Title Page

  • Inspection Type: (COSS Assurance)

  • Contractor:

  • Name of PIC/COSS:

  • Date:

  • Prepared by:

  • Project Title:

  • ELR & Mileage:
  • Weather & temp:

COSS Assurance:

COSS - Planning:

  • Was SSOWP reviewed & signed off by the PIC/COSS minimum shift in advance?

  • Has the PIC/COSS had to make any changes to the plan on the day?

  • What is the Safe System of Work?

  • What is the method/type of protection?

COSS - Site Briefing

  • Have Sentinel cards been scanned & relevant competencies confirmed?

  • Has site briefing taken place with all relevant staff in attendance and paying attention?

  • Has PIC/COSS briefed clearly all task & site risks and asked for confirmation of understanding?

  • Has the SSOW been tested prior to work commencing?

  • State how tested:

  • Generally were the PIC/COSS communications clear & concise on site and over the phone where required?

COSS - Awareness:

  • During work is the PIC/COSS reviewing the SSOW for continued effectiveness?

  • Are all Lookouts/Site Wardens in position to give adequate relevant warning to staff?

  • Do all staff retreat to a position of safety in good time?

  • Do all staff adhere to SSOW?


Actions to be entered into CMO:

  • Enter an Action, an Action Owner, and an Action Date.
    If N/A, enter “No actions”.

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  • 8.

  • All actions have been assigned correctly, and Close Calls recorded where required.

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.