Key summary and findings

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:

Site safety

COVID-19 controls present?

COSS brief:

SSOW:

Welfare available?

Emergency kit present?

Climbing rescue kit present?

Fuel spill mat present?

Boundary fenceline intact?

Adequate lighting? (Nights)

Site documents

Work package plan?

SSOW pack suitable?

Task brief suitable?

ALO form?

Risk assessments?

Daily/weekly work plan?

Tool & equipment check sheets?

Tool & plant service records?

HAVS forms?

Third party agreements?

Bird nesting form?

Ecology recommendations?

Operative competencies?

First aid competency?

LOLER certificates?

Work site & activities

Access/Egress:

Work site description:

Number of operatives and roles:

PPE:

Tools, plant, and equipment:

Work activities on site:

Work activity compliance:

Method used to secure plant:

Additional comments:

Work specification

Within 6.5m clearance area:

All woody vegetation removed?

Stumps lowered to 75mm or below?

Stumps over 50mm diameter eco-plugged?

Eco-plugs installed correctly?

Woody vegetation and stumps under 50mm treated with herbicide?

Outside 6.5m clearance area:

Vegetation with potential to fall into striking zone reduced/pollarded/removed?

Third-party vegetation pruned away from 6.5m clearance area?

Correct pruning cuts used on all remaining vegetation?

Stumps of leaf-fall species eco-plugged/treated with herbicide?

Arisings:

Wood chip located outside 6.5m clearance zone?

Wood chip spread to 100mm or less?

Windrows created to the correct specification?

Habitat piles created to the correct specification?

Monoliths situated outside the 6.5m clearance area and not within striking distance of any railway assets or 3rd party assets?

All arisings situated at least 1m away from railway assets?

Signature

Actions to be entered into CMO:

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

1.

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7.

8.

All actions have been assigned correctly, and Close Calls recorded where required.
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.