Information

  • Civil Contract audit been carried out on

  • Company Name

  • Supervisor Name

  • Team Name

  • PN / NBU - Number

  • DP - Number (Check drawing to-gather correct DP-Number)

  • Street Name
  • Conducted on

  • Build Area

O/H Audit Inspection: SD (RED) – Pole is planted at shallow depth – These are not currently prioritised for renewal. See section 18 for detailed information on access and permitted works on these poles. C (GREEN) – Shallow Climbable - Pole is marginally shallow, but is ok to climb as long as additional rules are followed (see additional info for “C” Poles in section 16). H (ORANGE) – Hazard –The pole is within 1m of a defined hazard (spiked railings etc) – MEWP access only, but full range of engineering activities are permitted. Z (GREEN) - Safe Climb Zone Pole – The pole is within 1m of a defined hazard, but has been assessed as having a safe climb zone, which allows those who have obtained accreditation (details of which are available via the Accreditation Guidelines) in the use of a Z pole to climb the pole. For those that do not have the accreditation in the use of Z poles, these poles can only be accessed and used via MEWP. A full range of engineering activities are permitted. Marked with a red D (aluminium, approx. 45mm x 45mm), and also a red date label. These poles MUST NOT BE CLIMBED, but may be accessed from a MEWP or scaffold tower

  • Civil Contract audit been carried out on

  • Pole Location i.e Footway, Verge or Carriageway

  • Are all tube's / cables behind Capping and Foot from the Ground up to 2.3m

  • Please take Photo more than one can be taken

  • Have all DP's been correctly fitted to the Pole (Correct Hight or Temporary at 2.3m from the Ground & restrained by Cable ties and not tape)

  • Please take Photo more than one can be taken

  • All Cables on every DP need to have a label clearly showing the correct PIANOI number with VM clearly marked on it.( this must be tied to the cable)

  • Please take Photo more than one can be taken

  • Are cables fixed 450mm intervals and must not impede access to the climbing steps.

  • Please take Photo more than one can be taken

  • As the Audit Passed or Failed

  • Pole Location i.e Footway, Verge or Carriageway

  • Are all tube's / cables behind Capping and Foot from the Ground up to 2.3m

  • Please take Photo more than one can be taken

  • Have all DP's been correctly fitted to the Pole (Correct Hight or Temporary at 2.3m from the Ground & restrained by Cable ties and not tape)

  • Please take Photo more than one can be taken

  • All Cables on every DP need to have a label clearly showing the correct PIANOI number with VM clearly marked on it.( this must be tied to the cable)

  • Please take Photo more than one can be taken

  • Are cables fixed 450mm intervals and must not impede access to the climbing steps.

  • Please take Photo more than one can be taken

  • As the Audit Passed or Failed

Conclusion

  • Auditor Signature

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.