GTR Health and Safety Audit

• Site conducted / Location
  Address

• Conducted on

  Date

• Conducted by

• Number of personnel present

• Brief description of works being carried out

• Is there any high risk works being carried out, e.g. confined space, working at height, hot works etc

  Yes

  No

  N/A

Safety briefings and safety documentation

• Have all key personnel attended the site management briefing and signed the briefing document?

  Yes

  No

  N/A

• Has the TSC ensured they have signed into the ES worksite?

  Yes

  No

  N/A

• Is there suitable means of communication between the TSC/ES/PICOP etc.

  Yes

  No

  N/A

• Has the site managers safety briefing details been cascaded to all those within the work group?

  Yes

  No

  N/A

• Have all personnel signed into the worksite (SAC)

  Yes

  No

  N/A

• Is all of the relevant documentation available and correct? Risk assessments, Method statements, safety briefing sheets, TSC book, and PEMS forms etc?

  Yes

  No

  N/A

• Are all personnel carrying their competency cards, in date and relevant to the works

  Yes

  No

  N/A

• Are all personnel fit and well to carry out their duties? (Oral yes or no required)

  Yes

  No

  N/A

Worksite - general setup and control

• Is the worksite set up in accordance with the works package plan and as per rule book?

  Yes

  No

  N/A

• Is there a TSC present overseeing the work group?

  Yes

  No

  N/A

• Are they easily identifiable wearing the correct armband?

  Yes

  No

  N/A

• Did they approach you on arrival at the worksite to deliver a safety briefing and sign you in?

  Yes

  No

  N/A

• Is all of the TSC paperwork complete and correctly annotated?

  Yes

  No

  N/A

• Are all personnel wearing the appropriate PPE according to their task?

  Yes

  No

  N/A

• Is the worksite suitably illuminated either from ambient lighting or portable lighting?

  Yes

  No

  N/A

• Is the worksite clean and tidy with good housekeeping?

  Yes

  No

  N/A

• Have all the tools and equipment been inspected prior to use?

  Yes

  No

  N/A

• Have all of the tools and equipment brought onto site been well stored so as to not cause any slips trips or falls?

  Yes

  No

  N/A

• Are all tools and equipment being used correctly and as per manufacturers instructions?

  Yes

  No

  N/A

• If hot works are being carried out (cutting, grinding etc.) is there a suitable exclusion zone implemented with signage to indicate this?

  Yes

  No

  N/A

• Is fuel/oils stored correctly?

  Yes

  No

  N/A

• Is all plant and combustion equipment being used in conjunction with a plant nappy/spill kit?

  Yes

  No

  N/A

• If working in and around plant and machinery is there a suitable exclusion zone implemented?

  Yes

  No

  N/A

• Are all personnel ensuring that they work safely and maintain a good overall safety attitude?

  Yes

  No

  N/A

• Is there any other safety issue identified during the visit to site? if yes, please detail.

  Yes

  No

  N/A

Post work completion

• Has the worksite been cleared of all tools and equipment and left safe an clear for the passage of trains?

  Yes

  No

  N/A

• Has the PEMS form been completed and signed off correctly?

  Yes

  No

  N/A

• Has the TSC ensured all personnel are safely removed from trackside?

  Yes

  No

  N/A

• Has the TSC ensured that all the relevant documentation has been handed into the site managers office, signed off and complete?

  Yes

  No

  N/A

• Has the TSC ensured that he/she has contacted the ES and communicated everyone is off track?

  Yes

  No

  N/A

• Have all personnel signed out of the worksite (SAC)

  Yes

  No

  N/A

• Were there any incidents reported during the shift? if yes, please detail.

  Yes

  No

  N/A

• Result of audit overall

  Pass

  Fail

  N/A

Names and Signature person carrying out the safety audit

• Name:

• Signature

  Sign

• Date and time

  Date
• Location
  Address

• Copy of audit emailed to management on completion?

  Yes

  No

  N/A