Title Page

  • DJ Reference

  • Conducted on

  • Prepared by

  • Location
  • Build Partner

Induction, Training & Consultation

  • (A01-01) Site safety induction?

  • (A01-02) CSCS/ECS card or equivalent?<br>

  • (A010-03) CPCS/IPAF card or equivalent?

  • (A01-04) Site supervisors SSSTS or similar?<br>

  • (A01-05) NRSWA for Operatives (LA + O1 to O8 / 001 to 009)

  • (A01-06) NRSWA for Supervisors (LA + S1 to S7 / 001 + 010 to 016)

  • (A01-07) IRATA for Operatives (Level 2 preferred)

  • (A01-08) IRATA for Supervisors (Level 3)

  • (A01-09) SWQR Card?

  • (A01-10) Other substantive lack of training?

  • (A01-11) Toolbox Talks?

  • (A01-12) Pole access SA001 - Safety Overhead

  • (A01-13) Safety Underground SA002

  • (A01-14) MEWP / Hoist training (IPAF)

  • (A01-15) NOPS (Smart Awards) card?

Project Management

  • (A02-01) Site Manager Appointed?

  • (A02-02) CPP available?

  • (A02-03) F10 available?

  • (A02-04) Liability Insurance?

  • (A02-05) Modern Slavery & Human Trafficking Policy?

  • (A02-06) H&S Policy?

  • (A02-07) H&S Poster/Card?

  • (A02-08) Environmental Plan/Waste Management?

  • (A02-09) Highways Permit?

RAMS & Emergency Arrangements

  • (A03-01) Method Statements?

  • (A03-02) Task risk assessments?

  • (A03-03) Manual Handling Assessments?

  • (A03-04) COSHH Assessments?

  • (A03-05) PUWER Assessments? (Noise & Vibration)

  • (A03-06) COVID-19 risk assessment?

  • (A03-07) Emergency Fire Arrangements?

  • (A03-08) First Aiders identified?

  • (A03-09) Near-miss/Accident book/Reporting Procedure?

  • (A03-10) Confined Space Emergency rescue plan?

  • (A03-11) WAH Emergency rescue plan?

  • (A03-12) Lone Worker Emergency system?

  • (A03-13) Procedures for inadvertent Asbestos exposure?

  • (A03-14) RAMS briefing?

Emergency Preparedness

  • (B01-01) Fire alarm?

  • (B01-02) Fire action notices?

  • (B01-03) Fire assembly point?

  • (B01-04) Escape routes?

  • (B01-05) Emergency lighting?

  • (B01-06) Fire extinguishers identified, inspected and secured?

  • (B01-07) First aid kits?

  • (B01-08) Eye wash?

  • (B01-09) WAH Emergency equipment accessible/used?

  • (B01-10) Confined Space Emergency equipment accessible/used?

  • (B01-11) Lone Worker system implemented?

  • (B01-12) Asbestos work controlled?

Breaking Ground

  • (B02-01) Utility prints available?

  • (B02-02) Services checked and marked out?

  • (B02-03) Cable avoidance tools used?

  • (B02-04) Adequate shoring or battering?

  • (B02-05) Safe access and egress to the excavation?

  • (B02-06) Edge protection (people and vehicles)?

  • (B02-07) Spoil and plant stored away from excavation?

  • (B02-08) Control of water ingress?

  • (B02-09) Tree protection zone followed?

Occupational Health Control

  • (B03-01) Hazardous substances clearly identified?

  • (B03-02) Hazardous substances adequately stored?

  • (B03-03) Hazardous substances bunded where necessary?

  • (B03-04) Dust suppression?

  • (B03-05) General COSHH practice?

  • (B03-06) Manual Handling aids used correctly and in good order?

  • (B03-07) Features of the environment suitable for Manual Handling operations?

  • (B03-08) Manual Handling good practice applied?

  • (B03-09) Gas monitor in use?

  • (B03-10) Gas monitors tested before use?

  • (B03-11) HAV limits identified?

  • (B03-12) COVID-19 measures implemented?

Welfare & Environmental Considerations

  • (B04-01) Spill kits / drip trays available?

  • (B04-02) Housekeeping/Waste provision?

  • (B04-03) Roads kept clean from site waste?

  • (B04-04) Waste transfer notes?

  • (B04-05) Consignment Notes?

  • (B04-06) Environmental nuisance controlled?

  • (B04-07) Sufficient conveniences serviced and in a clean condition?

  • (B04-08) Sufficient washing facilities?

  • (B04-09) Supply of drinking water?

  • (B04-10) Changing rooms and drying facilities provided?

  • (B04-11) Suitable rest areas provided?

Plant, Tools & Equipment

  • (B05-01) Plant, tools and equipment with appropriate guards?

  • (B05-02) Alarms and beacons?

  • (B05-03) Seatbelt worn where required?

  • (B05-04) Plant and equipment secured when not in use?

  • (B05-05) SWL marked on equipment?

  • (B05-06) LOLER certificates?

  • (B05-07) Calibration/PAT testing/Inspection tags?

  • (B05-08) Tools properly stored when not in use?

  • (B05-09) Whip checks in pressurized lines?

  • (B05-10) Use of 110V/Battery powered whenever possible?

  • (B05-11) Body Harnesses and lanyards?

Site Supervision

  • (B06-01) Work and site suitably supervised?

  • (B06-02) Site access controlled/Sign in?

  • (B06-03) Authorized staff identified and ID cards?

  • (B06-04) Signs to warn members of the public?

  • (B06-05) Site restricted zones controlled?

  • (B06-06) Materials safely stacked and stored within the site perimeter?

  • (B06-07) Lighting?

  • (B06-08) Pedestrian routes / walkways?

  • (B06-09) Traffic hazards identified and controls put in place?

  • (B06-10) Vehicle movements controlled by banksman?

  • (B06-11) Sufficient PPE provided?

  • (B06-12) PPE worn where required?

  • (B06-13) PPE in serviceable condition?

Street Works

  • (B07-01) Contact information clear and correct with full permit number displayed?

  • (B07-02) Supervisor available?

  • (B07-03) Correct Signs on site and placed?

  • (B07-04) Signs clean and in good condition?

  • (B07-05) Sufficient and correct barriers in place and clipped together?

  • (B07-06) Safety zones established?

  • (B07-07) Signs and barriers weighted where required?

  • (B07-08) Sufficient good and clean cones in place?

  • (B07-09) Portable signals in good condition?

  • (B07-10) SLG distances maintained?

  • (B07-11) Road/Footway plates and kerb ramps in place and secured?

  • (B07-12) Pedestrian route adequate and identified?

  • (B07-13) Red book available on site?

  • (B07-14) Permit complied with?

Working at Height

  • (B08-01) Work area identified and isolated?

  • (B08-02) Access and egress?

  • (B08-03) Edge protection/safe distance maintained (People and materials)?

  • (B08-04) Precautions for working on fragile surfaces?

  • (B08-05) Ladders rated BS EN 131 and in good condition?

  • (B08-06) Are ladders adequately secured?

  • (B08-07) Pole without visible damage? (hedge cutter damage, rusted stays, lose steps, etc)

  • (B08-08) Pole at least 1 metre from spiked railings, glass topped wall or similar?

  • (B08-09) Pole pre-climb test carried out?

  • (B08-10) Pole pre-climb label attached?

  • (B08-11) Hoist ground operator aware of emergency procedure?

  • (B08-12) Precautions from overhead power cables?

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