Title Page

  • Site inspected

  • Conducted on

  • Observed by

  • Completed by

  • Specific Location (include What3Words if necessary)

Positive Intervention Information

  • What was observed? What was the positive intervention?

  • Is there any photographic evidence?

  • Who was it raised to?

  • Was it escalated correctly?

  • Did the operatives involved have the correct training in place, were they inducted?

  • Were there Task Briefings / Lift Plans in place for the works? Do they require a review?

  • Were the correct tools and equipment in place to undertake the works correctly?

  • Were Daily Briefings completed and signed?

  • Was a POWRA required?

  • What were the environmental conditions like, did this impact what was observed?

  • How will they prevent a reoccurence?

Signatures

Project Engineer/Site Foreman Signature

H&S Safety Signature

  • Add signature

Project Manager Signature

  • Add signature

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