Title Page
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Employee Name
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Site Conducted
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Conducted on
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Prepared by
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Work Description
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Duration of Works
IDENTIFICATION & UNIFORM
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Does the employee have a company I.D card?
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Does the engineer have a valid Gas Safe License Card?
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Is the employee wearing company specified uniform?
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Is the uniform in good condition and presentable?
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Are safety boots / shoes being worn?
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Personal CO Detector being worn?
SITE INDUCTION & SIGN IN
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Signed in on site?
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Has a site induction been completed?
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Where applicable are site passes or permits to work in place?
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If the engineer is Lone Working have they made arrangements to maintain regular contact with a site representative?
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Asbestos Register reviewed where relevant?
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Is the engineer UKATA Asbestos Awareness trained?
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Does the engineer know what procedure to follow if Asbestos is confirmed or suspected in the work area(s)?
WORK INSTRUCTION / WELFARE
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Has the engineer received sufficient work instruction?
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Does the engineer understand what is required as part of the works? (i.e task, specification, method,equipment & tools needed etc)
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Are they aware of the Manager in charge of the works?
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Does the engineer have access to suitable welfare facilities? (handwashing, W.C, fresh drinking water)
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Clothing changing area available where required?
RISK ASSESSMENT, METHOD STATEMENTS & PERMITS TO WORK
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Does the engineer have access to a set of RAMS for the work / task being undertaken? (incl equipment, COSHH etc)
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Are the RAMS in date?
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Has the engineer reviewed & acknowledged the RAMS?
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Has a Point of Work Risk Assessment been completed on Joblogic?
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Is the engineer aware of the hazards associated with the task / job?
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Is the engineer able to suitably control the hazards identified?
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Are the recorded control measures being applied?
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Does the engineer have access to applicable Safe Systems of Work / Safe Working Procedures?
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If applicable, has a permit to work been completed and validated by an authorised person?
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Rate the engineers understanding of hazards and control measures?
ACCESS & HOUSEKEEPING
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Can the engineer access the work area(s) safely?
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Lighting in the work area adequate?
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Is the work area adequately controlled / segregated to prevent unauthorised access to third parties incl MOP?
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Are all nuisances being adequately controlled i.e. dust, noise?
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Is the work area tidy and are materials, tools & equipment stored safely to prevent slip, trip and fall hazards?
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Are all waste materials being disposed of in an approved waste receptacle?
EMERGENCY PREPAREDNESS
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Is the engineer aware of the sites evacuation plan & muster points?
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Are fire exits clearly signed and free from obstruction?
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Is the engineer able to raise the alarm in the event of a fire?
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Fire Extinguisher(s) present in or around the work area?
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Are flammable & combustible materials & liquids stored away from ignition?
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Is the engineer trained in Fire Safety Awareness?
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Does the work site have suitable provision for First Aid incl Appointed First Aiders, First Aid procedures, First Aid supplies etc?
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Is the engineer trained in Emergency First Aid at Work?
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Company mobile phone accessible for use in the event of an emergency?
PPE
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PPE Bag
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Safety Boots
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Hard Hat
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Manufacture Date
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Bump Cap
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Manufacture Date
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Hi-Vis Vest
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Safety Glasses / Safety Goggles
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Ear Defenders / Foam Ear Plugs
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Stanley Gripper Gloves
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Disposable Gloves
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Lvl 5 Cutmaster Gloves
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Knee Pads / Kneeling Pad
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Kevlar Sleeves
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Disposable RPE (FFP1, FFP2, FFP3)
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500v Class 00 Electrical Gauntlets
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Manufacture Date
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CO Monitor
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First Aid Kit
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Are the contents of the First Aid kit in date?
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Vehicle Fire Extinguisher
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A-Frame Warning Sign 'Works in Progress'
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Winter Coat
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Fall Restraint Safety Harness & Lanyard
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Has the Fall Restraint Safety Harness & Lanyard been subject to inspection within the last 6 months?
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Are there any other items of PPE available?
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Is all PPE in good condition & stored safely to prevent damage?
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Is the engineer aware of the requirement to maintain PPE, undertake pre-use inspections and the procedure to be followed to replace PPE?
