Information

  • LCL Number

  • Job / Project Number

  • Client Job/Project Title

  • Location
  • Conducted on

  • Team Names

Vehicle

  • Is Vehicle; Secure / ignition keys removed / parked safely?

  • Is the front of the vehicle clean and tidy?<br>

  • Are NRSWA permit conditions on site?<br>

  • Is the Site specific risk Assessment for the location sufficient and all team members aware of requirements?<br>

  • Are all Training Certificates for the team available and appropriate. <br>

  • Do all team members have DNO identification?<br>

  • Is COSHH information on site?<br>

  • Is the fire extinguisher suitable and in date? Record Date.

  • Record Date.

  • Is the first aid kit suitable and in date? Record Date.

  • Record Date.

  • Is the eye wash suitable and in date? Record Date.

  • Record Date

  • Is there a suitable spill kit?

  • Are all plant certificates on site?

  • Is Fuel stored correctly and labelled?

  • Take Photograph

  • Is water stored and labelled correctly?

  • Take Photograph.

Trailer

  • Is trailer gate up and secure?<br>

  • Is trailer in good order and are the lights functioning<br>

  • Is number plate correct and appropriate?

  • Is there a break away cable and is it in good condition?

  • Take Photograph of Trailer

  • Take Photograph of Trailer

Work Area

  • Is signing and guarding correct? (NRSWA)

  • Take photograph

  • Are plant, equipment, materials and vehicles arranged safely?<br>

  • Take photograph

  • Are operatives working safely - and wearing PPE?<br>

  • Is the general housekeeping of the site satisfactory?

  • Are appropriate information and courtesy signs posted?<br>

  • Take photograph

  • Is there Safe Access/Egress for site staff?<br>

  • Is there Safe Access/Egress for the public?<br>

  • Are walk boards fit for purpose?<br>

  • Are walk boards secured?

  • Is water suppression on cutting tools working correctly?

  • Is the back fill material being compressed correctly?

  • Will the correct tarmac / concrete depth be achieved on the final reinstatement?

  • Please record depths:

Signature

  • Please sign.

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.