Title Page

  • Employee Name

  • Site Conducted

  • Conducted on

  • Prepared by

  • Work Description

  • Duration of Works

IDENTIFICATION & UNIFORM

  • Does the employee have a company I.D card?

  • Does the engineer have a valid Gas Safe License Card?

  • Is the employee wearing company specified uniform?

  • Is the uniform in good condition and presentable?

  • Are safety boots / shoes being worn?

  • Personal CO Detector being worn?

SITE INDUCTION & SIGN IN

  • Signed in on site?

  • Has a site induction been completed?

  • Where applicable are site passes or permits to work in place?

  • If the engineer is Lone Working have they made arrangements to maintain regular contact with a site representative?

  • Asbestos Register reviewed where relevant?

  • Is the engineer UKATA Asbestos Awareness trained?

  • Does the engineer know what procedure to follow if Asbestos is confirmed or suspected in the work area(s)?

WORK INSTRUCTION / WELFARE

  • Has the engineer received sufficient work instruction?

  • Does the engineer understand what is required as part of the works? (i.e task, specification, method,equipment & tools needed etc)

  • Are they aware of the Manager in charge of the works?

  • Does the engineer have access to suitable welfare facilities? (handwashing, W.C, fresh drinking water)

  • Clothing changing area available where required?

RISK ASSESSMENT, METHOD STATEMENTS & PERMITS TO WORK

  • Does the engineer have access to a set of RAMS for the work / task being undertaken? (incl equipment, COSHH etc)

  • Are the RAMS in date?

  • Has the engineer reviewed & acknowledged the RAMS?

  • Has a Point of Work Risk Assessment been completed on Joblogic?

  • Is the engineer aware of the hazards associated with the task / job?

  • Is the engineer able to suitably control the hazards identified?

  • Are the recorded control measures being applied?

  • Does the engineer have access to applicable Safe Systems of Work / Safe Working Procedures?

  • If applicable, has a permit to work been completed and validated by an authorised person?

  • Rate the engineers understanding of hazards and control measures?

ACCESS & HOUSEKEEPING

  • Can the engineer access the work area(s) safely?

  • Lighting in the work area adequate?

  • Is the work area adequately controlled / segregated to prevent unauthorised access to third parties incl MOP?

  • Are all nuisances being adequately controlled i.e. dust, noise?

  • Is the work area tidy and are materials, tools & equipment stored safely to prevent slip, trip and fall hazards?

  • Are all waste materials being disposed of in an approved waste receptacle?

EMERGENCY PREPAREDNESS

  • Is the engineer aware of the sites evacuation plan & muster points?

  • Are fire exits clearly signed and free from obstruction?

  • Is the engineer able to raise the alarm in the event of a fire?

  • Fire Extinguisher(s) present in or around the work area?

  • Are flammable & combustible materials & liquids stored away from ignition?

  • Is the engineer trained in Fire Safety Awareness?

  • Does the work site have suitable provision for First Aid incl Appointed First Aiders, First Aid procedures, First Aid supplies etc?

  • Is the engineer trained in Emergency First Aid at Work?

  • Company mobile phone accessible for use in the event of an emergency?

PPE

  • PPE Bag

  • Safety Boots

  • Hard Hat

  • Manufacture Date

  • Bump Cap

  • Manufacture Date

  • Hi-Vis Vest

  • Safety Glasses / Safety Goggles

  • Ear Defenders / Foam Ear Plugs

  • Stanley Gripper Gloves

  • Disposable Gloves

  • Lvl 5 Cutmaster Gloves

  • Knee Pads / Kneeling Pad

  • Kevlar Sleeves

  • Disposable RPE (FFP1, FFP2, FFP3)

  • 500v Class 00 Electrical Gauntlets

  • Manufacture Date

  • CO Monitor

  • First Aid Kit

  • Are the contents of the First Aid kit in date?

  • Vehicle Fire Extinguisher

  • A-Frame Warning Sign 'Works in Progress'

  • Winter Coat

  • Fall Restraint Safety Harness & Lanyard

  • Has the Fall Restraint Safety Harness & Lanyard been subject to inspection within the last 6 months?

  • Are there any other items of PPE available?

  • Is all PPE in good condition & stored safely to prevent damage?

  • Is the engineer aware of the requirement to maintain PPE, undertake pre-use inspections and the procedure to be followed to replace PPE?

