Depot works On-Site

• CPA works order number

• Site name

• Conducted on

  Date

• Supervisor

• Location
  Address

• Gang Name

• Site photo

  Media

Safety Observations

• Housekeeping (free of hazards)

  Safe

  At Risk

  N/A

• Service avoidance (under and overhead) use of CAT

  Safe

  At Risk

  N/A

• PPE

  Safe

  At Risk

  N/A

• Noise/dust

  Safe

  At Risk

  N/A

• Manual Handling(reduced where possible)

  Safe

  At Risk

  N/A

• Fire protection and First Aid

  Safe

  At Risk

  N/A

• Ladders/cherry picker

  Safe

  At Risk

  N/A

• Cutting & Grinding

  Safe

  At Risk

  N/A

• Is COSHH being used correctly?(labelled containers etc)

  Safe

  At Risk

  N/A

• Lifting Equipment (in date test etc)

  Yes

  No

  N/A

• HAV's

  Safe

  At Risk

  N/A

Traffic management

• Are all signs and cones laid in accordance with CH8?

  Yes

  No

  N/A

• Is there a safe route for pedestrians?

  Yes

  No

  N/A

Quality

• Are works following design?(CVI)

  Yes

  No

  N/A

• Are the gang making Expected Progress ?

  Yes

  No

  N/A

• Are the materials correct to the job?

  Yes

  No

  N/A

• Are Plant & vehicle correct to the job?

  Yes

  No

  N/A

• Are the operatives correct for this work?

  Yes

  No

  N/A

• Does the Site layout look correct?

  Yes

  No

  N/A

Drainage

• Drainage

  Off

  On

• Is correct ironwork class in use? .i.e D400

  Yes

  No

  N/A

• Is line and level of pipe work correct?

  Yes

  No

  N/A

• Are manholes and gullies constructed correctly?

  Yes

  No

  N/A

• Does bed and surround meet spec?

  Yes

  No

  N/A

• Are Joints closed?

  Yes

  No

  N/A

Earthworks

• Earthworks

  Off

  On

• Is line and level correct ?

  Yes

  No

  N/A

• Edge Shoring: Have the tie wires been correctly installed ?

  Yes

  No

  N/A

• Edge Shoring: have the correct posts been used and are they driven to correct depth?

  Yes

  No

  N/A

• Gabion:Has the correct fill been used? Ie Class 6G

  Yes

  No

  N/A

• Gabions: has the correct basket been used?

  Yes

  No

  N/A

Patching

• Patching

  Off

  On

• Are patches planed to correct depth?

  Yes

  No

  N/A

• Has bond coat been applied? Including vertical edges

  Yes

  No

  N/A

• Has the material temp been checked before laying?

  Yes

  No

  N/A

• Are patches compacted satisfactorily?

  Yes

  No

  N/A

Grass/Hedge cutting

• Grass/Hedge cutting

  Off

  On

• Is the grass cut to 75mm +/- 25mm?

  Yes

  No

  N/A

• Are number of swathes cut correct?

  Yes

  No

  N/A

• Is strimming carried out around street furniture ?

  Yes

  No

  N/A

• Have all visibility splays been cut correctly?

  Yes

  No

  N/A

• Confirm sensitive sites have not been cut?

  Yes

  No

  N/A

Jetting/gullying

• Jetting/gullying

  Off

  On

• Is there evidence gully pots have been properly cleaned?

  Yes

  No

  N/A

• Have tops been cleaned and surround cut back 100mm?

  Yes

  No

  N/A

Roadmarkings

• Roadmarkings

  Off

  On

• Is line of the required quality?

  Yes

  No

  N/A

Sign maintenance

• Sign maintenance

  Off

  On

• Has the correct post foundation used ? Ie size and depth

  Yes

  No

  N/A

• Does the sign have a manufacturers label?

  Yes

  No

  N/A

• Has the correct post size been used and is the sign face installed at the correct height ?

  Yes

  No

  N/A

• Working at height (overhead cables,MEWPS)

  Safe

  At Risk

  N/A

Safety Defects

• Safety Defects

  Off

  On

• Have defects been saw cut with vertical edges?

  Yes

  No

  N/A

• Has bond coat been applied?

  Yes

  No

  N/A

• Is material hot/ compacted?

  Yes

  No

  N/A

Acknowledgement

• Chargehand signature

  Sign

• Supervisor Signature

  Sign