ES Supervised Shift Report

• Engineering Supervisor (ES)

• Supervisor Name:

• Conducted on (Date and Time)

  Date
• Location
  Address

Pre-Work Checklist

• Wearing Full PPE? (Photograph of individual in PPE)

  Yes

  No

  N/A

• Specialist PPE required?

  Yes

  No

  N/A

• PTS Card present and in date with TSC, PTS, PO and RRVC competency? (Photograph of card)

  Yes

  No

  N/A

• Have they been briefed and signed the RAMS (Photograph of documents)

  Yes

  No

  N/A

• Are they fit and well and capable of carrying out the works?

  Yes

  No

  N/A

• Briefed and signed any tool box talks?

  Yes

  No

  N/A

• Are they carrying the relevant paperwork to carry out the SSOW?

  Yes

  No

  N/A

• Checked the ES competency card (PTS, PO, TSC and ES) and ensured they are fit to work?

  Yes

  No

  N/A

Observations and Questions

• Has the ES been briefed by the site manager and signed in (photograph of sign in and task briefing sheet)

  Yes

  No

  N/A

• Is the brief suitable, relevant to the worksite and contains all of the information required?

  Yes

  No

  N/A

• Is the ES wearing the appropriate ES armband?

  Yes

  No

  N/A

• Has the ES checked the ES boards are functioning correctly?

  Yes

  No

  N/A

• Has the ES completed the correct paperwork and has all the relevant documents to carry out their duties? ES sheets, PEMS, TSC, WON etc.?

  Yes

  No

  N/A

• Has the ES signed in all relevant personnel to the worksites and recorded this on the ES form?

  Yes

  No

  N/A

• Do they have adequate communication method? Phone etc?

  Yes

  No

  N/A

• Was the ES given permission by the PICOP to set up the worksite?

  Yes

  No

  N/A

• Did the ES test the communication method with the PICOP prior to works commencing?

  Yes

  No

  N/A

• Were the marker boards place out correctly and confirmed with the PICOP?

  Yes

  No

  N/A

• Was the worksite granted by the PICOP and this time recorded?

  Yes

  No

  N/A

• Were all the correct details entered onto the Eng' Sup. Certificate?

  Yes

  No

  N/A

• Did the ES ensure all TSC's were signed in correctly?

  Yes

  No

  N/A

• Did the ES give permission to the TSC's to start work?

  Yes

  No

  N/A

• Did the ES give permission to the RRVC's to on track the RRV's?

  Yes

  No

  N/A

• Did the ES brief the extent of movements by all OTM's?

  Yes

  No

  N/A

• Did the ES ensure all movements were carried out safely and controlled?

  Yes

  No

  N/A

• All activities were carried out solely within the limits of the ES worksite

  Yes

  No

  N/A

• Did the ES take an active interest in the safety on-site?

  Yes

  No

  N/A

• Was the PICOP contacted when work was completed, or suspended?

  Yes

  No

  N/A

• Did the ES have to carry out a handover of duties? If yes, was this carried out correctly with the new ES given a thorough and detailed brief of the works being carried out?

  Yes

  No

  N/A

• Was permission received from the PICOP to remove marker boards?

  Yes

  No

  N/A

• Was the site cleared and checked correctly, ensuring the lines were clear and safe for the passage of trains?

  Yes

  No

  N/A

• Was the PEM form completed and signed off?

  Yes

  No

  N/A

• Was the ES certificate completed and signed off with the appropriate times recorded?

  Yes

  No

  N/A

• Did the ES confirm with the PICOP the marker boards were removed?

  Yes

  No

  N/A

• Did you have to step in or intervene at any point during the works to correct a safety critical aspect?

  Yes

  No

  N/A

Completion

• Reference Guide:
  • Look at the total score above and select the relevant overall rating:
  
  Pass: 75%-100%
  Further development required: >75%

• Recommendations / Overall Competency Assessment Rating

  Passed

  Further development required

  Not satisfactory performance

• Supervisor (Full Name and Signature)

  Sign

• Learner (Full Name and Signature)

  Sign

Supervisor feedback and notes

• undefined