Title Page

  • Conducted on

  • Prepared by

  • Work Description

  • Location
  • Contractor involved

  • Supervisor on site

  • Name of Operatives

  • Photograph any issues prior to site set up (Damage to property, infrastructure parked cars etc)

General Safety and Documentation

  • Do you want to answer the questions on General Safety and Documentation?

  • Has the site team undertook an induction to make you aware of work being undertaken and hazards

  • Is the at least one operative on site conversant with English

  • Has a suitable Point of work risk assessment been completed

  • Have the contractor got relevant RAMS relevant to the type of work

  • ID cards carried by operatives and in date / relevant for the task being complete

  • Operatives on site as per Gang Location Sheets / If changes made the changes have been recorded

Streetworks and site set up

  • Do you want to answer the questions on Streetworks and site set up?

  • Vehicle has been safety parked having regards for workforce and public and all vehicles positioned safely as per the code of practice.

  • Vehicle in good order, tyres, lights brakes etc and maintained clean and tidy inside

  • Site team have access to the Red Book - Safety at Street Works and Roads Work on site

  • Site Personnel have correct NRSWA Accreditation / Registration for the work being executed where required?

  • Site is maintained in a tidy condition, tools, materials stored to avoid hazards.

  • Contractors Information board displayed onsite and this displays appropriate streetworks permit number.

  • Correct size signs / barriers / cones for the speed of road and all plant and equipment placed within the barriers?

  • Pedestrian Walkway meets / exceeds COP minimum width requirements

  • Are the safety zones and controls in place sufficient to prevent injury to operatives and members of the public from any activities being carried out?

  • Are vehicles and required plant fitted with fully functional amber flashing beacons

  • Sandbags available and used effectively.

  • Operatives on site as recorded on Gang Location Sheets/ if changes made the changes have been recorded.

Manual Handling

  • Do you want to answer the manual handling questions

  • Where practical mechanical or other means are being used to reduce the need for manual handling

  • Operatives on site have relevant training?

  • Good ergonomics principals are being used for manual handling activities

  • Have the gang got the correct type of lid lifts and bars to enable correct lifting.

Plant & Equipment

  • Do you want to answer this section

  • Is the Plant and Equipment (including safety guards) in good condition and suitable for the work?

  • Are Operatives trained and competent to operate the plant and equipment on site in line with their appointed role?

  • Have the daily, weekly and monthly checks been logged in the On site/Inspection Register and has it been kept up to date?

Vehicles and Trailers

  • Is the van or truck in good condition ( tyres, lights, number plates, windscreens and windows etc.

  • Is the equipment, materials and plant stored securely and maintained in a tidy condition.

  • Where trailers and towed plant are used, are they in good condition -tyres, body work etc.

  • Driver of the vehicle pulling trailer has the correct driving license/ training for pulling trailer.

  • There is evidence of effective maintenance and servicing of trailers

  • Trailers have a breakaway cable which is in good condition and used correctly.

  • The jockey wheel is in good condition - effectively deployed.

  • Trailer number plate correct for the vehicle

  • Electric connectors both male and female ports are in good condition and effective to provide an effective power input to trailer lights.

  • Cabling trailer in good condition with no visible defects to hydraulics, jacks, spindles or locks etc.

  • Cabling drum correctly secured if still attached

  • Where reel has been detached it has been removed in a safe manner and is secured correctly for use.

  • Equipment and materials in flat bed trailer are placed and secured correctly

Work At Height

  • Are work at height operations being undertaken _ do you want to ask these questions.

  • Have a Permit to climb been completed (suitable pre climb check)

  • Safety Harness meet required standard and have been inspected by the wear

  • Safety Harness correctly are worn and used by operative where necessary?

  • Evidence of appropriate LOLER inspection undertaken (6 Months)

  • All operatives working at height have received relevant training for the type of work undertaken?

  • MEWP is in good order, maintained, serviced and covered by a current LOLER inspections

  • Ladder in use in good order and inspected regularly

  • Ladders are correctly secured and protected ready for or during use.

  • Location of electrical hazards have been identified (LV or HV) and correct controls in place

  • Work at height being undertaken in accordance with BT and WPD safety controls

  • Emergency rescue plan in place and suitable equipment and training provided?

Hygiene / Welfare

  • Do you wish to answer these questions

  • Do the Gang have First Aid supplies on site as required?

  • Operatives had the correct PPE and understand what it is for, how to store and look after it.

  • Is there a first aider on site?

  • Are Washing Facilities available on site?

  • Are Toilet Facilities / details of the nearest Toilet Facilities on site?

  • Is there an adequate supply of drinking water on site

Environmental

  • Do want to answer these questions

  • Water from Chamber / Excavations disposed of Properly?

  • Water testing kit on site

  • Can operatives demonstrate that water samples have been taken and checked for contamination

  • Care taken to prevent Damage / Contamination to Paving / Tarmac / Grass etc from Fuel, Oil etc?

  • Suitable spill kit available for fuel /oil

Work within Chambers

  • Have the team gas a suitable gas detector which is calibrated and fit for use.

  • Has the underground network been gas tested and chamber opened correctly

  • If the depth or other hazards associated with the chamber such that it is confined space has a suitable Permit to work been completed.

  • If confined space are the team trained and following the safe working method agreed, Ventilation (genny & blower) and has a suitable rescue plan been provided

  • Has the chamber been secured and safely signed and guarded to protect the operative and public

  • Have the cables been secured correctly (both the installation cables and pre-installed cables)

  • Have the cables been labelled correctly

  • Is the chamber clear of rubbish

  • Are the team aware of risk from leptospirosis and taking suitable controls.

  • Are the team aware of the risk of discarded used syringes and have the equipment to deal with them.

Subduct and Blowing Operations

  • Do you want to answer these questions

  • Has all the blowing equipment been PAT tested and has been checked by the operative that is in good working order and is safe to use.

  • Is operative trained to use blowing machines and is operative correctly using the blowing equipment as stated in training.

  • Operatives have 2 way radios and are using them effectively to communicate.

  • Has the sub duct been tested prior to blowing fibre (air tested or sponge been fired down the sub duct

  • lube duct is being used when blowing cables into the subduct.

Rodding, Cobra and Roping Operations

  • Do you want to answer these questions

  • Has the cobra /rods been transported and stored correctly to ensure it is safe to use.

  • Are eye protection and suitable gloves being worn together with other appropriate PPE for this operation.

  • Are the team using the using the cobra equipment safely and correctly

  • Team ensuring rodding and roping operations avoid trip hazards to the team and public.

  • Crew undertaking roping operations correctly (Back roping)

  • Is the cobra /rods in good working order with no visible defects

Gully Sucking Operations

  • Do you want to answer these questions

  • Is the gully sucking vehicle in good working order.

  • Has the gully sucking vehicle operator considered the impact the operation has on highway - suitable controls.

  • Is the waste being disposed of correctly and safely.

Splicing Operations

  • Do you want to answer these questions

  • Has Splicing equipment been checked to ensure it is in good working order, PAT tested and safe to use.

  • Has the crew got a suitable sharps box aviable and being used for cut fibre.

  • Are chemicals stored and used correctly.

  • COSHH assessment and chemical safety information aviable including emergency response.

Other SHE issues / Good Practice not covered

  • Issues / Good Practice Observed

  • Photographs of Issue / Good Practice

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.