CSS N W report pro Forma

• Report Reference Number:

• Site Inspected:

• Client

• Conducted on

  Date

• Advisor:

• Personnel

Risk Rating Scoring. 0 = Standards meet regulatory requirements and industry best practice, or item is not applicable. 1 = Standards fall short of industry best practice. 2 = Improvement needed to avoid breach of regulation. 3 = Breach of regulation, immediate action required to reduce the risk of harm and/or enforcement action.

0 Previous Inspections.

• Have matters identified during previous inspection been satisfactorily addressed.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

1 Scaffolds and Mobile Towers

• Designed - handed over - erected in accordance with recognised standards - statutory inspections carried out etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

2 Ladders & Stepladders.

• Fit for purpose - in good order - secured - inspected etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

3 Demolition.

• Demolition plan in place - work carried out in accordance with plan etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

4 Excavations & Groundworks.

• Safe digging - supported/battered - statutory inspections - access/egress etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

5 Lifting Operations.

• Lifting plan - testing/certification - ground conditions - SWL etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

6 Mobile Plant & MEWPs.

• Fit for purpose - tested/inspected etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

7 Portable Tools.

• PAT - fit for purpose etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

8 Access/egress.

• Adequate - maintained in good order etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

9 Electricity

• Inspection/test - isolation/lock off etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

10 Environmental.

• Waste management - spill kit - noise - dust - mud etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

11 Fencing/security.

• Adequate - maintained etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

12 Contractor Management.

• Co ordinated - supervised etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

13 Personal Protective Equipment.

• Fit for purpose - face fit tested etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

14 Edges/openings/stairways.

• Adequately guarded - handrails on stairs - stairs unobstructed etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

15 Site Good Order

• Housekeeping - slips/trips/falls - lighting etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

16 Fire Precautions.

• Fire plan - alarms - signage - extinguishers - exit routes - muster point - flammables etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

17 Occupational Health

• Noise - HAVS - MSDs - Dermatitis etc

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

18 Welfare

• Sufficient facilities - adequately equipped - suitably maintained.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

19 First Aid

• A&E location - first aiders - equipment.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

20 Competency

• Site inductions - tool box talks - training etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

21 Documentation

• Construction Phase Plan - Pre Construction information - statutory notices -

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

22 Asbestos.

• Survey report - management plan - re occupation certificate - licensed work etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

23 Safe Systems of Work

• Method Statements - COSHH - Risk Assessments - Permits etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

24 Traffic Management

• Traffic plan - segregated routes - routes maintained - signage etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

25 Temporary Works

• Designed - co ordinated etc.

  Risk Rating 3

  Risk Rating 2

  Risk Rating 1

  Risk Rating 0

• Overall Comments:

• Advisor

  Sign

• Company Representative

  Sign