Title Page

Site Overview

  • Todays date

  • Project Name

  • Project Ref no (E.G 5007)

  • Client name

  • Project Manager (PM at GEW2)

  • Is this a CDM 2015 notifiable site?

  • Is there a F10 form displayed on site (Red and white document with HSE on it)

  • Site Address/Location

Section 1: Scope of works (tick all that apply)

  • Testing/Sampling/Calibration Activities

  • Excavations

  • Soil Strip

  • Cable Laying

  • Jointing Operations

  • Concrete Pouring & Works

  • Fitting

  • RC Works & Form Works

  • Steel Fixing/Steel works

  • Timber Shuttering/Timber works

  • Site deliveries/Third Party Interface

  • Other (Please specify)

Section 2: Method Statement

  • Applicable Method Statement ref:

  • Does this work instruction form part of a sequence of work involving other parties

  • (If Yes) Please provide detail

  • undefined

Section 3: General Health and Safety Questions

  • Certificate of Competencies for all staff on site

  • Is there a Site-Specific Risk Assessment completed for today’s task?

  • Does it identify all the Hazards on site?

  • Is there sufficient Control measures in place to reduce the risk?

  • Site Safety notice board in place? With key site info?

  • COSHH & MSDS Sheets

  • Construction Program (Construction Phase Plan)

  • Works involving Permits occurring on site? (Digging/Hot works/WAH)

  • Is there a permit in date for the work?

  • Prepared by

Section 4: PPE

  • Boots with steel toe cap protection

  • Helmets worn

  • Hi-vis with reflective strip

  • Gloves

  • Safety Glasses (if required)

  • Other Specify

Section 5: Observations and non-conformances

  • Is there any non-conformances or observations of note today?

  • Please specify:

  • Have you submitted a close call to GEW2 for this?

  • General comments and notes

Section 6: Sign off

  • Name

  • Signed

  • Position

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