QTS LNW Civils Asset Management - HSE Audit Report

• Monitor Ref

• ELR & Mileage

• Description of Works

• Conducted on

  Date

• Inspected by

• Location
  Address

• Representative

1. Site Documentation

• 1.1 WPP & Task Briefing Sheets & Risk Assessments

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.2 Briefing Records

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.3 Permits (Dig, Hot Works, Height etc.)

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.4 F10 Form, HASAWA Notice

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.5 Contractors Safety Inspections

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.6 Consents / Notifications

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 1.7 COSHH Record of Briefing

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

2. Site Arrangements / Construction Safety

• 2.1 Scaffold, Access Equipment & Ladders

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.2 Protection from Falling Objects

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.3 Portable / Power Tools

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.4 Lifting Equipment

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.5 Mobile Plant

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.6 Locating Services

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.7 Welfare - Toilets / Washing / Changing

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.8 Confined Spaces

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.9 Access / Egress / Controls

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.10 Tidiness Of Site

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.11 Lighting / Working Environment

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.12 Site Demarcation / Boundaries

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.13 Security of Site / Public Safety

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.14 First Aid

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.15 Management of Traffic & Pedestrians

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.16 Protection of Infrastructure

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 2.17 Emergency / Fire Arrangements

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

3. Contractors Staff

• 3.1 Awareness Of Safety Brief

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.2 Hazard Awareness

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.3 Compliance WPP & Task

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.4 Correct Manual Handling

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.5 Sentinal Card / TVP

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.6 Wearing Task Specific PPE

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.7 PPE in Good Order

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.8 Aware of Limits of Work

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.9 Aware of Accident Reporting

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 3.10 Competency Certification (Non NWR)

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

4. Green Zones / Isolations

• 4.1 Complies with WON / GZAM / SSOW

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 4.2 In Accordance with Rule Book

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 4.3 Isolation of Form C

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 4.4 Wearing Railway Safety Badges

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

5. Environmental Arrangements

• 5.1 Noise / Light Intrusion

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.2 Fumes / Dust

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.3 Water Pollution

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.4 Vegetation (Jap Knotweed, etc)

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.5 Spillage's (Spill Kits, Crystals etc)

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.6 Waste Management

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• 5.7 Protected Species and SSSI's

  Yes

  No

  N/A

• Status

  Action Required

  Noted

  Acceptable

• Note - Any non-conformances (Action Required or Noted) are to be entered on the HSE Corrective Actions Section for action from the Contractor then sent back with actions completed via attachment on email.
  
  Could you please sign the corrective actions closed out section and return back to me via attachment on email.

LNW Civils Asset Management - Corrective Actions

• Monitor Ref

• Site

• Date & Time

  Date

• Inspected by

Corrective Actions

• Please list item numbers with title here

• Comments

• Guidance

Corrective Actions Close Out

• Close outs will not be accepted unless all signatures are present.
  
  Signatures required for close out.

• Site Manager

  Sign

• Project Manager

  Sign

• Network Rail Representative: