Title Page
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Inspection Type: (COSS Assurance)
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Contractor:
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Name of PIC/COSS:
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Date:
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Prepared by:
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Project Title:
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ELR & Mileage:
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Weather & temp:
COSS Assurance:
COSS - Planning:
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Was SSOWP reviewed & signed off by the PIC/COSS minimum shift in advance?
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Has the PIC/COSS had to make any changes to the plan on the day?
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What is the Safe System of Work?
- Safeguarded Green Zone All Blocked
- Fenced Green Zone with one or more lines blocked
- Separated Green Zone with one or more lines blocked
- Permanent Warning Systems (ATWS, SATWAS)
- Train Operated Warning Systems (TOWS)
- Lookout Operated Warning Systems (LOWS)
- Portable Warning Systems (ATWS, SATWS)
- Lookout Warning
- No Lines Blocked
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What is the method/type of protection?
- Line Blockage
- Line Blockage + Detonators
- Line Blockage + Disconnect
- Line Blockage + EPR
- Line Blockage + LOD
- Line Blockage + RETB
- Line Blockage + Route Barring
- Line Blockage + T-COD
- Line Blockage + Token
- Possession (T3)
- Possession RETB
- S.Box Agreement LB (Formal)
- Sidings Possession (T4)
- Signal Protection for Possession Support Staff (T3 clause 2.3)
- WON Line Blockage
- WON Line Blockage + Other
- Signal Controlled Warning System
- ATWS Permanent
- SATWAS Permanent
- TOWS
- LOWS
- ATWS Portable
- SATWAS Portable
- Lookout Fixed Refuge
- Lookout Distant
- Lookout Intermediate
- Lookout (site)
- Site Warden or COSS+1
COSS - Site Briefing
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Have Sentinel cards been scanned & relevant competencies confirmed?
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Has site briefing taken place with all relevant staff in attendance and paying attention?
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Has PIC/COSS briefed clearly all task & site risks and asked for confirmation of understanding?
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Has the SSOW been tested prior to work commencing?
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State how tested:
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Generally were the PIC/COSS communications clear & concise on site and over the phone where required?
COSS - Awareness:
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During work is the PIC/COSS reviewing the SSOW for continued effectiveness?
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Are all Lookouts/Site Wardens in position to give adequate relevant warning to staff?
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Do all staff retreat to a position of safety in good time?
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Do all staff adhere to SSOW?
Signature
Actions to be entered into CMO:
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Enter an Action, an Action Owner, and an Action Date.
If N/A, enter “No actions”. -
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All actions have been assigned correctly, and Close Calls recorded where required.
