PO Supervised Shift Report

• Points Operator (PO)

• Supervisor Name:

• Conducted on (Date and Time)

  Date
• Location
  Address

Pre-Work Checklist

• Wearing Full PPE? (Photograph of individual in PPE)

  Yes

  No

  N/A

• Specialist PPE required?

  Yes

  No

  N/A

• PTS Card present and in date with TSC competency? (Photograph of card)

  Yes

  No

  N/A

• Have they been briefed and signed the RAMS (Photograph of documents)

  Yes

  No

  N/A

• Are they fit and well and capable of carrying out the works?

  Yes

  No

  N/A

• Briefed and signed any tool box talks?

  Yes

  No

  N/A

• Are they carrying the relevant tools such as crank handle, Allen keys, access keys etc?

  Yes

  No

  N/A

• Do they have a mobile phone with all the relevant numbers?

  Yes

  No

  N/A

Observations and Questions T3 possession

• Has the PO been briefed by the site manager and signed in (photograph of sign in and task briefing sheet)

  Yes

  No

  N/A

• Does the PO know the POS and aware of their own safety

  Yes

  No

  N/A

• Does the PO know what the normal position is and the reverse position?

  Yes

  No

  N/A

• Were the points required to be scotched and clipped?

  Yes

  No

  N/A

• Were all messages received repeated back in confirmation

  Yes

  No

  N/A

• Did the PO know what way the road was to be set?

  Yes

  No

  N/A

• Did the PO reset the roads back to the original position?

  Yes

  No

  N/A

• Was the button pushed back in after completion?

  Yes

  No

  N/A

• Time and dater recorded?

  Yes

  No

  N/A

• Was all equipment removed from track after use?

  Yes

  No

  N/A

• Was the access gate locked after use?

  Yes

  No

  N/A

• Did the PO contact the signaler before taking control? RED ZONE ONLY

  Yes

  No

  N/A

• Did they confirm with the signaler that all train movements had stopped? RED ZONE ONLY

  Yes

  No

  N/A

• Did the PO set out their red lights/flag to oncoming train movements after taking control? RED ZONE ONLY.

  Yes

  No

  N/A

• Was control handed back correctly? RED ZONE ONLY?

  Yes

  No

  N/A

• If any issues arose during the shift, did the PO follow the required protocols and procedures, e.g. incident reporting?

  Yes

  No

  N/A

• Did the PO ask any questions relevant to his/her duties? if so please list below and the answers you gave in return?

  Yes

  No

  N/A

• Did you have to correct any actions by the PO, or step in on any safety critical aspects during the supervised shift of the PO? If yes, please detail the actions taken and the results of the same.

  Yes

  No

  N/A

Completion

• Reference Guide:
  • Look at the total score above and select the relevant overall rating:
  
  Pass: 75%-100%
  Further development required: >75%

• Recommendations / Overall Competency Assessment Rating

  Passed

  Further development required

  Not satisfactory performance

• Supervisor (Full Name and Signature)

  Sign

• Learner (Full Name and Signature)

  Sign

Supervisor feedback and notes

• undefined