Hi-Way Services Ltd

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Crew Chargehand

• Crew Operatives

• Vehicle Registration

• Random or Planned

  Select random planned

  • random
  • planned

Stud Installtion

• Stick On's

• Embedded Depressible

• Solars

• Embedded Non Depressible

• Glass

• Inserts

• Weather Conditions

• Surface

  Select New Tarmac Existing Tarmac

  • New Tarmac
  • Existing Tarmac

Quality

• Conforming to Drawings

  Yes

  No

  N/A

• Uniformity

  excellent

  good

  poor

• Bitumen Application

  excellent

  good

  poor

• Vacuuming of Planings

  excellent

  good

  poor

• Is milled depth to spec

  Yes

  No

  N/A

• Stud located in centre of gap

  Yes

  No

  N/A

TM

• TM provided by Hi-Way Services Ltd

  Yes

  No

  N/A

• TM provided by others

  Yes

  No

  N/A

Vehicle Inspection

• DRS Book

  Yes

  No

  N/A

• Vehicle Defect Book

  Yes

  No

  N/A

• Near Miss Book

  Yes

  No

  N/A

• Vehicle Crew Pack

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

• Water Container

  Yes

  No

  N/A

• Fire Extinguishers and in date

  Yes

  No

  N/A

• Condition of Cab

  excellent

  good

  poor

• Condition of Chassis Bed

  excellent

  good

  poor

• Spare Pics (Miller teeth)

  Yes

  No

  N/A

PPE

• Wearing Clean and Correct PPE

  Yes

  No

  N/A

• PPE Bags

  Yes

  No

  N/A

• Full High Visibility Clothing

• Hard Hat

• Face Visor

• Ear Defenders

• Eye Protection

• Breathing Apparatus + Appropriate Filter

• Safety Boots (Steed Toe)

• Appropriate to Task Gloves

• Burns Kit

• First Aid Kit

Plant and Equipment

• Stobes, Beacons, Working Lights

  operational

  faulty

• Vacuum

  operational

  faulty

• Compressor

  operational

  faulty

• Pre-Heater

  operational

  faulty

• Comments

• Auditor

  Sign

• Crew Chargehand

  Sign