• Block Name/Postcode

  • Engineer Name

  • Date of Inspection

  • Job type?

  • Internal or External?

  • Inspected by

  • Document No.

First Impressions - Engineer & Appearance

  • Is vehicle parked correctly and at a suitable location?

  • Is vehicle clean outside?

  • Is vehicle tidy inside?

  • Is engineer wearing LDTV uniform?

  • Is it clean and well presented?

  • Is engineer wearing a Hi-Vis vest?

  • Is engineer wearing safety boots?

  • Is the site in a tidy condition?

Health & Safety

  • Copy of Survey & Risk Assessment present?

  • Site Specific Risk Assessment present and filled in correctly?

Working at Heights - Ladders

  • Were Ladders being used at time of visit?

  • Ladders tied in with ratchet straps and eyebolts?

  • Rope on Ladder?

  • Engineer wearing Harness with cows tail & rope grab?

  • Ladder stand off (micro-lite) used?

  • Ladder stabiliser used?

  • Ladder leveller used?

  • Ladder at correct angle? (1 in 4)

  • Could 3 points of contact be maintained whilst ascending & descending?

  • Hard hat worn whilst on ladder?

  • Any comments or corrective actions taken place

  • Photos of Ladder setup (if required)

  • Is there evidence of WAH kit used, I.E-eyebolts or drill holes, kit left out etc?

  • Photos of WAH evidence

Working at Heights - Roof work

  • Was Roof Access required?

  • Pitched roof or Flat roof?

  • Does the flat roof have edge protection?

  • Was the engineer safe and risk of falls minimised?

  • Was a 2m exclusion zone set up around the roof edge?

  • Were suitable Anchor points available?

  • Was a man anchor required? (Dead mans anchor)

  • Details

  • Was the man anchor set up correctly with full fall restraint system in place?

  • Eyebolts drilled/Anchor points used and fall restraint system set up correctly?

  • Was Roof ladder set up correctly? (Strapped to triples etc)

  • Any comments or corrective actions taken place

  • Photos of roof areas, set up if required

Personal Protective Equipment (PPE)

  • Eye protection used when drilling?

  • Ear protection used? (Defenders or plugs)

  • Hand protection worn when required?

  • Dust masks worn when required?

  • Overshoes worn? (If applicable)

Signage & Barriers

  • Were road or pathway cordons set up?

  • Should road or pathway cordons have been implemented to protect the public etc?

  • Details and corrective actions taken place

  • Photos of areas that should have been cordoned off

  • Correct use of Cones?

  • Correct use of Barrier tape?

  • Correct use of signage? (Cable in progress etc)

  • Photos of cordons put in place


  • Has a full H&S kit inspection been carried out within the last month?

  • A full Health & Safety kit inspection is to be carried out

  • Date of last Kit Inspection

  • Document number

  • Any comments

  • Engineer Training required?

  • Details of training to be given

  • Engineer disciplinary required?

  • Details

  • Engineer 1

  • Engineer 2

  • Senior Supervisor or H&S manager

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.