Hen - SF07 - Trencher Team - Pre-Start site Governance Check-up form

• Civil Contract audit been carried out on

  City Fibre

  Virgin Media

  BAU - CF

  VM - PIA

• Company Name

  Select Heneghans Hardwick Cusack Axle SAUK McLoughlin AGM

  • Heneghans
  • Hardwick
  • Cusack
  • Axle
  • SAUK
  • McLoughlin
  • AGM

• Team Name of Pre-Start site Governance Check-up Form

• Supervisor Name

  Select Des Britton Des Rogan Sean Delaney Jonathan Kelly Jamie Ayrton Diogo Santos Richard Whitehead Scott Waldron John Walsh Phil Edgell John Whitehead Gary Handley Bob Morris Mick McElhinney Ben Moody Chris Gunn Rob Austin Kevin Murphy

  • Des Britton
  • Des Rogan
  • Sean Delaney
  • Jonathan Kelly
  • Jamie Ayrton
  • Diogo Santos
  • Richard Whitehead
  • Scott Waldron
  • John Walsh
  • Phil Edgell
  • John Whitehead
  • Gary Handley
  • Bob Morris
  • Mick McElhinney
  • Ben Moody
  • Chris Gunn
  • Rob Austin
  • Kevin Murphy

• Date

  Date
• Location
  Address

• Build Area

  Select

• Site Permit Conditions (Length NO more than 50m can be open at any ONE time).

Pre-Start site Governance Check-up Form "No work to start till completed"

• Does the Open Site length exceed 50m at any one Time (Combining Open trench and Trench waiting for reinstatement Must not exceed 50m)

  YES

  NO

• Works Must Stop until Permit Conditions are Met (length of track not to exceed 50m in total).

• Do the Team Have a Gang Pack & COSHH Pack

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Risk assessment been completed.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Pre-start sheet been completed

  Yes

  No

  N/A

• Please take a Photo of proof

  Media

• Plant Check Sheet been Completed

  Yes

  No

  N/A

• Please take a photo of Proo

  Media

• NRSWA (Street works Card Onsite)

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• First Aid cert on site

  Yes

  No

  N/A

• Please take photo of proof

  Media

• Trencher Operator Cert On site

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Mini Digger Operators Card on site

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Utility Drawings in Date (UTILITY DRAWING VALID PERIOD DAYS - GAS-28 / ELECTRIC-30 / B.T-90 / WATER-90 / VIRGIN-90 ).

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Vehicle parked safely within site or Outside work the Area

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Are all Team members waring Hi- Viz vest / clothing. (city fibre contract long sleeve + Logo vest must be worn)

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Is there a Fully stock spill kit on-sit / in Van

  Yes

  No

  N/A

• please take photo of proof

  Media

• Are Access signs for residents @ each end of works. (City fibre only)

  Yes

  No

  N/A

• Please take photo of proof.

  Media

• Is the relevant Covid-19 info available 0n-site i.e Covid message boards + Covid flyers for residents. (City fibre only)

  Yes

  No

  N/A

• Please take photo of proof.

  Media

• Is Virgin media or City fibre advertising banner displayed.

  Yes

  No

  N/A

• Please take photo of proof.

  Media

• Courtesy boards at both ends with the correct permit number displayed.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Are Men @ Work & Road narrows signs out (multi way junction) and including sandbags and Cone where required.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Directional Arrows, two at leading taper and one at exit with sandbags and Cones where required.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Footway close signage at both ends including sandbags.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Traffic cones where required i.e beside Signs, safety zone, beside kerb ramps (Are these in suitable Condition for the job in Hand).

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Barriers connected including inside barriers.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• All sand / Stone & spoil stored correctly within side Barriers - Not spilling Under / Over barriers

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Kerb Ramps & Walk Boards (pinned) where required.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Cat & Genny on Site & and in date all existing known utilities been mark up with spray paint i.e street lights, B.t Poles, House services.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Cat & Genny - Are batteries charged and fit for use (Test both equipment for power & noise indicators)

  Yes

  No

  N/A

• Have Trial hole's be Excavated at Known service Locations i.e B.T Poles, Street Lights, Electric House Services.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Is PPE Available on site and been worn whilst using plant and working near Grab / Mini Digger and While using Trencher

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Is the site tidy (housekeeping ) - free to trip hazards

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Traffic management setup correctly or Road Closure signs in Place and visible.

  Yes

  No

  N/A

• Please take a photo of Proof.

  Media

• Make any last changes to the Risk assessment ="safe to work"

• Please take a photo of Proof.

  Media

• Notes: Please list anything that our works will affect nearby, schools, shops, Hospitals. also please discuss any restrictions placed on the works (permit conditions).

Conclusion

• Supervisor Signature

  Sign

• Ganger Signature

  Sign

• Is this site set up asper the RED BOOK and ALL Other requirement are Met asper Pre-Start site Governance Check-up Form

  YES

  NO