Title Page
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Project Name/Number
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel on site during site survey
Health and Safety - Foreseeable Hazards
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If noise >80 dB is likely to be produced by Engineering techniques is a Noise Assessment available - If No assessment is available contact the SHEQ Dept
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Electricity Sub Station
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Pedestrian Subway
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School/Nursing home
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Ambulance Station
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Lifting Operations/Hoists
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Interference with Temporary Works
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Traffic sensitive road/speed restrictions
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Will a road closure be required
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Deep water/Sewer Channel/River etc.
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Is Lane Rental Required
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Close proximity of walls and fences
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Do the works require changes to permanent signs
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Restricted access for LGV movement
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Above Ground Hazards-If overhead power supplies are present - will the works encroach on safety distance (consider large plant/LGV tippers/cranes etc.
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Will existing street furniture need to be moved
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Underground hazards: Are high risk services present?<br>Oil filled, fibre optic,HV/LV cables, third party pipelines, underground structures, foundations.
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Network Rail/Metro/Tramway/Underground rail
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Proximity if Rail/Tramway crossing.
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Engineering/Structural difficulties
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Are there busses/Red Routes, bus stops or one way traffic schemes in operation
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Hot works, welding, brazing & soldering, Cathodic Protection
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Presence of Landfill site
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Areas of known vandalism, possible security risks
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Will the works affect a pedestrian crossing or other crossing point
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Is the site located where catastrophic damage could occur (e.g. Over a tunnel/tube tunnel/major sewer/major water pipe)
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Will parked cars affect the works
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Is there an Asbestos register, Are asbestos containing materials visible
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Will the scheme require "Out of Hours" site checks
Environmental - Notified by Local Authority
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Wildlife & Woodland habitat
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Tree Preservation Order Applicable
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Area of Outstanding Natural Beauty
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Noise Restrictions
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Site of Special Scientific Interest
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Conservation Area
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Work impact on Hedgerows or trees
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Listed Buildings
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Management of Excavation Water
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Noise Restrictions Does NG Environmental Impact Assessment apply
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Is temporary land acquisition required, for lay down area, storage and welfare facility
Environmental - Consideration of specific measures
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Housekeeping issues
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Trees/Hedgerows - Maintain 0.5m with Plant
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Planning Authority Consents
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Footways, Bridleways, Rights of Ways Affected
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Good Access / Egress
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Additional guarding (Heras/Crowd Control)
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Waste Disposal (Licences/Segregation)
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Risk to Watercourse - EA Consent
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Risk to Wildlife Habitat - EA Consent
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Specific RA - SSSI
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Adjacent Land Use
Technical requirements - Consideration
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Permits to work Required
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Method Statements
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Specific Risk Assessments
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Information/Instruction
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Emergency Arrangements
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Gas RO/NRO
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Cat & Genny Survey
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Trial Holes Required
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Location of Specific Area for Unloading
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Materials Storage/Security/Access Arraingments
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Welfare placement agreed/proposed
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Work carried out on 3rd Party Premises
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Are any Specific Site Rules Required
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Is site access and egress satisfactory
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Extraction/Ventilation to G5 required
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Shoring Design
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Mechanical Lifting Devices
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Handrail/Edge Protection
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Signs/Barriers
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Traffic Lights
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Containment & Removal of Spoil
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Temporary electric hookup points required
