Information

  • Document No.

  • Conducted on

  • Prepared by

Possession Details

  • WON Area & WON Week Number

  • Possession Reference Number

  • Item Number

  • Possession Limits

Possession Support Staff Details (PSS)

  • Staff Name

  • Employer

Location Details

  • Geographical Location Name

  • Line of Route & ELR reference

  • Access Point Name (including local name if relevant)

  • Has the PSS used an authorised access point?

Competence

  • Is the PSS in possession of their SENTINEL card?

  • Copy of SENTINEL Card

  • Is the SENTINEL card valid? <br>(Poor/damaged/tampered photograph readers card as invalid)

Safe Systems of Work (SSOW)

  • Does the PSS have a pre-planned SSOW?<br>(If accessing within the possession limits SSOW not required)

  • Is the SSOW suitable for the planned arrangements?

  • If accessing within the possession limits do they have suitable information for their planned work?<br>Diagram, WON extract & work instruction.

  • Have there been any changes to the planned SSOW?

Personal Protective Equipment

  • Is the PSS wearing full PPE?<br>High visibility upper body & lower body clothing.<br>Safety Helmet.<br>Safety boots.

  • Is the PPE in good clean condition clearly marked with the individuals correct sponsor?

  • Is the PSS in possession of the correct equipment?<br>Head torch.<br>Access keys.<br>SPRS.<br>Detonator Tube and metal ammunition box.

Protection Arrangements

  • Protection Limits - Beyond

  • Protection Limits - Approach

  • Has the PSS placed protection as planned and instructed by the PICOP?

  • Is the protection suitable?<br>In the correct location, in good working order, detonators in date, correct amount.

Other Observations

  • Detail any observations of good or bad practice - such as communications/dealing with trains.

  • Photographs of any non conformance where applicable, i.e. defective PLB etc

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.