Title Page

  • Project Name/Number

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel on site during site survey

Health and Safety - Foreseeable Hazards

  • 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

  • Electricity Sub Station

  • Pedestrian Subway

  • School/Nursing home

  • Ambulance Station

  • Lifting Operations/Hoists

  • Interference with Temporary Works

  • Traffic sensitive road/speed restrictions

  • Will a road closure be required

  • Deep water/Sewer Channel/River etc.

  • Is Lane Rental Required

  • Close proximity of walls and fences

  • Do the works require changes to permanent signs

  • Restricted access for LGV movement

  • Above Ground Hazards-If overhead power supplies are present - will the works encroach on safety distance (consider large plant/LGV tippers/cranes etc.

  • Will existing street furniture need to be moved

  • Underground hazards: Are high risk services present?<br>Oil filled, fibre optic,HV/LV cables, third party pipelines, underground structures, foundations.

  • Network Rail/Metro/Tramway/Underground rail

  • Proximity if Rail/Tramway crossing.

  • Engineering/Structural difficulties

  • Are there busses/Red Routes, bus stops or one way traffic schemes in operation

  • Hot works, welding, brazing & soldering, Cathodic Protection

  • Presence of Landfill site

  • Areas of known vandalism, possible security risks

  • Will the works affect a pedestrian crossing or other crossing point

  • Is the site located where catastrophic damage could occur (e.g. Over a tunnel/tube tunnel/major sewer/major water pipe)

  • Will parked cars affect the works

  • Is there an Asbestos register, Are asbestos containing materials visible

  • Will the scheme require "Out of Hours" site checks

Environmental - Notified by Local Authority

  • Wildlife & Woodland habitat

  • Tree Preservation Order Applicable

  • Area of Outstanding Natural Beauty

  • Noise Restrictions

  • Site of Special Scientific Interest

  • Conservation Area

  • Work impact on Hedgerows or trees

  • Listed Buildings

  • Management of Excavation Water

  • Noise Restrictions Does NG Environmental Impact Assessment apply

  • Is temporary land acquisition required, for lay down area, storage and welfare facility

Environmental - Consideration of specific measures

  • Housekeeping issues

  • Trees/Hedgerows - Maintain 0.5m with Plant

  • Planning Authority Consents

  • Footways, Bridleways, Rights of Ways Affected

  • Good Access / Egress

  • Additional guarding (Heras/Crowd Control)

  • Waste Disposal (Licences/Segregation)

  • Risk to Watercourse - EA Consent

  • Risk to Wildlife Habitat - EA Consent

  • Specific RA - SSSI

  • Adjacent Land Use

Technical requirements - Consideration

  • Permits to work Required

  • Method Statements

  • Specific Risk Assessments

  • Information/Instruction

  • Emergency Arrangements

  • Gas RO/NRO

  • Cat & Genny Survey

  • Trial Holes Required

  • Location of Specific Area for Unloading

  • Materials Storage/Security/Access Arraingments

  • Welfare placement agreed/proposed

  • Work carried out on 3rd Party Premises

  • Are any Specific Site Rules Required

  • Is site access and egress satisfactory

  • Extraction/Ventilation to G5 required

  • Shoring Design

  • Mechanical Lifting Devices

  • Handrail/Edge Protection

  • Signs/Barriers

  • Traffic Lights

  • Containment & Removal of Spoil

  • Temporary electric hookup points required

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.