Title Page

General information

Activity

  • Activity description

  • Activity type

Site

  • Site
  • Site type

  • Enel X Way Company

  • Technical line unit

Inspection

  • Inspection Code

  • Inspection done by

  • Inspector company name

  • Inspector Name

  • Date

Contractor

  • Contractor presence

  • Contract number

  • Customer

  • Contractor name

  • Contractor work order number

  • Contractor work order description

  • Foreman / responsible person

Sub-contractor

  • Sub-contractor name

  • Sub-contractor CUI/VMD Code

  • Sub-contractor VAT number

  • Sub-contractor activity description

  • Sub-contractor activity type

E-mobility

Site Type

  • Site type

SAFETY

A. Personnel Identification

  • A1. Workers within the work area are clearly identified (i.e. Works supervisor, emergency management, workers, etc.) and Company ID badge is shown The workers coincide with the roles and names authorized/listed in the work documentation: areas delivery, PtW, minutes, general / specific training lists / registers, qualifications for special vehicles and equipment, etc. - medium

  • A2. The staff has the professional profile/professional competence required for the work in progress - high

  • A3. The person in charge of the works on site is identified, present and supervise the works - high

B. Pre job activities

  • B1. The pre-job check was carried out, documented, conforms to the activity and takes into account the linguistic background of the workers - Medium

  • B2. The work permit / work plan and/or area / plant delivery is issued, present, managed and respected - high

  • B3. Risk assessment is available; takes into consideration the risks present in the workplace, the specific risks of the activity and the aspects inherent to the interferences (for ex. Electrical lines, mechanical works, etc.) - Medium

  • B4. The underground and aerial electrical cables are sheltered and the safety distances are respected according to the voltage level of the network - high

  • B5. Presence of existing underground facilities, cables, pipelines, explosive device and other interfering items has been investigated and reports are available - high

  • B6. Weather conditions are suitable for the performance of the planned activities - low

C. Availability and use of PPE / CPE

  • C1. PPE and CPE available in the work area; they are efficient and suitable (marked/certified according to the reference standard) - low

  • C2. PPE specific to current activities are worn and used correctly - medium

  • C3. The PPE for protection against ELECTRICAL RISK available on site, are efficient and suitable (complete, intact, marked/certified in accordance with standards/reference standards, etc.) (note: indicate the PPE concerned in the "Notes"). - medium

  • C4. PPE/CPE for protection from the risk of FALLING FROM HEIGHTS are available on site, efficient and suitable (complete, intact, marked/certified in accordance with standards/reference standards, etc.) (note: indicate the PPE/CPE concerned in the "Notes"). - medium

  • C5. PPE for protection against ELECTRICAL RISK is worn and used correctly (note: indicate the PPE concerned in the "Notes": dielectric gloves of the appropriate class, face shield/electric arc visor, electric arc protection clothing, etc.). - high

  • C6. PPE/CPE for protection from the risk of FALLING FROM HEIGHTS is worn and used correctly (note: indicate the PPE/CPE concerned in the "Notes"). - high

D. Electrical Hazards

  • D1. The disconnections of the power sources have been made - high

  • D2. Disconnect locking devices are effectively applied and signalled (e.g. Control Lock , Personal Lock, Tags) - high

  • D3. The absence of voltage check has been carried out - high

  • D4. The required grounding and short-circuit devices have been applied correctly on the working area - high

  • D5. The required equipotential/continuity devices have been correctly applied - high

  • D6. Protection of the possible adjacent live parts (distance, barriers, etc.) and of the work area has been carried out. - high

E. Work at height

  • E1. The equipment for access in elevation (stairs, brackets, crampons, scaffolding) available on the site are suitable (complete, intact, marked, certified) - low

  • E2. The protections and guards against falling from height are efficient and correctly used (complete, intact, marked/certified according to standards/reference standards, etc.). - high

  • E3. The equipment for access in elevation (stairs, brackets, crampons, scaffolding) are correctly installed and used - high

  • E4. Operations at height, and lowering to the ground and ascent to the top of the equipment / materials, are performed with safe methods against falling objects (for example, using suitable work belts, fixing lanyards, special containers, etc.) - medium

  • E5. The scaffolding is correctly constructed and/or used (on a visual examination, check the stability guaranteed by the bases at the lower extremities, the plane, the verticality). - high

  • E6. Analysis of the structure strength and anchoring system (in case of lighting pole, roof top, wall, etc.) which support ladders or allow stepping on has been positively performed according to internal procedures - high

F. Work procedures

  • F3. In case of prolonged work (e.g. video screens, door to door activity), if prescribed by law or procedure, the workers take short breaks at regular intervals - low

  • F4. Working procedures/methods are available for activities - medium

  • F5. The activities with generic risk and/or different from the specific "core"/prevalent risk of the job are carried out according to the standards, of the company operating procedures and the HSE contractual conditions / requirements (i.e electric work, work at height, confined spaces, ...) - medium

  • F6. Standards, contractor's operational procedures and HSE Terms are respected for the electric activities being performed (dead line or live line) - high

