Title Page

  • Conducted on

  • Prepared by

  • Location

Onsite

  • Site Address

  • Ref Number

  • Work Activity

  • Team Leader

  • Other Members

Safety of personnel

  • Is method statements in ‘Black Books’ available and in date

  • Does activity comply with method statement

  • Has pre work risk assessment been carried out

  • Up to date colour utility plans available

  • Proban treated clothing available and worn where appropriate

  • Safety helmets

  • Ear defenders

  • Safety goggles/ Safety Spectacles

  • Gloves

  • Comprehensive first aid kit readily available/ Eyewash available

  • Breathing apparatus x 2 available

  • Is it stored and/or in good condition ( not contaminated)

  • Is the face mask in date and fit for purpose

  • Does the BA box contain two fire resistant balaclavas

  • Has the team completed the monthly BA inspection form

  • Has the form been countersigned by a supervisor/agent

  • Safety boots

  • High visibility clothing

  • Has the team reported any near misses

  • Discuss the near miss with the team

Tools and Equipment

  • Gascoseeker

  • ElectroFusionBox

  • Butt fusion equipment

  • Continuity bonds

  • Extension lead (110v)

  • Tent – (to cover fusionbutt fusion equipment)

  • Leak detection fluid

  • Cable and pipe locator

  • Pressure test gauges

  • LP Bull Horns available and in date

  • MP Bull Horns available and in date: see 11a below

  • On Site teams will only carry the above for specific MP work

  • 2 x Fire extinguishers available and in Date

  • Hand tools issued to teams available/ in good condition/ fit for purpose

  • Lifting equipment, lifting slings, shackles etc in good condition and within inspection date

  • Voltstick available works and correctly used

  • Excavator/Dumper Seat Belt worn/ cab or roll over cage. Movement around site managed, including spoil storage area? Machine adequately secured to trailer when towing?

  • Small Air Drill, appropriate drill bit, Rivet Gun & rivets

Environmental

  • Evidence of waste segregation and management on site

  • Spill kits available for use

  • Fuel/Oil containing vessels stored & managed to avoid contamination (e.g: Drip Tray, Bung, plant nappy)

  • Equipment, Spoil & fuel stored to avoid contamination of drains & water courses

  • Risks to ecology or from invasive plants managed on site (E.g: Knott Weed, Wildlife)

  • Risks from contaminated land assesed & controlled on site (E.g: Coal Tar)

Underground & Overhead Utilities

  • CAT & Genny out with evidence of use

  • CAT & Genny and all attachments in date and in good condition

  • Good understanding of the location of utilities that corresponds with utility plans and visual indicators

  • Have overhead cables risks been identified/controlled (use of Diggers/HIAB's) Is spoil and materials stored under/away from OHLs?

  • Exposed utilities protected/supported as required

Excavations

  • Is excavation size suitable for the activity

  • Is there suitable means of access/egress for the size/depth of the excavation

  • Is spoil/materials stored a safe distance away from the edge of the excavation

  • Are tools/materials stored a safe distance or securely to prevent them falling or being kicked into the excavation

Meter Installations

  • Is the meter control valve accessible

  • Is the control valve fitted correctly

  • Is the on/off label fitted

  • Is the meter box secure

  • If no meter box, is the meter secure

  • Is the medium pressure label fitted (if required)

  • Is the outlet pipe sleeve satisfactory

  • Has the label been fitted, easily visible and in good condition

Jointing

  • Pipe/Fittings stored correctly and clean. Joint protected from weather as required

  • Clamps used and pipe cut/scrapped correctly. Joints/Fittings marked

  • Fusion cycled completed correctly. Joint/Fittings inspected following fusion and soap test completed

  • Correct separation distances between fittings/squeeze off etc

  • Is butt fusion controls ie dummy welds, inspection of beads etc being followed

Transport Compliance

  • Is vehicle, trailer, plant underweight and loaded correctly

  • Any damage found e.g., lights, mirrors, bodywork

  • Are tyres within legal limit

  • Is tow hitch assembly fit for purpose

  • Is daily defect check being carried out and compliant

  • Is tachograph process in place as per company policy

  • Is vehicle servicing in date

  • Is the 12 weekly plant inspection process in date

  • Is the vehicle fitted with a bunded flammables box

  • Are the lorry steps/ ladders in good condition

Qualifications

  • ID CARD – TEAM LEADER

  • ID CARD – SECOND TEAM MEMBER

  • ID CARD – THIRD TEAM MEMBER

  • Qualifications adequate for work being done team leader

  • Qualifications adequate second team member

  • Qualifications adequate third team member

  • Team Leader Signature confirming findings and accepting recommended actions:

  • Auditor Signature confirming that this report is a true reflection of findings on site:

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.