• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Add media

  • Select date

Health & Safety Risk Assessment + Method Statement

  • Working with CCTV Unit?

  • Site specific Risk Assessment & Method Statement on Vehicle?

  • Site File containing Training Certificates and Local Emergency Locations?


  • Safety Boots (Lace ups)

  • Hard hat

  • Suitable gloves for work being carried out

  • Hi visibility vest

  • Safety Glasses, Eye protection?

  • Ear defenders, ear protection

  • General appearance of personnel on site?

Signing Lighting & Guarding - Chapter 8

  • 2 Men at works signs

  • 2 road narrow signs

  • 2 Arrow signs

  • 6 Cones

  • Chapter 8 Book (small red book)

  • Barrier System with BB number clearly visible?

Jetting Equipment

  • Small Forward Facing Bomb

  • Small Rear Facing Bomb

  • Medium Rear Facing Bomb

  • Medium Spinning Bomb

  • Large Rear Facing Bomb

  • Do you have a Tiger Tale? (hose Guide)

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Safety Equipment

  • Gas Monitor & Charger?

  • Harness?

  • Safety Rope?

  • Escape set?

Ancillary Equipment

  • Standard Man Hole Keys

  • Pinch Bar

  • Crow Bar

  • 5 Foot Wrecking Bar

  • Screwdriver Set


  • First Aid Kit In Easy To Find Location

  • Fire Extinguisher, In Date + Unused

  • Does vehicle have Tax

Questions For Operator

  • Are all jets clear

  • Do the inserts in the bombs require changing?


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  • Add signature

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.