  • F7. The transported and/or suspended loads are controlled by guide ropes, are properly secured / slung; the lifting devices are in good condition; any containers used, are fit for purpose - high

  • F8. Equipment and tools introduced in the work area are suitable for the type of classification of the area at risk of forming explosive atmospheres. For example, intrinsically safe and / or explosion-proof equipment, non-sparking tools, etc. - medium

  • F9. Electronic equipment (cell phones, two-way radios, etc.) introduced into work areas are suitable for the type of area classification - medium

  • F10. In the case of complex activities, those are carried out according to the indications contained in the coordination / supervision documentation (e.g. Coordination report) - medium

  • F11. The participatio at coordination meetings has been performed and documented, if requested. - low

G. Equipment, tools and vehicles

  • G1. The equipment available in the work area is adequate, kept intact and functioning and accompanied by documentation relating to certifications, periodic checks and installation, use and maintenance instructions - low

  • G2. Equipment, tools and vehicles are correctly used and managed - medium

  • G3. The insulated tools/equipment available, in use or to be used, are in good condition (suitable for use, complete and intact - report in the "Notes" which) - high

  • G4. The required grounding and short-circuit devices available on sites, in use or to be used, are suitable (with markings conforming to the standard, complete, intact, etc. - report in the "Notes" which) - high

  • G5. Vehicles, construction site machinery (trucks, cranes, excavators, baskets, etc.) are adequate for the job, are maintained, undamaged, functioning, certified, checked according to the periodic legal checks - low

  • G7. The safety data sheets for chemicals are present in the workplace and made available to workers - low

  • G8. Vehicles, construction site machinery (trucks, cranes, excavators, baskets, etc.) are authorized, correctly used and stable with respect to the ground - medium

  • G9. Interferences are well managed (reference to interferences with activities, power lines, machines, vehicles, infrastructures, etc.) - high

H. Housekeeping and work signalization/segregation

  • H1. The work site is delimited, with adequate signalizations, clearly visible, illuminated and the dangerous areas inside are protected. In case the work site is on a roadway (even in-house road), it complies with the provisions of the Highway Code. - medium

  • H2. Workplaces are maintained in such clean condition and housekeeping/materials storage is adequate - low

  • H4. Area has suitable lighting sources for the tasks to carry out - low

  • H11. The activities are carried out in such a way as to avoid the risk of collapse or failure of structures / land (e.g. excavation stowage envisaged according to depth), etc. - high

I. First aid and emergency plan

  • I1. Fire-fighting equipment, first aid and recovery equipment of the injured person are present, suitable and efficient - low

  • I3. The Emergency Plan is available, suitable for the type and extent of the works, complete and easy to implement with indication of escape routes and collection points - medium

  • I4. The Emergency Plan is updated, periodically tested and identifies safe and risk areas (e.g. risks related to the location inside and outside the buildings) - medium

  • I5. Emergency maps are updated and posted on the walls - low

  • I6. Safe areas can be easily found in case of emergency - low

Documentation

L. Documentation

  • L1. The environmental plan (risk assessment and management of environmental aspects as defined in the HSE Conditions) is available on site and applied. - medium

  • L2. Activities are carried out in compliance with the authorizations obtained as per local legislation and in relation to the specific environmental requirements / work site limits (e.g. emissions, water discharges, noise, etc.) - high

M. Working areas

  • M1. Materials, chemical substances packaging are properly stored in the work areas. The waste storage areas are correctly identified and separated from the material or by-product storage areas. - medium

N. Emergency plan

  • N1. The Environmental emergency plan is available on site and workers know how to react in case of Environmental emergencies - medium

  • N2. Leakage preventive measures (e.g. containment basins) and mitigation measures (e.g. absorbent material, emergency kit) have been implemented in the event of spillage of hazardous substances to prevent soil and surface / underground water contamination - medium

O. Environmental aspects management

  • O1. Waste are properly managed (classified, labelled, stored, transported and disposed) guaranteeing the traceability in all phases. - medium

  • O2. Contractor's availability of all the necessary authorizations for waste transport and disposal, relevant to all the companies, under Contractor's responsibility, managing these activities. - high

  • O3. Excavated soil and rocks are correctly managed according to local legislation - medium

  • O5. The environmental noise impact of the activities was assessed and the mitigation measures identified were implemented - medium

Quality

Q. Quality Aspects

  • Q1. Worksite area is well organized, tiny and clear. - medium

  • Q2. Documents required by Law (i.e., Local Authorities authorization) to execute the activities planned, if any, are available. - high

  • Q3. “For construction” design documents required to execute the activities planned, if any, are available. - high

  • Q4. Deviations from the “for construction” design documents during the activities execution, if any, are recorded and issued in updated “as built” design documents - high

  • Q5. Documents necessary to execute the activities planned (Procedures, Manuals, etc…) are available. - medium

  • Q6. Measurement tools needed in executed the activities are properly and correctly calibrated. - medium

