Title Page
-
Site conducted
-
Conducted on
-
Prepared by
-
Team
-
Location
-
Activity being undertaken
General Safety and Documentation
-
Do you want to answer the questions on General Safety and Documentation?
-
Has a suitable Point of work risk assessment been completed or checked by Supervisor
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Has a suitable Permit be completed or checked by Supervisor and being followed by the team.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Work activity covered by relevant RAMS and they can locate them and demonstrate they are followed.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
ID and training cards carried by Supervisor ( in date / relevant for the task being complete)
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Is the Supervisor wearing the correct PPE and is this in good condition.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Vehicle
-
Do you want to answer the questions on Vehicle?
-
Vehicle has been safety parked having regards public
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Vehicle in good order, tyres, lights brakes etc and maintained clean and tidy inside
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Are vehicles and required plant fitted with fully functional amber flashing beacons
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Tools are stored correctly in the vehicle and secured to avoid damage
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor has the correct tools on board vehicle
- CAT
- Genny
- Lid Lifter
- Mechanical Lifter
- Gas detection Unit
- Harness, lanyard and or work positioning belt.
- Splicing Kit
- Other
-
provide details of additional equipment
- Compliant
- Some learning
- Poor
- N/A
-
Tools are in good condition, inspected and calibrated
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Site Set up
-
Do you want to answer the Site Set Up questions
-
Supervisor have correct NRSWA Accreditation / Registration for the work being executed where required?
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor have access to the Red Book - Safety at Street Works and Roads Work on site
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
General site set up in good order and follows the Red Book -Signing, lighting, guarding, Safety zones, Pedestrian Walkway meets / exceeds COP minimum width requirements
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Site is maintained in a tidy condition, tools, materials stored to avoid hazards.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
All contractors vehicles positioned safely as per the code of practice.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Hygiene / Welfare
-
Do you wish to answer these questions
-
Do the Team have First Aid supplies on site as required?
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Are Washing Facilities available on site?
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Work within Chambers
-
Do you wish to answer questions relating to accessing or working in chambers
-
Does supervisor have a suitable gas detector which is calibrated and fit for use.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Where practical mechanical or other means are being used to reduce the need for manual handling
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Has the underground network been gas tested and chamber opened correctly
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Has the chamber been secured and safely signed and guarded to protect the operative and public
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor aware of risk from leptospirosis and taking suitable controls.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor aware of the risk of discarded used syringes and have the equipment to deal with them.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Behaviours and Leadership
-
Supervisors demonstrating commitment to health and safety and encouraging contractors/ employees to work safely.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrates good awareness about the importance of reporting hazards, incidents and injuries and know how to do this using JFL systems.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrating commitment to ensuring good quality of work and encouraging contractors / employees to strive to provide high quality standards
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrating interest and care in customer experience - demonstrates the ability to understand customer' expectations and needs
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrating willingness and ability to include and collaborate with others to ensure improved operations, compliance and safety
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrating behaviors which are appropriate to demonstrate integrity, accepting of own responsibility and accountability, dealing with other employees honestly and fairly.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrates a good understanding of company policy and procedures and is behaving in an appropriate manner to adhere to these.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisor demonstrating ability to solve problems and help others to find suitable solutions -thinking out of the box and going that extra mile.
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Supervisors demonstrating good communication skills and engaging well with employees /contractors
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
-
Other notable Good Practice seen
- N/A
- Good Practice
- Compliant
- Some learning
- Poor
- Repeat Failure
Sign Off and Learning
-
Provide details of any learning or action agreed for the Supervisors
-
Supervisor sign to identify they understand the finding of the Inspection
-
Inspector sign to demonstrate the Inspection is a record of the findings