Title Page
-
Date
-
Report Completed by
-
Task/s this shift
- Thermoplastic linemarking instatement only (Preformed)
- Removal / grinding off of existing linemarking only
- Linemarking removal and reinstatement
- Water based linemarking instatement
- No works undertaken
-
Name of First Aid Representative Onsite
-
Pre start meeting conducted, with all workers present.
-
The SDS Register available and accessible to all Personal
-
SWMS Training Completed
-
Employee inductions completed
-
Equipment pre start inspections completed.
-
Plant and equipment on hire this shift and the Suppliers details
- Graco Linemarker
- Utility
- Equipment trailer
- Other (item to be listed in the “notes”)
- Supplier - GPM
- Supplier - other ( to be listed in the “notes”)
-
Notes
-
Related Photos
Employee - Shift Sign On Declaration
-
Daily pre start Sign on by all Service Stream employees is a mandatory requirement.
By signing this Declaration, you Acknowledge, Confirm and Agree to comply with each of the following individual statements -
Note : Failing to comply will result in disciplinary action and or termination of employment.
1. Mandatory Training : You confirm -
- you will not operate any vehicle, plant, equipment or tooling unless you have previously undertaken and successfully completed the minimum “Service Stream” / “Connect Sydney”, “Government”
OR
- You are currently undergoing training and will proceed only under the instruction / direct supervision of a suitably pre qualified trainer.
- You hold the required tickets and licenses required to be in control a piece of plant, equipment, tooling, vehicle.
2. OH&S Training, You confirm -
- OH&S Construction Induction Training - you have successfully completed and obtained the White Card induction training and have the card in possession and ready for inspection if asked.
- Inductions - you have successfully completed all required Service Stream / Client / Connect Sydney inductions.
- SWMS Training - you have successfully undertaken task related SWMS training and signed on.
- Pre Start Meeting - you have attended / signed on to todays pre-start. - SDS Training - you have received adequate training in and have also completed a review of any task related SDS.
- you will always comply to the related SDS / SWMS relating to the task at hand.
3. PPE: You agree, you will at all times -
- to comply to the Service Stream stipulated PPE rules and regulations.
- to wear the correct PPE that is required and in accordance with the task related SDS / SWMS. - to source, engage, correctly wear and maintain all task, SDS / SWMS stipulated / related PPE, correctly, and as stipulated by the manufacturer.
4. Conduct, You agree -
- to present and conduct yourself in a professional, polite and approachable manner whenever representing Service Stream.
- to promote, maintain and conduct yourself in a manner that ensures a safe working environment for both yourself and also the people and the environment at all times.
- To follow, implement and enforce the correct task related practices / protocols and procedures, in accordance with the related Service Stream / SDS / Client, mandatory task related protocols and requirements.
5. Reporting: You agree to -
- Sign on to this report daily, doing so at the allocated shift start time for this shift.
- Immediately report all accidents, incidents or near misses, to your Service Stream supervisor / manager, immediately after the situation is deemed safe.
- Complete all pre start inspections prior to the operation of any vehicle, plant, equipment or tooling.
6. Plant and Equipment Pre Start inspections: You confirm that -
- You have completed and signed the required vehicle, plant, equipment and tooling pre start inspections prior to commencement of operation.
- you will immediately report to your supervisor any issue of fault observed, for subsequent assessment and rectification.
7. Drugs and Alcohol: You confirm, agree and consent that -
- you have not and will not take or administer any drugs or alcohol that are illegal, non prescribed and or that may affect your ability to preform a task or duty.
- you have not consumed or administered any drugs or alcohol for the 12 hour period prior to starting this shift.
- you will not take or administer illegal or non prescribed drugs or alcohol directly after or during this working shift.
- you will undertake random drug and alcohol testing when you are instructed or required to do so.
- you are not under the influence of any drugs or alcohol at the start of this shift.
- you are fit, well and healthy to undertake all tasks that maybe assigned to you. -
Shift Type
-
Shift Start Time
-
Employee 1 - Sign on / Declaration
-
Employee 2 - Sign on / Declaration
-
Employee 3 - Sign on / Declaration
-
Employee 4 - Sign on / Declaration
-
Notes
Employee Shift Sign Off
-
Shift End
-
Employee 1 - Sign off
-
Employee 2 - Sign off
-
Employee 3 - Sign off
-
Employee 4 - Sign off
-
Notes
Traffic Control
-
Is Traffic Control Engaged this Shift
-
Cancellation of TC Crew. (If Applicable)
-
TC Company Engaged this Shift
-
Number of Accredited Traffic Controllers Working Onsite
-
TC Setup Time / Road Closure is in Accordance with the ITP / TCP -
-
TC Time Onsite
-
TC Time Off Site
-
Total TC Crew Hire Hours
-
TC Equipment Left Onsite
-
Additional TC Requirements (Next Shift)
-
Additional TC Resources Required Next Shift
-
Notes
-
Related Photos
Linemarking Removal Operation
-
Task preformed
- Thermoplastic linemarking instatement only (Preformed)
- Removal / grinding off of existing linemarking only
- Linemarking removal and reinstatement
- Water based linemarking instatement
- No works undertaken
-
Site Location
-
Sweeper engaged
-
Company supplying sweeper
-
Sweeper time on site
-
Sweeper time off site
-
Total area of linemarking removed (square meters)
-
Total waste collected by Suction sweeper (Tonnes)
-
Description of waste type
-
Proposed method of disposal
-
Disposal site address
Completed Works Log (Linemarking)
Job Site 1. Site Details
-
Location
-
Client
-
Task preformed
- Thermoplastic linemarking instatement only (Preformed)
- Removal / grinding off of existing linemarking only
- Linemarking removal and reinstatement
- Water based linemarking instatement
- No works undertaken
-
Status
- Commence
- On Hold
- Cancelled
-
Job Progress Status
-
Shifts Remaining
-
Time Onsite
-
Time Off Site
-
Weather Onsite
-
Details of Unexpected Delays / Time Lost.