  • Q7. A checklist to verify that all the activities planned have been executed according to the relevant required are used. - medium

  • Q8. Detected non-conformities or criticalities occurred during the activities execution (in the materials, in the measurement tools, in the documentation, in the working methods) are properly recorded. - medium

SAFETY

A. Personnel Identification

  • A1. Workers within the work area are clearly identified (i.e. Works supervisor, emergency management, workers, etc.) and Company ID badge is shown The workers coincide with the roles and names authorized/listed in the work documentation: areas delivery, PtW, minutes, general / specific training lists / registers, qualifications for special vehicles and equipment, etc. - medium"

  • A2. The staff has the professional profile/professional competence required for the work in progress - high

  • A3. The person in charge of the works on site is identified, present and supervise the works - high

B. Pre job activities

  • B1. The pre-job check was carried out, documented, conforms to the activity and takes into account the linguistic background of the workers - Medium

  • B3. Risk assessment is available; takes into consideration the risks present in the workplace, the specific risks of the activity and the aspects inherent to the interferences (for ex. Electrical lines, mechanical works, etc.) - Medium

C. Availability and use of PPE / CPE

  • C1. PPE and CPE available in the work area; they are efficient and suitable (marked/certified according to the reference standard) - low

  • C2. PPE specific to current activities are worn and used correctly - medium

D. Electrical Hazards

  • D1. The disconnections of the power sources have been made - high

  • D2. Disconnect locking devices are effectively applied and signalled (e.g. Control Lock , Personal Lock, Tags) - high

  • D3. The absence of voltage check has been carried out - high

  • D4. The required grounding and short-circuit devices have been applied correctly on the working area - high

  • D5. The required equipotential/continuity devices have been correctly applied - high

  • D6. Protection of the possible adjacent live parts (distance, barriers, etc.) and of the work area has been carried out. - high

F. Work procedures

  • F3. In case of prolonged work (e.g. video screens, door to door activity), if prescribed by law or procedure, the workers take short breaks at regular intervals - low

  • F4. Working procedures/methods are available for activities - medium

  • F5. The activities with generic risk and/or different from the specific "core"/prevalent risk of the job are carried out according to the standards, of the company operating procedures and the HSE contractual conditions / requirements (i.e electric work, work at height, confined spaces, ...) - medium

  • F6. Standards, contractor's operational procedures and HSE Terms are respected for the electric activities being performed (dead line or live line) - high

  • F7. The transported and/or suspended loads are controlled by guide ropes, are properly secured / slung; the lifting devices are in good condition; any containers used, are fit for purpose - high

  • F8. Equipment and tools introduced in the work area are suitable for the type of classification of the area at risk of forming explosive atmospheres. For example, intrinsically safe and / or explosion-proof equipment, non-sparking tools, etc. - medium

G. Equipment, tools and vehicles

  • G1. The equipment available in the work area is adequate, kept intact and functioning and accompanied by documentation relating to certifications, periodic checks and installation, use and maintenance instructions - low

  • G2. Equipment, tools and vehicles are correctly used and managed - medium

  • G3. The insulated tools/equipment available, in use or to be used, are in good condition (suitable for use, complete and intact - report in the "Notes" which) - high

I. First aid and emergency plan

  • I1. Fire-fighting equipment, first aid and recovery equipment of the injured person are present, suitable and efficient - low

Documentation

L. Documentation

  • L2. Activities are carried out in compliance with the authorizations obtained as per local legislation and in relation to the specific environmental requirements / work site limits (e.g. emissions, water discharges, noise, etc.) - high

M. Working areas

  • M1. Materials, chemical substances packaging are properly stored in the work areas. The waste storage areas are correctly identified and separated from the material or by-product storage areas. - medium

O. Environmental aspects management

  • O1. Waste are properly managed (classified, labelled, stored, transported and disposed) guaranteeing the traceability in all phases. - medium

  • O2. Contractor's availability of all the necessary authorizations for waste transport and disposal, relevant to all the companies, under Contractor's responsibility, managing these activities. - high

QUALITY

Q. Quality Aspects

  • Q1. Worksite area is well organized, tiny and clear. - medium

  • Q2. Documents required by Law (i.e., Local Authorities authorization) to execute the activities planned, if any, are available.- high

  • Q3. “For construction” design documents required to execute the activities planned, if any, are available.- high

  • Q4. Deviations from the “for construction” design documents during the activities execution, if any, are recorded and issued in updated “as built” design documents - high

  • Q5. Documents necessary to execute the activities planned (Procedures, Manuals, etc…) are available. - medium

  • Q6. Measurement tools needed in executed the activities are properly and correctly calibrated. - medium

  • Q7. A checklist to verify that all the activities planned have been executed according to the relevant required are used. - medium

  • Q8. Detected non-conformities or criticalities occurred during the activities execution (in the materials, in the measurement tools, in the documentation, in the working methods) are properly recorded. - medium

SIGN OFF

  • Completed by (Name, Signature & Sign Date)

Final considerations

Stop Work

  • Has the stop work been applied?

Note

  • Note

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.