COSS On-Site Inspection

• Conducted on

  Date

• Week

• Prepared by

• Location
  Address

• Is it DAY or NIGHT

  Day

  Night

• COSS Name

• COSS Phone Number

• COSS Employer

• COSS Line Manager

• Is the COSS in possession of their SENTINEL card?

  Yes

  No

• Reason for not having their SENTINEL card?

• Copy of SENTINEL Card

  Media

• Is the SENTINEL card valid? <br>(Poor/damaged/tampered photograph readers card as invalid)

  Yes

  No

• Explanation / Action Taken

• Does the COSS hold the correct competency for the duty been undertaken?

  Yes

  No

• Explanation / Action Taken

• Sentinel card check - ATTACH SCREEN SHOT

  Media

• is the work a short notice emergency work or pre-planned?

  Emergency

  Pre-Planned

• Details of Emergency

• SWP Ref & GZAC Number

• Does the COSS have a suitable IRP filled out?

  Yes

  No

  N/A

• Reason

• If Pre-Planned does the COSS have a suitable SSOWP?

  Yes

  No

• Details

• In what form is the SWP?

  Paper

  Tablet

  Phone

• If Pre-Planned was the SSWOP accepted and verified one shift in advanced by the COSS?

  Yes

  No

• When did the COSS receive his SSOWP? (explanation needed)

• if Pre-Planned what type of SSOW was Planned?

  Safeguarded

  Fenced

  Site Warden

  Equipment Warning

  Lookout Warning

• If Pre-Planned have any changes been made to the SSOWP?

  Yes

  No

• Did the COSS seek permission for the change?

  Yes

  No

• Reason for not getting permission?

• Who gave permission for change?

• what was changed and why?

Location Deatils

• Geographical Location Name

• Lines affected with mileage

• Line of Route & ELR reference

• Access Point Name (including local name if relevant)

Work / Protection Details

• Was the COSS observed carrying out their duties ON or NEAR THE LINE

  Yes

  No

• Can the COSS demonstrate knowledge of the line and the limits of the worksite?

  Yes

  No

• Total number of members in the group - incl the COSS?

• Type of work taking place?

• Does the work effect the safety of the Line?

  Yes

  No

• Type of protection planned / being used?

• Is the protection planned / being used appropriate?

  Yes

  No

• Is the type of protection being used set up correctly?

  Yes

  No

  N/A

• Was the SSOW tested?

  Yes

  No

  N/A

• Reason for not testing the SSOW method?

• Where necessary, has the COSS protected any adjacent line(s)?

  Yes

  No

  N/A

• Is anyone in the group at RISK?

  Safe

  At Risk

  N/A

• Explain / Action Taken

Communications

• Is the COSS aware of the affected signal boxes and in receipt of the correct telephone numbers?

  Yes

  No

• Suitable communication equipment arranged, tested and in working order?

  Yes

  No

  N/A

• Has any safety critical communication been observed?

  Yes

  No

• Was key information repeated back?

  Yes

  No

• Was the conversation accurate, brief, clear while using the phonetic alphabet?

  Yes

  No

• Was Line, signals and points clearly referenced?

  Yes

  No

PPE

• Relevant arm bands worn correctly?

  Yes

  No

• Are all the group wearing the correct and approved PPE?

  Yes

  No

• Is all PPE Clean?

  Yes

  No

• Is the correct equipment available for the group to carry out the works in a safe way?

  Yes

  No

• Is the correct LOGO displayed on the back of the PPE?

  Yes

  No

Briefing

• Has the COSS briefed the group on the work content/limits, protection, hazards, emergency arrangements and movement of any OTP/trains etc?

  Yes

  No

  N/A

• Have the group confirm they fully understood the brief?

  Yes

  No

  N/A

• Has all the group signed the RT9909 Record of arrangements form?

  Yes

  No

  N/A

• Did the COSS check the groups sentinel cards?

  Yes

  No

  N/A
Group SENTINEL card checks

• Staff Name?

• Employer?

• Role on site?

• Is the staff in possession of their SENTINEL card?

  Yes

  No

• Reason for not having their SENTINEL card?

• copy of SENTINEL card

  Media

• Is the SENTINEL card valid? <br>(Poor/damaged/tampered photograph readers card as invalid)

  Yes

  No

• Does the individual hold the correct competency for the duty been undertaken?

  Yes

  No

COMMENTS / RECOMMENDATIONS

• Detail any observations of good or bad practices

• Any Actions Required?

  Yes

  No

• what actions required?

• Auditor - print & sign name

  Sign

• COSS - print & sign name

  Sign