Title Page
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Location
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Conducted on
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Audited by signature
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Location
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Team Leader signature
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Second Man
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Vehicle Registration
Pre Start Checks
Pre Start Site Specific Safety Briefing
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Is the vehicle tidy? All kit, fittings, and pipes stored correctly?
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Nearest hospital location known?
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What3words?
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What3words made known to workers?
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Brief of works to be undertaken explained?
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Brief of conditions that will be worked in and expected throughout?
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Location of first aid kit and eye wash made known to workers?
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Location of spill kit made known to workers?
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Are the spill kits an appropriate size for the task?
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Fueling point selected away from drains or watercourses?
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Diesel / Oil / Fuels tagged and safely stored in drip trays?
Documentation
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Individual ID cards on-site and available?
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Risk Assessment for the location sufficient?
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Are all Training Certificates / ID Cards on-site and in date?
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Are all safety documents / work instructions adequate and understood?
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Fuel Card?
Plant and Equipment
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CAT working and calibrated?
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CAT expiry date:
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Genny working and calibrated?
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Genny expiry date:
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Fire Extinguisher visual check performed?
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Fire Extinguisher expiry date:
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Excavator in good working order and fit for purpose - checks performed?
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Trailer in good working order and fit for purpose - checks performed?
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All general and insulated hand tools in good working order?
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Plant and tools in good condition with no significant damage?
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Stihl Saw - In good working order - visual pre-checks performed, guards in place?
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Stihl Saw - Service date
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Trash Pump - In good working order - visual pre-checks performed, guards in place?
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Trash Pump - Service date
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110V Generator - In good working order - visual pre-checks performed?
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110V Generator - Service date
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Blow torch available and in good working order?
Personal Protective Equipment
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Flame Retardent Overalls in good condition and being worn?
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Safety footwear in good condition and being worn?
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Hearing protection available and being worn when required?
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Head protection available and being worn when required?
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Gloves appropriate of the task available and worn when required?
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Eye protection available and being worn when required?
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Dust masks available and being worn when required?
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Is all PPE correctly stored?
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Sink / Bowl for eye washing available? Or antibacterial wipes / gel?
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First aid kit available?
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First aid kit expiry date:
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Eye wash station available?
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Eye wash expiry date:
Environmental Awareness
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Stockpiled spoil is away from drains and watercourses?
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Stockpiled spoil does not exceed 50m³ in volume?
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Filter sock available and used where required?
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Team leader knows how to identify invasive plants that may affect pipeworks - Japanese Knotweed, Himalayan Balsam etc.?
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All tools, equipment, and detritus removed from the location on completion of works?
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A final visual check conducted by the team leader for any refuse left behind?
Water Quality
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Chlorine spray (fully labelled) available?
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Chlorine tablets available if required?
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Standpipe available for flushing with non return valve?
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Standpipe kept clean and in a protective bag when not in use?
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Sample bottles available and within date?
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Chlorine comparator, tablets, tubes and crusher available?
Comments, Actions Required or Observations
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Audited by
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Report Completed by