PIPELINES MAINTENANCE CENTRE SHEQ ACTIVITY MONITORING FORM

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Depot or Job Description
  Address

• Date of audit

  Date

• NB: To be completed by authorised persons on visits to site and copies retained. All findings require description. Where actions are required they shall be detailed on the audit in order of importance.

• Identification

  Yes

  No

  N/A

• Generic RAMS Information

  Yes

  No

  N/A

• STAM/R.A V.4

  Yes

  No

  N/A

• Toolbox talk undertaken?

  Yes

  No

  N/A

• Manual Handling

• Mechanical lifting

• Plant

• Working at heights

What required permitry is on site?

• PTW

  Select Yes NO N/A

  • Yes
  • NO
  • N/A

• NRO

  Yes

  NO

  N/A

• RO

  Yes

  NO

  N/A

• Any other?

Authorities

PPE

• Is P.P.E being worn?

  Yes

  No

  N/A

• Is the P.P.E being worn in a well maintained state?

  Yes

  No

  N/A

• Add media

  Media

Welfare

• Add media

  Media

Working time directive

• Add media

  Media

First Aid

• Add media

  Media

Security

• Add media

  Media

Lighting

• Add media

  Media

Housekeeping

• Add media

  Media

Slips/Trips/Falls

• Add media

  Media

Noise and Vibration

• Add media

  Media

Working at Height

• Add media

  Media

Safety critical equipment

Fire extinguishers

• In date?

  Yes

  No

  N/A

Breathing apparatus

• Has it been recently checked?

  Yes

  No

  N/A

Personal gas monitoring

• Has it been recently checked?

  Yes

  No

  N/A

Testing and monitoring equipment

Transport condition

COSHH

• Are all COSHH items stored correctly and safely?

  Yes

  No

  N/A

• Add media

  Media

Environmental controls and mitigation

• Add media

  Media

Pollution control

• Add media

  Media

Waste management

• Add media

  Media

Electrical equipment/Cables

• Has all electrical equipment been tested recently?

  Yes

  No

  N/A

• Has all electrical equipment been clearly marked?

  Yes

  No

  N/A

Lifting equipment

• Being used?

  Yes

  No

  N/A

• Tested?

  Yes

  No

  N/A

• Showing signs of wear and tear?

  Yes

  No

  N/A

• Suitable for the task?

  Yes

  No

  N/A

Location of services

Breaking ground

Excavation

• Add media

  Media

Confined space

Mobile plant

Other equipment

Competence

• Print Name and Designation

  Sign

• Please Sign

• Select Date

  Date

• Ops Engineer

  Sign

• Please Sign
  

• Select Date

  Date

• Off

  On

Overall findings (check as appropriate)

• Satisfactory?

  Off

  On

• Unsatisfactory?

  Off

  On