored a safe distance away<br>from the excavation?

  • CIV04.06 - Excavations carried out so as not to undermine<br>existing structures?

  • CIV04.07 - Suitable safe access and egress provided?

  • CIV04.08 - Trial (Pilot) holes undertaken onto expected or<br>anticipated services

PLANT & EQUIPMENT

  • CIV05.01 - Is the Plant and Equipment (including safety<br>guards) in good condition and suitable for the work?

  • CIV05.02 - Are All Portable Electric Tools And Equipment In<br>Good Condition And Have They Been PAT Tested?

  • CIV05.03 - Are Operatives competent to operate the plant and equipment on site in line with their appointed role?

  • CIV05.04 - Have the daily, weekly and monthly checks been<br>logged in the On site/Inspection Registe and has it been kept<br>up to date?

  • CIV05.05 - Where trailers and towed plant are used, are they in good condition with an adequate means of securing the load during transport?

ENVIRONMENTAL

  • CIV06.01 - Are Resins and other Compounds securely stored<br>and separated from inert material prior to disposal?

  • CIV06.02 - Water from Chamber / Excavations disposed of<br>Properly?

  • CIV06.03 - Is there a risk of contamination from the storage of concrete products/spoil/run off liquids entering adjacent<br>drains/gullies?

  • CIV06.04 - Can operatives demostate that water samples have been taken and checked for comtamination

  • CIV06.05 - Care taken to prevent Damage / Contamination to Paving / Tarmac / Grass etc from Fuel, Oil etc?

STOP WORK NOTICE

  • CIV07.01 - Stop Work Notice issued for breach of Safety<br>Requirements?

  • CIV07.02 - Stop Work Notice issued for breach of Contractual Requirements?

SITE AMD OTHER DOCUMENTATION

  • CIV08.01 - Code of Practice “Specifications for Reinstatement of Openings in the Highway” available on site?

  • CIV08.02 - Is Site Specific Daily Dynamic Risk Assessment<br>Available And Completed On Site?

  • CIV08.03 - Is Safety Information Available On Site Applicable<br>To The Works Being Undertaken Including COSHH, RAMS etc..?

  • CIV08.04 - Access to current issue of relevant Specification<br>available

  • CIV08.05 - Work Pack containing all necessary Prints and<br>schematic Drawings available on site?

  • CIV08.06 - Contractor has required NRSWA Notice?

  • CIV08.07 - Site Personnel have correct NRSWA Accreditation / Registration for the work being executed where required?

  • CIV08.08 - Operatives working in accordance with training,<br>accreditation and licensing rules

QUALITY

  • CIV09.01 - Correct material laid around duct before backfill<br>(SAND/PEA SHINGLE)

  • CIV09.02 - Is fresh Type 1 being used on site?

  • CIV09.03 - Backfill/Subbase been stored or disposed of<br>correctly (To stop contamination) (Type 1)

  • CIV09.04 - Was grey/black duct used?

  • CIV09.05 - Was green fibre warning tape used

  • CIV09.06 - Work site left tidy/Contrators rubbish removed?

SIGN OFF

  • CIV10.01 - Does the overall audit constitute a risk to the<br>publics health and safety

  • CIV10.02 - Has the overall audit passed or failed based on the<br>questions above

  • Comments

  • Lead Engineer Signature

  • Auditor Signature

  • Closure Date

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