Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Worksite Details

  • Access Point

  • Protection Method

  • trains in use

  • Site Supervisor

  • Time worksite Granted

  • Time Worksite Handed Back

  • RRAP used

  • Late worksite- reason for delay

Planned Works v Actual

  • Planned Work For Shift

  • Actual work Carried Out During Shift

  • If Shortfall, reason why

  • Reason for delay to task

Staff and Plant on Site

  • Members of Staff on site

  • RRV's / Plant / Attachments

  • Small Plant in Use

  • Staff Competence checked

  • Breakdowns

Detail of Breakdown

  • Lost time

  • Reason for Breakdown

  • Photographs

Any Issues

  • Staff

  • S&T

  • Technical/Design

  • Welding/Flame Cutting

  • PPE

  • Handback

  • All paperwork in place

  • Equipment suitable for works

  • lighting sufficient for works

  • House Keeping

  • Welfare

  • First Aider and Kits

  • Are Staff Fully PPE Compliant

Close Calls / Good Working Practices

  • Close call / Good Working Practices

  • Comments

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.