PFP Landscapes DR & PTD

• Prepared by:

• Location of site:
  Address

• Date/Time:

  Date

• Job reference number:

• Has a CDM Wizard CPP Risk Assessment been completed for this job?

  Yes

  No

  N/A

• Enter a description of the works including safe methods of completing the works:

• Photograph of work area:

  Media

• Do all operatives have the necessary training / certification / competence to carry out the work?

  Yes

  No

  N/A

• Can the work area be accessed safely?

  Yes

  No

  N/A

• Are the environmental conditions safe for work to proceed and are they unlikely to affect site safety and / or personal safety

  Yes

  No

  N/A

• Have an inspection of all tools / equipment been carried? Are they fit for purpose / in good repair?

  Yes

  No

  N/A

• Are there adequate Safe Systems Of Work with controls in place?

  Yes

  No

  N/A

• Has the necessary PPE been issued to all persons working and is it fit for the task?

  Yes

  No

  N/A

• Where necessary, are adequate warning signs / barriers in place?

  Yes

  No

  N/A

• Are adequate welfare facilities available?

  Yes

  No

  N/A

• Have details of the nearest Accident and Emergency (A&E) Department or First Aid assistance been identified?

  Yes

  No

  N/A

• Have you informed all people who may be affected by your proposed work including any lone working arrangements?

  Yes

  No

  N/A

• Have all operatives been briefed in relation to the site specific hazards, safe systems of work including controls, health & safety arrangements including first aid and welfare, and any emergency procedures?

  Yes

  No

  N/A

• Number of workers briefed. (To be identified in section 5)

• If you answer NO to any question above then DO NOT START WORK until you have consulted your Line Manager

HAZARDS

• Select any of the following hazards listed below and rate them either Low, Medium or High, where you believe the hazard exist either for the task being carried out, or for the environment where the work will take place. Your rating should be based on current controls in place.

• HIGH - Risk of serious injury / fatality
  MEDIUM - Risk of loss time injury (over 7 days) / Risk of long term health effects
  LOW - Risk of injury is minimal

• Use or Exposure to Electricity

  Low

  Medium

  High

• Use or Exposure to Gas

  Low

  Medium

  High

• Fire

  Low

  Medium

  High

• Adverse Weather

  Low

  Medium

  High

• Moving Vehicles / Machinery

  Low

  Medium

  High

• Confined Spaces

  Low

  Medium

  High

• Vibration

  Low

  Medium

  High

• Noise

  Low

  Medium

  High

• Heat

  Low

  Medium

  High

• Violence / Aggression

  Low

  Medium

  High

• Slips / Trips / Falls - e.g Uneven Surfaces

  Low

  Medium

  High

• Working at Height - e.g Steps / Ladders / Elevated Work Platforms

  Low

  Medium

  High

• Manual Handling

  Low

  Medium

  High

• Ventilation

  Low

  Medium

  High

• Dust / Fumes

  Low

  Medium

  High

• Chemicals

  Low

  Medium

  High

• Needles / Sharps

  Low

  Medium

  High

• Poor Lighting

  Low

  Medium

  High

• Work near water

  Low

  Medium

  High

• Vermin e.g Weils Disease

  Low

  Medium

  High

• Offensive Waste

  Low

  Medium

  High

• If you have any high or medium risks then you must inform your line manager prior to starting work activities.

• Please record any other health and safety concerns / comments/ arrangements:

• Does this work involve activities which require breaking the ground? e.g Fencing, Planting or Removing shrubs and trees , Use of a mechanical breaker/digger

  Yes

  No

  N/A

• If YES then you must complete the Permit to Dig in section 3
  IF NO then please go to section 4

• Risk Assessment completed By:

  Sign

• IF BREAKING THE GROUND, WORK MUST NOT START UNTIL THIS PERMIT HAS BEEN COMPLETED AND SIGNED BY A CONTRACT MANAGER OR AN AUTHORISED PERSON

• Permit valid from date

  Date

• Contract manager responsible for the works

• Is the person in charge of the excavation fully conversant with the principles of safe digging and/or avoidance of underground services?

  Yes

  No

  N/A

• Are all operatives aware of the risks associated with underground services and are they competent in safe digging practices?

  Yes

  No

  N/A

• Have relevant underground service maps been obtained and made available on site?

  Yes

  No

  N/A

• Has the work area been scanned using cable detection equipment by a competent person to identify any underground services?

  Yes

  No

  N/A

• State type and serial number of cable avoidance equipment used:

• Cable avoidance equipment calibration date:

  Date

• Has a visual inspection been carried out to identify signs of any services? e.g Inspection covers, Pipe markers, Sub stations, Street lights, recent excavations etc

  Yes

  No

  N/A

• Have all identified underground services been clearly marked / labelled?

  Yes

  No

  N/A

• Have all operatives been briefed in relation to the location of any detected underground services?

  Yes

  No

  N/A

• Have the appropriate tools / equipment for the task been provided? e.g Insulated hand tools for use near detected cables

  Yes

  No

  N/A

• If plant is being used, is the operator trained and competent to carry out the work.

  Yes

  No

  N/A

• Is there a valid Risk Assessment and Safe Systems Of Work with controls in place?

  Yes

  No

  N/A

• Is there a emergency procedure in place?

  Yes

  No

  N/A

• Have all operatives been briefed in relation to the site specific hazards, safe systems of work including controls, health & safety arrangements including first aid and welfare, and any emergency procedures?

  Yes

  No

  N/A

• Number of workers carrying out the work and briefed. (To be identified in section 5)

• If you answer NO to any question above then DO NOT ALLOW WORK TO START until you have consulted your Line Manager

• N.B A PFP Landscapes PTD closure form must be completed following completion of the works

• Completed and issued by:

  Sign

• This procedure must be followed in the event of any incidents involving contact with underground services.
  
  Service Strike Immediate Action
  • STOP all work immediately
  • Take care not to touch exposed cables or tools and equipment which could be live.
  • Identify any casualties - Do not move a casualty unless they are in direct danger and it is safe to do so.
  • Any electrical burn or electric shock injury must be given medical attention however minor it may seem.
  • Call an ambulance on 999 if necessary.
  • Evacuate workers and others to a safe distance and keep vehicles and members of the public away from the area.
  
  Electrical Incidents
  • Call 105 for Electric incidents immediately
  
  Gas Incidents
  • Call 0800 111 999 for Gas incidents immediately
  • No smoking or naked flames
  
  All Other services
  • Contact the Service providers as soon as possible (numbers of local service providers should be obtained prior to any works starting)
  
  For All Service Strikes
  • Contact your line manager as soon as possible
  • Warn Local Residents and Businesses where necessary
  • Do not attempt repairs
  • Do not back fill any holes which contain damaged services.
  • Report all damage, no matter how minor even if leaks or loss of power are not evident.
  
  Any additional emergency arrangements including local contact numbers for service providers, must be identified prior to works taking place and brought to the attention of all workers on site.
  

• Give details of any local arrangements / emergency procedures in place

• Provide local service providers emergency contact numbers where necessary e.g water, telecommunications etc N.B National Emergency Gas and Electricity numbers are provided above.

• By signing below I confirm that I have been informed of the site specific hazards, safe systems of work including controls, health & safety arrangements including first aid and welfare, and any emergency procedures? . I also confirm that I have been provided with the correct PPE and equipment to carry out the task safely.

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