HSE Report Principle Contractor

• Client / Site

• Project number

• Conducted on

  Date

• Prepared by Peter Barlow Grad IOSH, RaMPS MD KPSS 07817980811

• Number of operatives on site

Site safety

• Access Equipment/Edge Protection/Scaffolding<br>Action Code<br>Score<br>

  Safe

  At Risk

  N/A

• Clear Routes/Walkways/Housekeeping/Materials<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Evacuations/Protection of Services<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Plant, Machinery & Lifting Equipment/ Appliances (test certification)<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Others (electricity, confined spaces, fire, asbestos, First Aid)<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Total Score for Section:

  Safe

  At Risk

  N/A

• Project Manager close out section<br>Signature<br>Date

  Yes

  No

  N/A

Public/Visitors/Operatives

• Protection/Appearances<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Trip/Slip/Fall Hazard<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• PPE/RPE<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Road Street Works Management<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Total score for section:

  Safe

  At Risk

  N/A

• Project Manager close out section<br>Signature<br>Date

  Yes

  No

  N/A

Welfare/Health

• Notices/Posters<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Suitability/Cleanliness (offices, toilets) (CDM 2015 requirements)<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Accidents<br>Action Code:<br>Score:

  Accident

  No Accidents

• COSHH/Noise/Dust/Manual Handling/HAV,s/Asbestos<br>Action Code:<br>Score:

  Safe

  At Risk

  N/A

• Total for section:

  Safe

  At Risk

  N/A

• Project Manager close out section<br>Signature<br>Date

  Yes

  No

  N/A

Management

• Safety Records/Statutory Registers/Permits to Work<br>Action Code:<br>Score:

  Yes

  No

  N/A

• RAMS<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Safety Reviews/Safety Tours/Communication/Training Certificates.<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Site Security/Site Entry/Safety Visible/Corporate Image<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Environmental Issues/SWMP/Waste Disposal<br>Action Code:<br>Score:

  Yes

  No

  N/A

• Total score for section:

  Safe

  At Risk

  N/A

• Project Manager close out section<br>Signature<br>Date

  Yes

  No

  N/A

Audit Completion

• Safety Overview

  Safe

  At Risk

  N/A

• Peter Barlow RMaPS, Grad IOSH MD KPSS 07817980811

  Sign

• Name: Title: Project Manager

  Sign

Guideline to the scoring matrix

• A= Same Day. <br>B= Within 24hrs. <br>C= Within 3 days. <br>D= Within 7 Days. <br>O= Observation<br><br><br>Guide to scoring<br><br>10. =. Consistently Excellent<br><br>8. =. Consistently Good and Continual Improvement in control of standards<br><br>5. =. Meets policy and Company requirements<br><br>2. =. Minor problem <br><br>0. =. Unacceptable<br><br>>. 80. Excellent approach to health and safety<br><br>70-80. Good efforts being made to continually improve standards <br><br>50-70. Standards satisfactory or site just set up<br><br>< 50. Standards below Company requirements (MD and CD informed)

  Yes

  No

  N/A