-
Notes
-
Photos
Job site 1. Instated Linemarking Record
-
L1 or Lane Lines (Total Number of Individual Lines Instated)
-
S1 or Double Centrelines (Measurement in Lineal Meters)
-
E1 or Edge Lines. (Measurement in Lineal Meters)
-
C1 or Merge Lines. ( Total Number of Individual Dashes Instated )
-
Transverse “Stop” Lines. ( Measurement in Lineal Meters )
-
Transverse “Giveway” Dashes. ( Total Number of Individual Dashes Instated )
-
Dragons Teeth ( Total Number of Individual Teeth Instated)
-
Road Signage “40km” ( Total Number of Individual Stencils Instated)
-
Directional Arrows. ( Total Number of Individual Arrows Instated)
-
Notes
Job Site 2. Site Details
-
Location
-
Client
-
Task preformed
- Thermoplastic linemarking instatement only (Preformed)
- Removal / grinding off of existing linemarking only
- Linemarking removal and reinstatement
- Water based linemarking instatement
- No works undertaken
-
Shift Status
- Commence
- On Hold
- Cancelled
-
Job Progress Status
-
Shifts Remaining
-
Time Onsite
-
Time Off Site
-
Weather Onsite
-
Details of Unexpected Delays / Time Lost
-
Notes
-
Photos
Job site 2, Instated Linemarking Record
-
Record Measurements as per instruction
-
L1 or Lane Lines (Total Number of Individual Lines Instated)
-
S1 or Double Centrelines (Measurement in Lineal Meters)
-
E1 or Edge Lines. (Measurement in Lineal Meters)
-
C1 or Merge Lines. ( Total Number of Individual Dashes Instated )
-
Transverse “Stop” Lines. ( Measurement in Lineal Meters )
-
Transverse “Giveway” Dashes. ( Total Number of Individual Dashes Instated )
-
Dragons Teeth ( Total Number of Individual Teeth Instated)
-
40km Zone Stencils. ( Total Number of Individual 40km Zone Stencils Instated)
-
Directional Arrows. ( Total Number of Individual Arrows Instated)
-
Notes
Employee Training Log
-
Name of Trainee
-
Training Type
-
Name of Trainer
-
Total Number of Training Hours (this shift)
Trainee 2
-
Name of Trainee
-
Training Type
-
Name of Trainer
-
Total Number of Training Hours (this shift)
Trainee 3
-
Name of Trainee
-
Training Type
-
Name of Trainer
-
Total Number of Training Hours (this shift)
Trainee 4
-
Name of Trainee
-
Training Type
-
Name of Trainer
-
Total Number of Training Hours (this shift)
Accident, Incident, Near Miss Register
-
If applicable: All occurrences must be reported to Service Stream management and this report completed in detail, immediately and directly after all personal are safe and receiving the appropriate / correct level of cared, AND the site / situation is deemed to be as safe as it possibly.
-
Incident Type
-
Name of Persons Involved
-
Did Anyone Sustain Seriously Injury
-
Did Anyone Sustain Minor Injury
-
Has this matter been Immediately Reported to Service Stream Management
-
Service Stream Manager Notified
-
Have Emergency Services been Called
-
Did Emergency Services Attend the Scene
-
Was anyone hospitalised
-
Detailed Report
-
Related Photos
Traffic Control Incident / Accident Register
-
Details of Accidents/ Incident
-
Has this been Reported to Service Stream Management
Stock / Tooling Request
Stock / Equipment Request
-
Stocks Request
-
List in detail the stock and the amount required
-
Date Required
-
Tooling / Equipment Request
-
Details of tools and or equipment required
-
Date Required
Waste Management
-
1. Type of Waste
-
1A. Amount Produced this Shift (Kilograms)
-
1B. Proposed Method of Disposal
-
2. Type of Waste
-
2A. Amount Produced this Shift (Kilograms)
-
2B. Proposed Method of Disposal
-
3. Type of Waste
-
3A. Amount Produced this Shift (Kilograms)
-
3B. Proposed Method of Disposal
-
4. Type of Waste
-
4A. Amount Produced this Shift (Kilograms)
-
4B. Proposed Method of Disposal
-
5. Suction Sweeper total waste tonnes
-
Decription
