Title Page
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Site location
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Day conducted
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Prepared by
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Gang ID number:
TO BE CHECKED BY COMPETENT PERSON
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Is the relevant work stream manual on site?
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Is the work area free from slip/trip hazards?
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Has a daily check / visual inspection taken place on all plant to be used?
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All SLG to code of practice? (Insert applicable C.O.P. page No)
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One gang member holds the required NRSWA unit for the work activity?
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Is all the relevant PPE to be used in good condition?
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Are all control measures in place as per the generic based RAMS?
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Is the material storage safe and the site security adequate?
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Do operatives on site have the appropriate PPE?
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Is an adequate safety zone in place for lifting operations?
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Can the minimum separation to overhead power lines be maintained?
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Is all lifting equipment certified and fit for purpose?
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Are the GDU in calibration? Date:
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Can the site be secured ? 360 guarded
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Has a daily check / visual<br>inspection taken place on<br>all plant to be used?
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Do operatives on site<br>have the appropriate<br>accreditation?
Lead engineer name
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Personal 1
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Personal 2
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Add signature
Personal 3
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Additional information
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