Health, Safety and Environment Report

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Is the H&S Rep undertaking the inspection jointly

  Yes

  No

Type of Inspection

• Behavioural Safety Tour in the work place

• Number of people seen on the safety tour?

• Number of people interactions on the safety tour?

• Type of work being undertaken

• Commendable Health, Safety and Environment Actions Observed

• Safe system of work aspects seen

  Select Site Briefing Booking on Procedure followed Calibrated Equipment in use Authority to Work Certificate Correct documentation for the works being under take Work site kept safe

  • Site Briefing
  • Booking on Procedure followed
  • Calibrated Equipment in use
  • Authority to Work Certificate
  • Correct documentation for the works being under take
  • Work site kept safe

Cat A: reactions of colleagues when you arrive on site

• Colleagues adjust their PPE

  Yes

  No

• Colleagues changing their position

  Yes

  No

• Colleagues re-arranging their job

  Yes

  No

• Operations or supervisor stops the job

  Yes

  No

• Colleagues alter or adjust machinery lookouts or targets etc

  Yes

  No

Cat B: Position of colleagues (including ergonomics), can you see people at risk

• Striking against objects

  Yes

  No

• Being struck by objects

  Yes

  No

• Being caught between objects

  Yes

  No

• Falling from heights, tripping & slipping

  Yes

  No

• Contact with temperature extremes

  Yes

  No

• Inhaling a hazardous substance

  Yes

  No

• Contact with live electricity

  Yes

  No

• Swallowing hazardous substances

  Yes

  No

  NA

• Injury to bad posture, lifting or twisting

  Yes

  No

• Handling loads or exertion

  Yes

  No

  NA

Cat C: Procedures & housekeeping

• Are procedures inadequate for the job

  Yes

  No

• Are procedures not known or understood

  Yes

  No

• Are procedures not being followed

  Yes

  No

• Appropriate work permits not being used

  Yes

  No

• Inadequate house keeping

  Yes

  No

• Materials inappropriately stored

  Yes

  No

• Waste not being segregated correctly

  Yes

  No

  NA

• Spill kits not available

  Yes

  No

  NA

Cat D: tooling & equipment - can you see

• Wrong tools for the job being used

  Yes

  No

• Tools being incorrectly used

  Yes

  No

• Tools in an unsafe condition

  Yes

  No

  NA

• Tool grips unfit for purpose

  Yes

  No

  NA

• People being exposed to vibration

  Yes

  No

  NA

• People being exposed to extremes of temperature

  Yes

  No

• Inadequate or insufficient lighting for the task or the work

  Yes

  No

  NA

• People being exposed to extremes of noise

  Yes

  No

Cat E: PPE - are people not wearing the correct protection or clothing for:

• Eyes & face

  Yes

  No

  NA

• Ears

  Yes

  No

  NA

• Head (no hood +/- drawstring)

  Yes

  No

  NA

• Hands & arms

  Yes

  No

  NA

• Feet & legs

  Yes

  No

• Respiratory system

  Yes

  No

  NA

• Trunk

  Yes

  No

• The task they are undertaking or environment they are in

  Yes

  No

  NA

• Add photos here as required

  Media

Type of inspection

• Office inspection

• H&S at work poster displayed

• Staff assembly point displayed

• PA system or fire system present in office

• First aid facilities available

• Fire extinguisher in date

  Yes

  No

  NA

• Walk way condition (Poor: 0, Good: 5)

• Unsafe conditions need to be logged & actioned (note APCC job number as required)

• Add photo here

  Media

• Additional information as required

Type of inspection

• Room inspection (SER, IMR, SCR etc)

• Door signage correct (contact details etc)

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Door & Door seal condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Steps & ladder conditions

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Lighting (normal & emergency)

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Fire extinguishers in date

  Yes

  No

  NA

• No water ingress

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Floors clean/ level etc

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Phone operation

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Power socket condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• General room integrity/ decor (no flaking paint, cracks in walls etc)

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Relay condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Wiring condition (not degraded & run correctly as per installation standards)

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Cable ducts sealed

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Fuse bay condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Interlocking machine/ computer system condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Transformer/ condenser condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Diagrams & monitor condition

  Select NA Not Observed Above Standard At Standard Borderline Below Standard

  • NA
  • Not Observed
  • Above Standard
  • At Standard
  • Borderline
  • Below Standard

• Corrective actions must be logged on Ellipse/ Maximo

• Add photos here as required

  Media

• Additional information as required

Type of inspection

• Asset inspection

• General Track circuit condition

  Safe

  At Risk

  N/A

• General Signals asset condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Trainstop/ trip cock testers asset condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Point asset condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Relays & Cases condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Trackside kiosks & boxe condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Cable run condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General air main condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General Position detectors, APR, beacon condition

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• General access ladders, tagged & fit for purpose

  >10 years expected asset life

  5-10 years expected asset life

  1-5 years expected asset life

  <1 years expected life

• Corrective actions are to be logged on Ellipse/ Maximo

• Add photos as required

  Media

• Add additional information as required