Title Page
Site Overview
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Todays date
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Project Name
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Project Ref no (E.G 5007)
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Client name
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Project Manager (PM at GEW2)
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Is this a CDM 2015 notifiable site?
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Is there a F10 form displayed on site (Red and white document with HSE on it)
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Site Address/Location
Section 1: Scope of works (tick all that apply)
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Testing/Sampling/Calibration Activities
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Excavations
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Soil Strip
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Cable Laying
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Jointing Operations
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Concrete Pouring & Works
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Fitting
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RC Works & Form Works
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Steel Fixing/Steel works
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Timber Shuttering/Timber works
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Site deliveries/Third Party Interface
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Other (Please specify)
Section 2: Method Statement
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Applicable Method Statement ref:
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Does this work instruction form part of a sequence of work involving other parties
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(If Yes) Please provide detail
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Section 3: General Health and Safety Questions
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Certificate of Competencies for all staff on site
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Is there a Site-Specific Risk Assessment completed for today’s task?
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Does it identify all the Hazards on site?
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Is there sufficient Control measures in place to reduce the risk?
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Site Safety notice board in place? With key site info?
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COSHH & MSDS Sheets
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Construction Program (Construction Phase Plan)
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Works involving Permits occurring on site? (Digging/Hot works/WAH)
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Is there a permit in date for the work?
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Prepared by
Section 4: PPE
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Boots with steel toe cap protection
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Helmets worn
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Hi-vis with reflective strip
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Gloves
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Safety Glasses (if required)
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Other Specify
Section 5: Observations and non-conformances
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Is there any non-conformances or observations of note today?
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Please specify:
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Have you submitted a close call to GEW2 for this?
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General comments and notes
Section 6: Sign off
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Name
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Signed
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Position
Untitled Page