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
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is the at least one operative on site conversant with English
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has a suitable Point of work risk assessment been completed
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Have the contractor got relevant RAMS relevant to the type of work
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
ID cards carried by operatives and in date / relevant for the task being complete
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Operatives on site as per Gang Location Sheets / If changes made the changes have been recorded
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Vehicle in good order, tyres, lights brakes etc and maintained clean and tidy inside
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Site team have access to the Red Book - Safety at Street Works and Roads Work on site
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Site Personnel have correct NRSWA Accreditation / Registration for the work being executed where required?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Site is maintained in a tidy condition, tools, materials stored to avoid hazards.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Contractors Information board displayed onsite and this displays appropriate streetworks permit number.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Correct size signs / barriers / cones for the speed of road and all plant and equipment placed within the barriers?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Pedestrian Walkway meets / exceeds COP minimum width requirements
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
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?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are vehicles and required plant fitted with fully functional amber flashing beacons
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Sandbags available and used effectively.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Operatives on site as recorded on Gang Location Sheets/ if changes made the changes have been recorded.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Operatives on site have relevant training?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Good ergonomics principals are being used for manual handling activities
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Have the gang got the correct type of lid lifts and bars to enable correct lifting.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are Operatives trained and competent to operate the plant and equipment on site in line with their appointed role?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Have the daily, weekly and monthly checks been logged in the On site/Inspection Register and has it been kept up to date?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Vehicles and Trailers
-
Is the van or truck in good condition ( tyres, lights, number plates, windscreens and windows etc.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is the equipment, materials and plant stored securely and maintained in a tidy condition.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Where trailers and towed plant are used, are they in good condition -tyres, body work etc.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Driver of the vehicle pulling trailer has the correct driving license/ training for pulling trailer.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
There is evidence of effective maintenance and servicing of trailers
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Trailers have a breakaway cable which is in good condition and used correctly.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
The jockey wheel is in good condition - effectively deployed.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Trailer number plate correct for the vehicle
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Electric connectors both male and female ports are in good condition and effective to provide an effective power input to trailer lights.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Cabling trailer in good condition with no visible defects to hydraulics, jacks, spindles or locks etc.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Cabling drum correctly secured if still attached
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Where reel has been detached it has been removed in a safe manner and is secured correctly for use.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Equipment and materials in flat bed trailer are placed and secured correctly
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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)
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Safety Harness meet required standard and have been inspected by the wear
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Safety Harness correctly are worn and used by operative where necessary?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Evidence of appropriate LOLER inspection undertaken (6 Months)
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
All operatives working at height have received relevant training for the type of work undertaken?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
MEWP is in good order, maintained, serviced and covered by a current LOLER inspections
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Ladder in use in good order and inspected regularly
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Ladders are correctly secured and protected ready for or during use.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Location of electrical hazards have been identified (LV or HV) and correct controls in place
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Work at height being undertaken in accordance with BT and WPD safety controls
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Emergency rescue plan in place and suitable equipment and training provided?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Hygiene / Welfare
-
Do you wish to answer these questions
-
Do the Gang have First Aid supplies on site as required?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Operatives had the correct PPE and understand what it is for, how to store and look after it.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is there a first aider on site?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are Washing Facilities available on site?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are Toilet Facilities / details of the nearest Toilet Facilities on site?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is there an adequate supply of drinking water on site
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Environmental
-
Do want to answer these questions
-
Water from Chamber / Excavations disposed of Properly?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Water testing kit on site
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Can operatives demonstrate that water samples have been taken and checked for contamination
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Care taken to prevent Damage / Contamination to Paving / Tarmac / Grass etc from Fuel, Oil etc?
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Suitable spill kit available for fuel /oil
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Work within Chambers
-
Have the team gas a suitable gas detector which is calibrated and fit for use.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has the underground network been gas tested and chamber opened correctly
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
If the depth or other hazards associated with the chamber such that it is confined space has a suitable Permit to work been completed.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
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
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has the chamber been secured and safely signed and guarded to protect the operative and public
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Have the cables been secured correctly (both the installation cables and pre-installed cables)
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Have the cables been labelled correctly
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is the chamber clear of rubbish
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are the team aware of risk from leptospirosis and taking suitable controls.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are the team aware of the risk of discarded used syringes and have the equipment to deal with them.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is operative trained to use blowing machines and is operative correctly using the blowing equipment as stated in training.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Operatives have 2 way radios and are using them effectively to communicate.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has the sub duct been tested prior to blowing fibre (air tested or sponge been fired down the sub duct
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
lube duct is being used when blowing cables into the subduct.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are eye protection and suitable gloves being worn together with other appropriate PPE for this operation.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are the team using the using the cobra equipment safely and correctly
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Team ensuring rodding and roping operations avoid trip hazards to the team and public.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Crew undertaking roping operations correctly (Back roping)
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is the cobra /rods in good working order with no visible defects
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Gully Sucking Operations
-
Do you want to answer these questions
-
Is the gully sucking vehicle in good working order.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has the gully sucking vehicle operator considered the impact the operation has on highway - suitable controls.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Is the waste being disposed of correctly and safely.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
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.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Has the crew got a suitable sharps box aviable and being used for cut fibre.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
Are chemicals stored and used correctly.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
-
COSHH assessment and chemical safety information aviable including emergency response.
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
- N/A
Other SHE issues / Good Practice not covered
-
Issues / Good Practice Observed
-
Photographs of Issue / Good Practice