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Does the engineer have access to the necessary PPE required for the task / job today?
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PPE training undertaken?
TOOLS & EQUIPMENT
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Fluke Digital Clamp Meter
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Two probe voltage indicator
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Proving Unit
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Lock Off Kit
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Volt Stick
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Flue Gas Analyser
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Has the FGA got valid calibration date?
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Manometer
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Gas Sniffer
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Electrical Insulated Hand Tools VDE1000
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Battery Operated Floodlight
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Wet n Dry Vacuum
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Heat Gun / Blow Torch
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Socket Set
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Stilsons
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Battery Operated Drill(s), Grinder, Reciprocating Saw
- Yes
- No
- N/A
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Extension Reel
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RCD Plug
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A-Frame Safety Sign
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List any other company owned tools & equipment that the engineer has?
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Are tools & equipment in good condition & stored safely and securely?
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Are all portable appliances PAT tested and do they have valid labels in place?
LADDERS & STEPLADDERS
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Do ladders & stepladders conform to EN:131?
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Are stepladders constructed of fibreglass?
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If in use are the ladders / stepladders positioned correctly, and where necessary secured to prevent unwanted movement?
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Do the ladders / stepladders have asset numbers on?
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Is a valid ladder tag on the equipment showing inspection within the last 3 months?
VEHICLE
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Is the engineers vehicle parked safely in a designated parking area?
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Does the engineer complete weekly documented vehicle inspections?
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Is the vehicle clean & tidy with tools and equipment stored safely?
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Is the driver aware of guidance relating to driving rest breaks? (15 mins every 2 hrs)
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Any current issues with the vehicle ?
MOBILE ELEVATED WORK PLATFORMS
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Does the engineer hold valid IPAF training for the category of equipment being operated?
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Is the equipment suitable for the works being undertaken in terms of height, reach, ground type etc?
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Is there evidence available to confirm that the equipment has been subject to a LOLER inspection within the last 6 months?
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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)
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Is a Rescue Plan in place?
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Two operatives assigned to the task?
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Have precautions been taken to prevent the equipment from being struck by vehicles?
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Has a suitable area surrounding the equipment been cordoned off to prevent unauthorised access by third parties incl MOP?
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Fall restraint safety harness & lanyard being used & worn?
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Anemometer available to check windspeed?
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Can the MEWP be parked and stored safely on site?
MOBILE ACCESS TOWER
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Does the engineer hold valid PASMA training?
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Has the Mobile Tower been inspected prior to use? (Mobile Tower Inspection Checklist to be evidenced)
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Is the tower erected on firm, level and stable ground?
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Is the equipment suitable for the works being undertaken
MANUAL HANDLING
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Are mechanical aids or lifting straps provided where necessary? If used are they suitable for the task?
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Has the engineer completed Manual Handling training?
COSHH
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Are COSHH assessments available for each hazardous substance the employee uses?
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Are MSDS available for the hazardous substances?
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Does the engineer have all hazardous substances & chemicals stored correctly?
ACCIDENT, NEAR MISS & HAZARD REPORTING
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Does the engineer know the company's Accident Reporting procedure?
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Does the engineer understand the company's Hazard & Near Miss reporting procedure?
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Has the engineer got the WhatsApp reporting group set up on his phone for reporting Hazards & Near Misses?
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Does the engineer understand their legal responsibility to report Accidents?
EMPLOYEE H&S CONSULTATION
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Does the engineer feel that they are consulted on, or supported with matters relating to health, safety & wellbeing?
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Has an up to date copy of the Employee H&S Handbook and Drivers Handbook been issued to the engineer?
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Does the engineer have any concerns, questions, items to raise or suggestions for improvement relating to health & safety?
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Is the engineer aware of the Employee Assistance Programme?
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Is there any additional training that the engineer may require or indicates interest in?
TECHNICAL AUDITS
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Has the engineer had a technical audit conducted by appointed technical manager(s) within the last 12 months?
UNSOLVED ISSUES /AOB
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Are there any other issues identified that need corrective action or investigation as a result of the audit?