Pole Overhead Safety Assurance Audit

• Who is conducting this audit?

• 

• Document No. OHSF-PR-08-03 Version 1 Revision 0 Dated 11/12/2019

• (Format:- City name - Job Pack / PN Number) E.g Aberdeen S12345 Always insert City name and Job Pack / PN number if known

• CityFibre Holdings Ltd, 15 Bedford St, London, WC2E 9HE

• Conducted on

  Date

Location

• Location
  Address

• Please answer the following 3 questions based on your dynamic risk assessment on arrival at the site. If you answer 'No' to any of the following questions please explain this in the free text field which appears with a 'No' answer, take the appropriate action and, when safe to do so, continue the audit.

• Is it safe for you to conduct this audit?

  Yes

  No

• Please explain why and what action you have taken as a result.

• Is it safe for the construction workers to continue work?

  Yes

  No

• Please explain why and what action you have taken as a result.

• Is it safe for members of the public, in the areas surrounding the site, that they are able to access?

  Yes

  No

• Please explain why and what action you have taken as a result.

• Who is the Principal Contractor?

  Select

Reference materials (Streetworks Code of Practice etc.)

• Code of Practice (Red Book)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/safety-at-streetworks.pdf

• CDM Code of Practice
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/l153(1).pdf

• CityFibre Fibre Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SFI01%20-%20Fibre%20Specification.docx?d=wc41be78482c44d1eb56b968a21e799cf

• Contractor Monitoring Risk Assessment
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/3.%20%20OHSM%20Risk%20Assessments/OHSF%E2%80%93PR-03-01-019%20RA%20Monitoring%20Contractor%20Work%20Sites.doc?d=wc53e3603bd7a41198b86334459838ff2

• Are you inspecting BT or CityFibre pole?

  CityFibre

  BT

  Other

• Please advise who own the asset

• What is the Pole ID?

• Has the engineer got the correct accretations (NRWSA, SA001, SA7)?

  Yes

  No

  N/A

Pole check/ test

• Have drop wires minimum height checks been completed?

  Yes

  No

• Under no circumstances should joint user poles be climbed

• Has the engineer checked the correct depth of installation?

  Yes

  No

  N/A

• Is there any sign of damage to the pole? *Damage caused by hedge trimming, vehicle damage, Vandalism etc.

  Yes

  No

• Is the pole in date to climb?

  Yes

  No

• What is the test Date?

• Can at least three quarters of the circumference of the pole be seen and tested?

  Yes

  No

• D = Defective (Decay) DO NOT CLIMB SC= Shallow climbable SD= Shallow depth (THESE POLES SHOULD NOT BE CLIMBED) H + Z = Hazard near the pole, if an engineer can safely position their ladder in such a way to reduce the hazard then the pole can be climbed.

• Is there a D, SC, SD, H or Z tag?

  Yes

  No

  N/A

• Is there any decay or rot suspected on the pole?

  Yes

  No

  N/A

Pre-climb set up

• Is the site set up in accourdance street work ( red book)

  Yes

  No

• It the pole accessed by ladder or MEWP?

  Ladder

  MEWP

• Is the engineer accredited for ladder use:

  Yes

  No

• have the ladders been safety checked and set up as per SA001?

  Yes

  No

• Is the harness fitted, serviceable and in date?

  Yes

  No

• Is the engineer accredited for mobile platform use?

  Yes

  No

• Has the site and mobile access been set up as per regulations

  Yes

  No

• Is the harness fitted, servicible and in date

  Yes

  No

PPE

• Is PPE correct and serviceable for the task being carried out?

• Has the engineer got the correct footwear (Boots with 90-degree heel) and are they clean of any mud dirt on the sole?

  Yes

  No

• Is the engineer wearing a hard hat with chinstrap in place?

  Yes

  No

• is the engineer wearing eye protection?

  Yes

  No

• is the engineer wearing a Clean high vis jacket?

  Yes

  No

• Have all rings been removed or taped up to stop catching on pole steps?

  Yes

  No

• Is the harness is good order (no tears signs of loose stitching rust on D rings)?

  Yes

  No

• Has the harness got its serial number and test certificate?

  Yes

  No

• Is the fall arrest restraint in good order (No tears signs of loose stitching carabiner in good working order)?

  Yes

  No

  N/A

• Is the pole belt in good working order (No tears loose stitching carabiners in good working order)?

  Yes

  No

  N/A

Commencement of Climb

• Is the pole been accessed as per SA001

  Yes

  No

• Has the engineer secured their pole belt and fall arrest system over their shoulder before climbing?

  Yes

  No

  N/A

• Are three limbs in contact always whilst climbing?

  Yes

  No

  N/A

• Has the fall arrest system been attached to the pole before engineer proceeds onto the first pole step?

  Yes

  No

  N/A

• Has engineer confirmed carabiner secure before commencing work?

  Yes

  No

  N/A

Bringing Tools and Equipment to work area

• Is the engineer using a tool bas to bring equipment up to the work area?

  Yes

  No

  N/A

• Has the tool bas been secured to the harness in such a way that it will pull away if snagged (Looped length of rope under the harness)

  YES

  NO

  N/A

ASN Checks

• Has the equipment been fitted safely and securely in accordance with CF & OR specs?

  Yes

  No

• Describe why?

Route Visit Complete? (Check all mandatory fields have been completed)

• Assessor

  Sign

• Would you like to highlight any good practice?

  Yes

  No

• Who would you like to highlight?

  Contractor / Gang

  Individual

  Other

• If answer is other, please specify.

• Please name the group / individual you would like to highlight

• Which category best describes the good practice? Categories TBC

  Select

• Please describe the category of the work being recognised.

• Please give a description of the practice you have observed and would like recognised.

• Please provide the name of the Supervisor or Sub-Contractor.

• Please provide the name of the Gang Leader.

• Auditor Signature

  Sign