PAIR Form - Supervision & Site Safety

• Inspection Type: (Supervision & Site Safety)

• Contractor:

• Team:

• Date:

  Date

• Prepared by:

• Project Title:

• ELR & Mileage:
  Address

• Weather & temp:

Supervision

• Name of PIC:

• Rail experience (years):

• Vegetation experience (years):

• Vegetation qualifications:

• Comments:

• Name of Contractor Supervisor:

• Rail experience (years):

• Vegetation experience (years):

• Vegetation qualifications:

• Comments:

• Name of Team Leader:

• Rail experience (years):

• Vegetation experience (years):

• Vegetation qualifications:

• Comments:

Site safety

• Work activities on site:

• SSOW:

• COSS brief:

  Good

  Adequate

  Poor

  N/A

• Task brief (verbal):

  Good

  Adequate

  Poor

  N/A

• Cables and Underfoot hazards highlighted?

  Yes

  No

  N/A

• Cable avoidance measures briefed and understood?

  Yes

  No

  N/A

• Welfare available?

  Yes

  No

  N/A

• Work at Height rescue plan recorded?

  Yes

  No

  N/A

• Climbing/Steep Slope access rescue kit present?

  Yes

  No

  N/A

• Emergency kit present? (first aid, fire extinguisher, spill kit etc)

  Yes

  No

  N/A

• Fuel spill mat present?

  Yes

  No

  N/A

• Vehicle fuel storage secure?

  Yes

  No

  N/A

• Boundary fenceline intact?

  Yes

  No

  N/A

• Adequate lighting? (Nights)

  Yes

  No

  N/A

• Additional comments?

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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• 3.

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• 5.

• 6.

• 7.

• 8.

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

  Sign