Title Page
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Conducted on
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Prepared by
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Location
Asset Details For Reference
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Asset Type e.g. manhole number, chainage etc.
Contractor(s) Onsite
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Name of Contractors Visible Onsite
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List the number of workers onsite and their trade i.e. Foreman, construction worker, traffic controller etc.
Plant Onsite
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List the type and number of visible plant onsite.
Weather Condition
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Weather
- Sunny
- Hot
- Cold
- Humid
- Overcast
- Rain (light)
- Rain (heavy)
- Windy
Works Being Performed
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Type(s) Of Work
- Pipe Lining
- Steaming
- Junction Sealing
- Junction Cutting
- Pipe Cleaning
- End Sealing
- Civil Works
- CCTV
- Drilling
- Tunneling
- Pot Hole Excavation
- Other
Observations / Comments / Compliance
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Has the Contractor performed and documented a pre-start?
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Check that the Safe Work Method Statement (SWMS) / Work Method Statement (WMS) are onsite, relate to the work and have been implemented.
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Have the required Traffic Management Plans (TMP’s) been approved by the relevant authority (Council, DTMR etc.)?
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Are control measures in place (signs, barricading) for both public vehicle traffic and pedestrians, and are they in accordance with the approved TMP
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Emergency procedures and plans are available
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Check that the confined space entry permits and risk assessment have been filled out and implemented.
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Local Govt. worker documentation completed (if works located in private property)
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PPE in good condition and being worn?
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Housekeeping adequate (including storage areas)?
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Any safety or environmental concerns?
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Photos taken of what, where, when and why.
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Variations – Anything that needs to be recorded for information or proof of variations?
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Any community or customer concerns?
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Were there any discussions had or comments made that need to be documented?
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Photos
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Inspection Complete
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Verified By (Signed)
