Title Page

  • POWRA No.

  • Site address (Road Name)

  • Conducted on

  • Supervisor name

  • Location
  • The persons named below have been issued Risk Assessment and Method Statement (RAMS) and have read, understood & been inducted. Personnel (Write names of all personnel on site)

Hazards

  • Is there working at height involved as part of these works?

  • All operatives must have a valid working at heights certificate (SA001 or equivalent). Ladders must be inspected, tagged and set on level ground at the correct angle (1 in 4). Where this cannot be achieved additional stabilising devices must be employed. All ladders to be secured by eye bolts and straps. Safety harnesses must be worn and attached using rope and cowl when three points of contact cannot be maintained.

  • Is a MEWP required for these works?

  • All MEWP operators are to be trained and competent in its use (IPAF), WAH harnesses and fall restraint devices to be worn whilst in the bucket. MEWP must have a pre use check and a current certificate of thorough examination. Ground conditions to be checked prior to erecting MEWP. Do not operate MEWP in windy conditions (above 28mph).

  • Are the works on the public highway (including footway)?

  • Operatives are to ensure that work areas (including base of ladders) are completely cordoned off with Gate Guards, barriers, cones & barrier tape (internal MDU) and suitable signage to prevent un-authorised entry. If possible try to minimise works within these areas. If working in a public highway works must comply with the New Road Street Works Act 1991.

  • Are you working near live traffic?

  • Traffic management plan required/available.; Signs, lighting & guarding to NRSWA standard.; Traffic lights needed.; Position vehicle to minimise risk to you and your team.; Wear appropriate hi-visibility Reflective Garments.

  • Is there any manual handling involved in your works?

  • Operatives to use TILE methodology: Task (Does the task need to be done manually or can it done by other means i.e. mechanical devices?) Individual (Are you up to the lift?) Load (What is it that you are going to lift) and Environment (What are the conditions and do you have a clear route?). All have been trained in manual handling techniques

  • Are you at risk from slips, trips and falls?

  • Plan how and where you walk around your work area.; Set out the work area to avoid hazards (E.g. positioning of spoil or tools etc.) ; Identify obstructions and underfoot risk areas before you start.; The work area/site is tidy and safe.

  • Are you undertaking excavations and groundworks?

  • All kit is calibrated and tagged.; Suitable training on cable avoidance tool.; Ensure Safe Digs are available on site; Hand dig around known services.; Completed permit to dig.; Mark up all services with spray paint.

  • Is a breaker / beaver pack required for these works?

  • Observe any special precautions required and wear all relevant PPE (Hi Viz clothing, Safety Boots, Ear Defenders, Eye Protection, FFP3 Face Mask); Check safe digs and CAT & Genny area for buried services before breaking ground. Ensure Spill Kit available for any hydraulic leaks. Inspection and tagged.

  • Is a petrol saw required for these works?

  • Observe any special precautions required and wear all relevant PPE (Hi Viz clothing, Safety Boots, Ear Defenders, Eye Protection, FFP3 Face Mask); Use water suppression during cutting; use job rotation to ensure within HAVS limits. Have fire extinguisher to hand during refuelling. Inspection and tagged.

  • Are you working near electricity?

  • Adhere to all safety rules.; All tools are insulated.; Check for buried services in walls prior to drilling; Check for operation restrictions. ; Trained and authorised in writing to work with and on electricity systems and networks.

  • Are you working on the underground PIA network?

  • All operatives must be SA002 (or equivalent) trained; Check that GDU is calibrated and switched on; check and continuously monitor within all open chambers; Use correct chamber lid lifter and roll bar; keep all equipment (cobra, chamber lid, lid lifter) within barriers; gate guards to completely surround open chamber and equipment.

  • Will your work involve the use of tools, work equipment or plant?

  • Tools, plant & equipment secured/immobilised when not in use.; Observe any special precautions required and wear all relevant PPE (Hi Viz clothing, Safety Boots, Ear Defenders, Eye Protection, FFP3 Face Mask.; Ensure tools & equipment are maintained, undamaged, tagged (where applicable) and in good condition.

  • Add a picture(s) of the site setup (Barriers, Signage, Permit Board etc)

Completion

  • Engineer signature

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