Engineers Worksheet

• Job No:

• Clients Reference/WO number

• Engineers Name

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site Contact

Breakdown Details:

• Reason for call out:

• Details of work completed/method statement:

• Special Needs:

• Extra Manpower:

• How many?

  1

  2

  3

  4

  Other

• Details:

• Permit:

• Permit no:

• Specialist Equipment:

• Other:

• Details:

Materials

• Did you need to use any materials / consumables?

Material Used:

• Description:

• Quantity:

Labour

• Total Travelling Time:

• Total Mileage:

• Time on Site

• Start Time:

  Date

• Finish Time:

  Date

Risk Assesment

• Assesment of Risk:

  Select High Medium Low None

  • High
  • Medium
  • Low
  • None

• Evidence of Risk:

  Media

• Details and action taken:

• Hazards:

  Select Overhead Cables Underground Services Working at Height Working in Confined Spaces Asbestos Fragile Surfaces Heights Over 2M Drainage Works Manual Handling Hot Work / Grinding Underfloor Work Other

  • Overhead Cables
  • Underground Services
  • Working at Height
  • Working in Confined Spaces
  • Asbestos
  • Fragile Surfaces
  • Heights Over 2M
  • Drainage Works
  • Manual Handling
  • Hot Work / Grinding
  • Underfloor Work
  • Other

• Details:

• PPE Required:

  Select Safety Helmets Safety Boots Gloves Eye Protection Face Mask Coveralls High Vis / Jacket Ear Defenders Knee Pads Safety Harness Over Shoes Other

  • Safety Helmets
  • Safety Boots
  • Gloves
  • Eye Protection
  • Face Mask
  • Coveralls
  • High Vis / Jacket
  • Ear Defenders
  • Knee Pads
  • Safety Harness
  • Over Shoes
  • Other

• Details:

• Tools & Equipment:

  Select Ladders Step Ladders Trestles 110V Equipment Safety Harness Battery Operated Tools Roof Man Anchor Crawling Boots Mobile Tower Scaffolding Lighting Warning Notices Safety Barriers Fire Extinguishers First Aid Kit Protective Sheets Other

  • Ladders
  • Step Ladders
  • Trestles
  • 110V Equipment
  • Safety Harness
  • Battery Operated Tools
  • Roof Man Anchor
  • Crawling Boots
  • Mobile Tower
  • Scaffolding
  • Lighting
  • Warning Notices
  • Safety Barriers
  • Fire Extinguishers
  • First Aid Kit
  • Protective Sheets
  • Other

• Details:

• "I confirm that I have carried out the requirements of the items marked above" Engineers Signature & Print:

  Sign

Observations:

• Is the reason for breakdown due to user error?

  Yes

  No

  N/A

• Details:

• Photo Evidence

  Media

• Corrective Action Plan:

• Any other Recommendations?

  Yes

  No

  N/A

• Details:

• Details:

Customer Confirmation

• How happy are you with the service provided today?

• Thank you! We're glad your happy with our service as we aim to provide you a 10/10 service every time. We look forward to working with you again.

• Thank you for your feedback, please can you provide a few comments so we can constructively improve our service.

• We are sorry to hear your dissatisfied with our service, please can you provide a few comments so we can address the matter.

• Any Comments?

  Off

  On

• Comments:

• Client Signature & Print

  Sign