Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Name
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Programme Area
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Function
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Description of Work
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Office/ Site name
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Date/ Time
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PC Name
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Contractor Representative
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Is the Coss Holding the Form C
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If no, stand works down and raise with NOM (Comments/Observations)
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Is the COSS's Sentinel card endorsed with 'OLP' ? i.e. do they hold the correct competency to take a Form C ? (PTS/AC and test before touch)
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If no, stand works down and raise with NOM (Comments/Observations)
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Has the COSS signed the Form C to confirm they understand the arrangements ?
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If no, stand works down and raise with NOM to rebrief (Comments/Observations)
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Does the COSS know how to contact the "NOM"
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If no, establish the reason why not ?
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Does the COSS know where to return the C Form and test before touch document at the end of the shift?
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If no, discuss with NOM
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Does the COSS fully understand the limits of isolations on the Form C permit they are holding? Can they demonstrate/ describe physically where the limits are? Do they know where the nearest live electrical hazard is ?
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If no, stand works down and discuss with NOM to rebrief
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Does the Form C cover the full works for the shift including RRAP access ?
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If no, stand works down and review arrangements (Comments/Observations)
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Have all staff received a Form C brief from the COSS ?
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If no, stand works down and review and identify why not
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Does the team fully understand the lines and safe earthed working limits ?
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If no, stand works down and review and identify why not (Comments/Observation)
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Does the PIC and Supervisor for the works understand where the nearest live equipment is adjacent to site of work
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If no, stand works down and review (Comments/Observations)
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Was the test before touch completed prior to works commencing in this location?
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Include where it was carried out - review test before touch document (Comments/Observations)
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If no, why was the test before touch not completed ?
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Are they in possession of test before touch document ?
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If no, stand works down NOM to issue test before touch document
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Do they understand method and is document completed properly ?
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Was the test before touch completed prior to works commencing in this location
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If yes where was it carried out- review test before touch document
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If no, why not ?
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Does the SWP include electrical hazards that state the electrical permit requirements? Detailed information isn't required in the TBS, this is documented on the Form C
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Comments/Observations
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If there is a permanent scaffold in place is this bonded ?
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If not stop immediately and quarantine (Comments/Observations)
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Are there OTP or off track plant in use and is a Machine Controller directing movements ?
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Comments/Observations
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If working close to the OLE or structures is jib restriction in use?
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Comments/Observations
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Are controls in place to avoid making contact with OLE or structure
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Comments/Observations
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Do any machines require Engineering Acceptance, if so has this been obtained ?
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What does the EAC say about working under OHL ? (Comments/Observations)
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Has the operator seen a copy of the Engineering, Acceptance certificate ?
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Comments/Observations
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Where is the RoLE demarcation (Comments/Observation)
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What RoLE equipment is being used ?
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Who is allowed to move/adjust RoLE equipment ?
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Do you have any concerns ? (Comments/Observations)
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Summary Comments or Observations
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Summary of open actions and timescales for close out
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Open actions- Responsible person- close out time (List)
