Octavius ASSURANCE REVIEW CHECKLIST

• Site conducted

  Select

• Completed on

  Date

• Completed by

• Location
  Address

• Date & Shift:

  Date

• Location:

• Job No

Customer (Minor Wks Area/ CP6 IP/LUL etc):

• Who is the customer

  IP or Non IP

  Rail Services Kent

  Rail Services Sussex

  Rail Services Wessex

  Rail Services Managed stations

• Type of SSOW Planned

  Select Safeguarded Fenced Site Warden Open Line Highstreet LUL Engineering Hours N/A

  • Safeguarded
  • Fenced
  • Site Warden
  • Open Line
  • Highstreet
  • LUL Engineering Hours
  • N/A

• Site Lead:

• Responsible Manager:

• PIC/COSS/SPIC etc:

• Octavius Supervisor On Site:

  Yes

  No

  Other

• Who is the First Aider?

• Do they have their Cert

  Yes

  No

  Other

• Is there a First aid kit on site

  Yes

  No

  N/A

• Is the First Aid Kit well stocked?

  Yes

  No

  N/A

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

Supplier undertaking the Physical Works:

• Works Sub-contractor Supervisor On Site:

  Yes

  No

  N/A

• Details of any Photos Provided

  Media

WORKS PACKAGE PLANNING

• Is there a WPP on site?

  Yes

  No

  N/A

• Is the WPP generic or specific?

  Generic

  Specific

  N/A

• Does the WPP describe the works being carried out?

  Yes

  No

  Other

• Is the WPP signed as authorised?

  Yes

  No

  Other

• Who has signed and authorised the WPP

• Have all members of the workgroup signed the WPP briefing record?

  Yes

  No

  Other

• TASK BRIEFINGS

  Yes

  No

  Other

• Is there a Task Briefing on site?

  Yes

  No

  Other

• Is the Task Briefing generic or specific?

  Generic

  Specific

  N/A

• Does the Task Briefing describe the works being carried out?

  Yes

  No

  Other

• Is the Task Briefing signed as authorised?

  Yes

  No

  Other

• Who has signed and authorised the Task Briefing

• Have all members of the workgroup signed the Task Briefing record?

  Select Yes No Other

  • Yes
  • No
  • Other

• Have all permits referred to in the WPP & TBSs been completed and signed as required (hot works incl. with extinguisher, excavations, isolations, HV Switch outs etc.)

  Yes

  No

  Other

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• SAFE WORK PACK/SENTINEL

• Is a valid Safe Work Pack on site?

  Yes

  No

  N/A

• Has the SSOW been briefed to and understood by everyone on site?

  Yes

  No

  N/A

• Does everyone hold the required Sentinel Competencies (PTS/ICI/COSS/ES etc)

  Yes

  No

  N/A

• Is everyone wearing the correct rail approved PPE?

  Yes

  No

  Other

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

MISCELLANEOUS

• Are the planned welfare facilities (as per the WPP/TBS) in place?

  Yes

  No

  Other

• What type of access towers/ladders are being used? (GRP/aluminium) and do staff have PASMA competence Certificates

• Is there a trained and competent member of staff on site

  Yes

  No

  N/A

• Do plant/tool operators have competence certificates with them?

  Yes

  No

  N/A

• Do staff have CSCS cards?

  Yes

  No

  Other

• Is manual handling being managed?

  Yes

  No

  N/A

• Is a valid ALO plan in place and being managed effectively

  Yes

  No

  N/A

• Comments & Opportunities to Improve (including immediate):

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• Details of any Photos Provided

  Media

• Site Assurance Review Undertaken by:

• Daren Norris / Matt Hewett/ Craig Wood/ Steve Paul, Andy Childs or Other (delete as appropriate)

• Signed by PDM:

  Sign

• Signed by Site Rep:

  Sign