PAIR Form DPM

• Site conducted

  Select

• Full Name/Team/Contractor:

• Date:

  Date

• Prepared by:

• Project Title:

• ELR & Mileage:
  Address

• Lift plan on site and Correct?

  Yes

  No

  N/A

• ALO available and on site?

  Yes

  No

  N/A

• Briefed and signed?

  Yes

  No

  N/A

• All plant on site as previosuly listed ?

  Yes

  No

  N/A

• Sentinel Checked and correct?

  Yes

  No

  N/A

• NPTC / CPCS / NPORS / City and Guilds present ?

  Yes

  No

  N/A

• Company Specific ATW On site and correct?

  Yes

  No

  N/A

• Duplex Communication used?

  Yes

  No

  N/A

• Exclusion Zones briefed and adhered to?

  Yes

  No

  N/A

• Good Awareness of other plant is use throughout the site?

  Yes

  No

  N/A

• Is there and on site Fitter?

  Yes

  No

  N/A

• Storage area or haulage agreed?

  Yes

  No

  N/A

• Traffic Management required and used?

  Yes

  No

  N/A

Actions to be entered into CMO:

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

• 1.

• 2.

• 3.

• 4.

• 5.

• 6.

• 7.

• 8.

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

  Sign