  • Does the engineer have access to the necessary PPE required for the task / job today?

  • PPE training undertaken?

TOOLS & EQUIPMENT

  • Fluke Digital Clamp Meter

  • Two probe voltage indicator

  • Proving Unit

  • Lock Off Kit

  • Volt Stick

  • Flue Gas Analyser

  • Has the FGA got valid calibration date?

  • Manometer

  • Gas Sniffer

  • Electrical Insulated Hand Tools VDE1000

  • Battery Operated Floodlight

  • Wet n Dry Vacuum

  • Heat Gun / Blow Torch

  • Socket Set

  • Stilsons

  • Battery Operated Drill(s), Grinder, Reciprocating Saw

  • Extension Reel

  • RCD Plug

  • A-Frame Safety Sign

  • List any other company owned tools & equipment that the engineer has?

  • Are tools & equipment in good condition & stored safely and securely?

  • Are all portable appliances PAT tested and do they have valid labels in place?

  • LADDERS & STEPLADDERS
  • Do ladders & stepladders conform to EN:131?

  • Are stepladders constructed of fibreglass?

  • If in use are the ladders / stepladders positioned correctly, and where necessary secured to prevent unwanted movement?

  • Do the ladders / stepladders have asset numbers on?

  • Is a valid ladder tag on the equipment showing inspection within the last 3 months?

VEHICLE

  • Is the engineers vehicle parked safely in a designated parking area?

  • Does the engineer complete weekly documented vehicle inspections?

  • Is the vehicle clean & tidy with tools and equipment stored safely?

  • Is the driver aware of guidance relating to driving rest breaks? (15 mins every 2 hrs)

  • Any current issues with the vehicle ?

MOBILE ELEVATED WORK PLATFORMS

  • Does the engineer hold valid IPAF training for the category of equipment being operated?

  • Is the equipment suitable for the works being undertaken in terms of height, reach, ground type etc?

  • Is there evidence available to confirm that the equipment has been subject to a LOLER inspection within the last 6 months?

  • Has the MEWP been subject to a documented pre-use inspection at the start of the shift or upon change of operator?(MEWP Pre-Use Checklist to be evidenced)

  • Is a Rescue Plan in place?

  • Two operatives assigned to the task?

  • Have precautions been taken to prevent the equipment from being struck by vehicles?

  • Has a suitable area surrounding the equipment been cordoned off to prevent unauthorised access by third parties incl MOP?

  • Fall restraint safety harness & lanyard being used & worn?

  • Anemometer available to check windspeed?

  • Can the MEWP be parked and stored safely on site?

MOBILE ACCESS TOWER

  • Does the engineer hold valid PASMA training?

  • Has the Mobile Tower been inspected prior to use? (Mobile Tower Inspection Checklist to be evidenced)

  • Is the tower erected on firm, level and stable ground?

  • Is the equipment suitable for the works being undertaken

MANUAL HANDLING

  • Are mechanical aids or lifting straps provided where necessary? If used are they suitable for the task?

  • Has the engineer completed Manual Handling training?

COSHH

  • Are COSHH assessments available for each hazardous substance the employee uses?

  • Are MSDS available for the hazardous substances?

  • Does the engineer have all hazardous substances & chemicals stored correctly?

ACCIDENT, NEAR MISS & HAZARD REPORTING

  • Does the engineer know the company's Accident Reporting procedure?

  • Does the engineer understand the company's Hazard & Near Miss reporting procedure?

  • Has the engineer got the WhatsApp reporting group set up on his phone for reporting Hazards & Near Misses?

  • Does the engineer understand their legal responsibility to report Accidents?

EMPLOYEE H&S CONSULTATION

  • Does the engineer feel that they are consulted on, or supported with matters relating to health, safety & wellbeing?

  • Has an up to date copy of the Employee H&S Handbook and Drivers Handbook been issued to the engineer?

  • Does the engineer have any concerns, questions, items to raise or suggestions for improvement relating to health & safety?

  • Is the engineer aware of the Employee Assistance Programme?

  • Is there any additional training that the engineer may require or indicates interest in?

TECHNICAL AUDITS

  • Has the engineer had a technical audit conducted by appointed technical manager(s) within the last 12 months?

UNSOLVED ISSUES /AOB

  • Are there any other issues identified that need corrective action or investigation as a result of the audit?

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.