OnSite Waterways

OnSite Pre-survey document

• Conducted on

  Date

• Culvert Reference

• Prepared by

• Address

• GPS Location
  Address

• Access Issues

• Access Drawing

  Drawing

• Assessed priority

  Low

  Medium

  High

• Nature of Works

Confined Space Classification

• NC1<br>

  Low

  Medium

  High

• NC2

  Low

  Medium

  High

• NC3

  Low

  Medium

  High

• NC4

  Low

  Medium

  High

Can works be conducted without the need to enter the Confined Space?

• Yes

  No

  N/A

Confined Space Classification during work task/activities?

• NC1

  Low

  Medium

  High

• NC2

  Low

  Medium

  High

• NC3

  Low

  Medium

  High

• NC4

  Low

  Medium

  High

Self & Assisted Rescue at Confined Spaces

• Self Rescue

• Assisted Rescue

Specified Risks are: -

• • Loss of consciousness arising from gas, fumes, vapours or the lack of oxygen

• • Loss of consciousness arising from an increase in body temperature

• • Serious injury arising from a fire or explosion

• • Drowning from an increase in the level of liquid

• • Asphyxiation from a free flowing solid or inability to reach a respirable atmosphere due to entrapment in a free flowing solid.

• Approx length

• Summary of findings

• Silt sample required?

  Yes

  No

• Number of men required for task

• Photo of Inlet structure

  Media

• Comments

• Photo of Watercourse upstream from inlet

  Media

• Comments

Culvert inlet

• Height (mm)

• Width (mm)

• Water depth (mm)

• Material

  Concrete

  Brick

  Plastic

  Other

• If other please detail

• Approx silt depth at inlet (mm)

• Additional notes

• Overhead services

Access to Culvert

• Type of land

  Public

  Landowner

  Highways

  Railway

  Other

• If other please give details

• Restrictions & contact numbers

Working area

• Off road parking?

  Yes

  No

• Restrictions / directions

• Soft / uneven ground?

  Yes

  No

• Restrictions / directions

• Stock present?

  Yes

  No

• Restrictions / directions

• Traffic Management

• Restrictions / directions

Bridges

• Is there a bridge restricting access?

  Yes

  No

• Location

• Weight restriction

• Width restriction (mm)

• Height restriction. (mm)

• Photo of outlet structure

  Media

• Comments

• Photo of watercourse downstream from outlet

  Media

• Comments

Culvert outlet

• Height (mm)

• Width (mm)

• Water depth (mm)

• Material

  Concrete

  Brick

  Plastic

  Other

• If other please detail

• Approx silt depth at outlet (mm)

• Additional notes

• Overhead services

Access to culvert

• Type of land

  Public

  Landowner

  Highways

  Railway

  Other

• If other please give details

• Restrictions & contact numbers

Working area

• Off road parking?

  Yes

  No

• Restrictions / directions

• Soft / uneven ground?

  Yes

  No

• Restrictions / directions

• Live stock present?

  Yes

  No

• Restrictions / directions

• Traffic management

• Restrictions / directions

Bridges

• Is there a bridge restricting access?

  Yes

  No

• Location

• Weight restriction

• Width restriction (mm)

• Height restriction (mm)

Additional photos

• Additional photo 1

  Media

• Note

• Additional photo 2

  Media

• Note

• Additional photo 3

  Media

• Note

• Additional photo 4

  Media

• Note

• Additional photo 5

  Media

• Note

• Additional photo 6

  Media

• Notes

Environmental & pollution control

• Environmental or pollution Control Matters which might effect the risk Assessment .

• Any other matters relevant to the risk Assessment ?

Report preparation

• Signature

  Sign