Title Page

  • B #

  • Client / Site

  • Conducted on

  • Prepared by

  • Work Order

  • Location
  • Personnel

Site Specific

  • Date and Time Arrived on site

  • Risks identified and working in Accordance with IMSAD-11035 Safe Work Method Statements

  • Has a Site Specific Risk Assessment carried out? Have any other risk been identified?

Signal Action

  • SCATS Operation upon arrival

  • Personality timing sheets compared and changes identified?

  • Are there phasing changes identified?<br>

  • Any wiring alterations required?

  • Works carried out?

  • Signal operation checked?

  • Loop inputs and push buttons checked and operation confirmed?

  • SCATS Operation Upon Departure

  • Further Action?

Sign Off

  • Date and Time Finished on site

  • Technicians on Site

  • Lead Technician Sign Off

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.