Title Page
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Site conducted
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Name of PIC/COSS
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Sentinel Number
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Company/Sponsor
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Please specify
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Site
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PIC/COSS contact Number
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Observer
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Please Specify
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Conducted on
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Type of Duty
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Please Specify
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Nature of Work / Protection Type
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COSS Classification
- Unknown
- Known
- Bronze
- Silver
- Gold
- Platinum
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Potential for Progression
- Unknown
- Known
- Bronze
- Silver
- Gold
- Platinum
Section 1 - General
Group 1: Paperwork, Sentinel Check & Planning
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Challenging Conversation?
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Please give more details
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Did the COSS check the 3rd rail location before starting work? pay particular attention to 3rd Rail being in the CESS side in Platform areas and in areas of darkness
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if not, why not brief on recent OCC
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Pre Site Visit
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Please give more details
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Sentinel Card Check of work group
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Please give more details
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Sentinel Swipe of work group
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Please give more details
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Track Permits (OLP/CRP)
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Please give more details
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SWP Check by PDM
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Please give more details
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Planning (Does the PIC/COSS understand the plan they will be implementing)
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Please give more details
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Does the COSS/PIC have access to the Rule Book
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Please give more details
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Was their Time Keeping acceptable? Was the individual on site 90 mins pre start time
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Why Not
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Compliance Paperwork (COSS briefing checklist, CP checklist, Marker board erection, PIC H&S checklist, PC Checklist
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Please give more details
Group 2: Set up SSOW
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Was the NR3180 completed properly and fully?
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Please give more details
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Authority Number (Red zone authority/change of SSOW etc)
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what was the Authority number(S) for?
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Did the COSS/PIC use the COSS briefing checklist for their brief to the staff?
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Please give more details
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Was the SSOW Implemented Correctly ?
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Please give more details
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Was the Protection Set Out Correctly?
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Please give more details
Group 3: Minimum Standards Requirements
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Was their PPE adequate, clean and tidy and correct sponsor shown?
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Please give more details
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Was their equipment in good condition and with applicable certification/Calibration?
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Please give more details
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Does the COSS/PIC have sufficient Rulebook Knowledge (ask questions to ascertain)
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Please give more details
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Does the individual have the ability to communicate in English (both written and oral)
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Feedback directly to the rail assurance team. please stay with the individual until the works are completed
Group 4: Site Specific Requirements
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Site Limits Defined correctly?
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Please give more details
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Access and Egress Limits Defined
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Please give more details
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Welfare
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Please give more details
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Did the COSS/PIC identify any Additional Hazards?
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Please give more details
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Did the COSS/PIC understand and Brief the Emergency Procedures
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Please give more details
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Nearest Hospital
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Please give more details
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did the COSS/PIC brief any Life Saving Rules?
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Please give more details
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Is there sufficient task Lighting? (Pay particular attention to track level works especially within platform areas?
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Consider stopping works until resolved
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Site Conditions (eg wet, dry, flog...etc)
Section 2 & 3 - Behaviours (non-technical skills)
Situational Awareness: • Attention to detail • Overall awareness • Maintain concentration • Retain information (during shift) • Anticipation of risk
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Situational Awareness Score:<br>1 - Support & Mentoring Required<br>2 - Working to Satisfactory Levels<br>3 - Exceeding Required Levels
Conscientiousness: • Systematic and thorough approach • Checking • Positive attitude towards rules and procedures – ask team why they believe we are having operational close calls. • Understands purpose of role and takes responsibilities seriously
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Conscientiousness Score:<br>1 - Support & Mentoring Required<br>2 - Working to Satisfactory Levels<br>3 - Exceeding Required Levels
Communication: • Listening (people not stimuli) • Clarity - Was the COSS briefing understandable and clear on the Safe System of Work (SSOW)? • Did the COSS use open questioning to check the group’s understanding of his/her briefing? • Did the COSS provide opportunity/ time for workgroup challenge? • Did the ES clearly understand the extent of the isolation, worksite limits and marker board positions? • Assertiveness • Did the COSS provide constructive feedback to the workgroup? • Did the COSS welcome constructive feedback on his/her performance? • Sharing information (How many Close Calls – have discussion)
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Communication Score:<br>1 - Support & Mentoring Required<br>2 - Working to Satisfactory Levels<br>3 - Exceeding Required Levels
Workload management: • Multi-tasking and selective attention • Prioritising • Calm under pressure • How many staff signed in with PC or COSS or ES?
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Workload Management Score:<br>1 - Support & Mentoring Required<br>2 - Working to Satisfactory Levels<br>3 - Exceeding Required Levels
Self-management: • Time management • Alert and energised (not suffering from fatigue/tiredness) • Motivation • Confidence and initiative • Maintain and develop skills and knowledge • Prepared and organised
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Self-Management Score:<br>1 - Support & Mentoring Required<br>2 - Working to Satisfactory Levels<br>3 - Exceeding Required Levels
Behavioural, Cultural & Additional Skills
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Safety Responsibility Statement signed?
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Attendance at Safety Critical Induction?
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Attendance at Stop Think session?
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Attendance to Osborne Safety Critical Communication Training?
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SMSTS Held?
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SSSTS Held?
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First Aid?
Section 4 - Southern Shield & Other Initiatives
Have you been formally briefed and do you understand the requirements of the Southern Shield Access Protocol? Questions to ask to confirm this…
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Does the COSS/PIC have sufficient Southern Shield Process Knowledge
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Please give more details
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Does the COSS/PIC have access to the Southern shield paperwork applicable to the site? I.E F2001, LBA or LCR's
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What was missing and why?
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How many days in advance must COSSs be named?
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What arrangements must be made if staff are to enter the 4ft in a line blockage?
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What authorisation form must be included with the SSOWP if Site Warden is to be used adjacent to an open line?
Have you been formally briefed and do you understand the requirements of the Southern Shield Working near Live Conductor Rails (LCR) Protocol? Questions to ask to confirm this…
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Explain the 3 levels of control and their respective distances when walking or working within 1m of the live conductor rail?
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What documentation must be with the SSOWP to authorise working within 1 metre of the live conductor rail?
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Who may authorise any works within 1m of the live conductor rail.
Have you been fully briefed on Octavius processes, including all additional paperwork, morning reports and support?
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Who is Octavius RIPS Manager?
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Who may authorise Open Line Working?
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when implementing a Line Blockage with Detonator protection, what form needs to be completed?
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At the end of each shift, what form needs to be completed?
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Before you leave site where do you need to send all completed paperwork and pictures?
Have you been formally briefed and do you understand the requirements of the controls required on Octavius sites when Working in multiple COSS Line Blockages with PC? Questions to ask to confirm this…
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Explain the signing in arrangements for COSS with PC, and how authority to access the track is authorised once the line is blocked?
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How many COSSs may a PC sign in on to the line blockage?
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When acting as a PC what form needs to be completed?
Have you been formally briefed and do you understand the requirements of the ‘Till Dawn Lamps Process? Questions to ask to confirm this…
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Explain the purpose of the ‘till dawn process and who is responsible for implementing it.
Section 5 - Overall recommendations, feedback and reflections
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Please detail your overall recommendations and any commendations/Improvement Opportunities:
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COSS/PIC Signature
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PDM Signature
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A COPY OF THIS COMPLETED FORM MUST BE SENT TO THE PRINCIPAL CONTRACTOR’S RIPS MANAGER AND SOUTHERN SHIELD SLT REPRESENTATIVE.
