HCL-HSF00 Safety Health & Environmental Inspection Form Rev 000

• Site name and address

  Select

• Date and time

  Date

• Inspection carried out by

• undefined

• Have action/s from the previous inspection been closed out?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Are SHEQ inspection being carried out weekly by Site Management?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Construction Phase Plan - present and up to date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• SHEQ policies displayed and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Insurances displayed and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• HSWA poster displayed and filled in?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Site Induction - induction register completed correctly and in full?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Competencies - have copies (both sides) of competency cards been recorded and attached to induction record?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Risk assessments and method statements (RAMS), suitable and sufficient for work currently being undertaken?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Daily plant checks completed?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Thorough examination certificates, are they available and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Tool box talks, has one been completed in the past 7 days to the workforce?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Asbestos

• If an R&D Survey is carried out, Have all operatives received asbestos awareness training?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Have all areas been surveyed for Asbestos?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Have areas of identified asbestos been clearly marked?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Are all re­occupation certificates available on site before work commences?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Site, Cabins and Welfare

• Housekeeping, slips trips and falls, general tidiness on site

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Welfare - are adequate for the numbers on site, clean and tidy?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Offices - are adequate for the numbers on site, clean and tidy?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Stores - is there enough space to store items safe, clean and tidy?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Electrics

• Temporary electrics and RCD's - 3 monthly cert available and in test date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• PAT Testing - 110v 3 monthly - 240V monthly

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Fire, First Aid, Environmental Emergency

• Fire risk assessments - in place, relevant and up to date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Fire Detection & Alarm Equipment Weekly Test Record in place?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Fire extinguishers in test date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Fire extinguisher locations - are they in the required locations according to fire plan?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• First aid supplies are all in date and suitable and sufficient for activities and size of site? Eye wash in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Emergency response test - Within the first 3 months and every 3 months following

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Personal Safety

• Is four point PPE in place?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Noise is it being controlled?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Hand arm vibration (HAV's) is it being monitored and controlled?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Manual handing are there measures in place to remove or reduce the risk? Manual handling aids in use?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Working at Height

• Edge protection in place where required? Is it suitable and sufficent?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Scaffold - design and handover certificate in place? Weekly checks completed? Scaff tags in place and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Mobile towers - permit issued, built correctly, scaff tag in place and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Podiums - permit issued, used correctly, scaff tag in place and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Step ladders - permit issued, used correctly, scaff tag in place and in date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• MEWPS - permit issued, daily pre-start checks completed?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Ladders - permit issued, used correctly, scaff tag in place and in date? (ladders only to be used if no other safer options are viable. If viable options are available and ladder is in use, mark as significant non-conformance)

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Fragile surfaces protected or secured?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Confined Space

• Confined space permit issued?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Operatives with correct level of confined space certification?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Equipment calibrated and tested?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Temporary Works

• Temporary works register in place and completed correctly?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Temporary works design certificate in place?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Temporary works design check certificate in place?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Permit to Load / Strike in place where required?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Lifting Operations

• Lift plan in place, checked and communicated?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Thorough examination certificates available for all lifting equipment and associated accessories (chains, slings, bolts, shackles etc.)?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Traffic and Pedestrian Management

• Segregated, signed access and egress too, from and across site?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Highway works to Chapter 8?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Excavations

• Permit to dig issued?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Temporary support or sides battered to less than the natural angle of repose of the material being excavated?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Undermining nearby structures has not occurred?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Safe access and egress provided?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Falls from height - edge protection minimum 1m from sides of excavation?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

COSHH

• Is construction dust being controlled?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• RPE - being worn where identified (RAMS), face fit certification available?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Flammable substances secured in lockable cabinets / containers (no more than 50ltrs)

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Are flammable, toxic and Oxygen (or any Oxidizer) separated by a minimum of 3m apart from each other? and in a secure cage outside?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Environment / Sustainability

• Waste management plan in place and up to date?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Fuel storage bunded, secure and a suitable and sufficient spill kit available?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Waste streams segregated into seperate skips that are signed accordingly?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Quality

• Have all suppliers and subcontractors in use on site been approved?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Have non-conforming products been identified and recorded into SHEQ F 43 Non-Conformance Form?

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

• Have any complaints been received verbally or formally? Have they been recorded in SHEQ F 77 Customer Complaints Record

  Select Excellent compliance Minor non-conformance Significant non-conformance Major non-conformance (immediately stop) Not Applicable Not reported on

  • Excellent compliance
  • Minor non-conformance
  • Significant non-conformance
  • Major non-conformance (immediately stop)
  • Not Applicable
  • Not reported on

Signatures

• Inspectors Signature

  Sign

• Receivers Signature

  Sign