Information

  • Inspection report number

  • Team

  • Position

  • Prepared by

  • Conducted on

  • Client / DNO

  • Location

1.0 Vehicles and Staff

  • 1.1 Vehicles present on site

  • 1.2 Staff present of site

2.0 Site Observations

  • 2.1 Is there a restricted area set up, including overhead lines work signs? (Include photo)

  • 2.2 Are vehicles clean, tidy and parked safely? (Include photo)

  • 2.3 Signing, lighting and guarding for street works present and correct? (NRSWA) (Include photo)

  • 2.4 Public safety satisfactory?

  • 2.5 Housekeeping - a safe and tidy site? (Include photo)

  • 2.6 Has a point of work risk assessment been completed and all staff signed on? (Include photo)

3.0 Safe Systems of Work - Working at Height

  • 3.1 Are there staff working at height? (Include photo)

  • 3.2 While working at height are staff wearing helmet chin straps? (Include photo)

  • 3.3 If working in MEWP or scaffolding is the safety lanyard attached? (Include photo)

  • 3.4 While working at height are exclusion zones in place? (Include photo)

  • 3.5 If climbing can you observe 2 points of attachment? (Include photo)

  • 3.6 If working on ladders is the ladder tied to prevent falls? (Include photo)

  • 3.7 MEWP spreader plates in use? (Include Photo)

4.0 Safe Systems of Work - HSG47 and Lifting Operations

  • 4.1 Has HSG 47 paperwork been completed? (Include photo)

  • 4.2 Is there a Cat and Genny present on site? (Include photo)

  • 4.3 Have known services been identified and clearly marked?

  • 4.4 Is mechanical digging being overseen by a banksman? (Include photo)

  • 4.5 Lifting chains and equipment serviceable and fitted with LOLER tag (colour tag)

5.0 Safe Systems of Work - Electrical Safety

  • 5.1 Are staff Working Live?

  • 5.2 If working live are staff wearing correct live working PPE? (Include photo)

  • 5.3 Are live working procedures being followed in accordance with the Distribution Safety Rulebook?

  • 5.4 Do staff have additional earths installed and boxed in? (include photo)

6.0 Health and Safety Compliance

  • 6.1 Have all risk assessments been submitted on WhatsApp group for this week?

  • 6.2 Have all current toolbox talks been signed off by all staff?

  • 6.3 Have all climbing gear checks been completed for the week?

  • 6.4 Have all vehicle checks been completed today?

  • 6.5 Are all staff wearing 5 points of PPE? (Include photo)

7.0 Safety Equipment

  • 7.1 Is there a first aid kit present on site?

  • 7.2 Is there a burns kit present on site?

  • 7.3 Is there a pole top rescue kit close at hand in case of emergency?

  • 7.4 Is there a serviceable fire extinguisher present on site?

  • 7.5 Is there an eye wash kit available on site?

8.0 Completion

  • 8.1 Actions and outstanding issues (list them here)

  • 8.2 Image of site

  • 8.3 Auditor

  • Add signature

  • 8.4 Chargehand

  • 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.