Title Page

  • Job Number

  • Exchange

  • Survey Conducted on

  • Prepared by

  • Location

Moleplough Survey Details

  • Client Reference Number

  • Survey Valid for 60 Days

  • Date Valid From:

  • 2: Work location:

  • 3: Scope of Works:

4: Important Job Details

  • Estimated Duration of works:

  • Key Safety and Environmental Hazards:

  • Environmental aspects: Machine failure could cause pollution to water courses, Noise Pollution for duration of works. Dust. Damage to wildlife. Damage to Trees Plants. Live stock in fields or raoming.

  • Control Measures: Machinery is to be serviced regularly, spill kits are to be carried, no refuelling on site, engines are not to be left idling. Times and duration of work is to be considered if working in pedstrianised areas or if shools are nearby. Gates to fields and public access to be closed and barriered if necessary to stop access temporarily. Water to be used to supress duct particles. No work to be carried out adjacent to or close to High speed traffic or Railways without a specific risk assessment and traffic management in place. Work must stop if evidence of endangered species or invasive plants and guidance sought.

  • 05: Method of Working:

  • Key Person and contact details:

  • Client Surveyor Planner:

  • Client Assistance:

  • Client Health and Safety Representative:

  • EMERGENCY TELEPHONE NUMBER 999

06: Training:

  • All operatives and supervisors/site liasions are competent, fully trained and experienced in the use of any plant machinery and tools required to carryout the works. At least one member of the team carries a NRSWA accreditation

  • PPE Requirements:

  • All operatives wear as standard and compulsory long sleeved flame retardant hi visibility jackets, flame retardant and anti static overalls or trousers gloves, saftey boots with ankle support., additional ppe will be used depending on task, i.e FFP3 Face Fitted dust mask, Hard Hat Glasses or Eye Protection

  • Additional PPE Will also include site specific requirements:

07: Housekeeping:

  • All plant and machinery will be maintained within the set site boundaries and removed from site on a daily basis

08: Deliveries to Site:

  • Deliveries to site will be made by the gang all materials will be transported to site unless stated otherwise, if we need to import materials permission will be sought prior to deliveries being organised

09: Security:

  • Eltel operatives will maintain security on site and have been briefed on site security during their induction, any breaches of security should be reported to Eltel-UK Ltd's Head office immediatley. 01642706238

10: The nearest Hospital:

  • The nearest Hospital is 0000 mins drive away and is located at :

  • The nearest Hospital with A & E (Urgent Care) department:

  • Map Showing The nearest Hospital with A & E (Urgent Care) department:

11: Openreach-Client Notes:

  • Would you like to add notes from Job Pack to help with construction of works? (take photo of notes within job pack for reference)

  • Notes:

12: Site Survey Photos

  • Is this Job Feasible for Moleplough Method?

  • Yes-No-Part

  • Survey Photos:

  • Todays Date:

  • Name:

  • Signature:

IMPORTANT - Completed Documents.

  • Once this document is completed, Please email to chris.briggs@eltel-uk.info and mike.ritchie@eltel-uk.info and also save in gdrive under the relevant folder name. Chris Briggs will then upload the document to solo.

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.