Pre Construction Information Site Survey.

• Project Name/BRM Number

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel on site during site survey

• Local Authority

Health and Safety - Foreseeable Hazards

• Standard SLG required

  Yes

  No

  N/A

• Traffic lights required (2 way / multi-way)

  Yes

  No

  N/A

• Interference with Temporary Works

  Yes

  No

  N/A

• Footway closure required

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Will a road closure be required

  Yes

  No

  N/A

• Bus Lane or other restriction

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is Lane Closure Required

  Yes

  No

  N/A

• Traffic sensitive road/speed restrictions

  Yes

  No

  N/A

• Will parked cars affect the works

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Ambulance Station

  Yes

  No

  N/A

• Fire Station

  Yes

  No

  N/A

• Pedestrian Subway

  Yes

  No

  N/A

• School/Nursing home

  Yes

  No

  N/A

• Electricity Sub Station

  Yes

  No

  N/A

• Lifting Operations/Hoists

  Yes

  No

  N/A

• Requirement for existing lights to be bagged?

  Yes

  No

  N/A

• Deep water/Sewer Channel/River etc.

  Yes

  No

  N/A

• Close proximity of walls and fences

  Yes

  No

  N/A

• Do the works require changes to permanent signs

  Yes

  No

  N/A

• Restricted access for LGV movement

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Will existing street furniture need to be moved

  Yes

  No

  N/A

• Network Rail/Metro/Tramway/Underground rail

  Yes

  No

  N/A

• Proximity if Rail/Tramway crossing.

  Yes

  No

  N/A

• Engineering/Structural difficulties

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Areas of known vandalism, possible security risks

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Presence of Landfill site

  Yes

  No

  N/A

• If noise >80 dB is likely to be produced by Engineering techniques is a Noise Assessment available - If No assessment is available contact the HSEQ Dept

  Yes

  No

  N/A

Environmental - Notified by Local Authority

• Wildlife & Woodland habitat

  Yes

  No

  N/A

• Tree Preservation Order Applicable

  Yes

  No

  N/A

• Area of Outstanding Natural Beauty

  Yes

  No

  N/A

• Noise Restrictions

  Yes

  No

  N/A

• Site of Special Scientific Interest - SSSI

  Yes

  No

  N/A

• Conservation Area

  Yes

  No

  N/A

• Work impact on Hedgerows or trees

  Yes

  No

  N/A

• Listed Buildings

  Yes

  No

  N/A

• Management of Excavation Water

  Yes

  No

  N/A

• Noise Restrictions Does Natural Gas Environmental Impact Assessment apply

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Environmental - Consideration of specific measures

• Housekeeping issues

  Yes

  No

  N/A

• Trees/Hedgerows - Maintain 0.5m with Plant

  Yes

  No

  N/A

• Planning Authority Consents

  Yes

  No

  N/A

• Footways, Bridleways, Rights of Ways Affected

  Yes

  No

  N/A

• Good Access / Egress

  Yes

  No

  N/A

• Additional guarding (Heras/Crowd Control)

  Yes

  No

  N/A

• Waste Disposal (Licences/Segregation)

  Yes

  No

  N/A

• Risk to Watercourse - Environmental Agency Consent

  Yes

  No

  N/A

• Risk to Wildlife Habitat - Environmental Agency Consent

  Yes

  No

  N/A

• Specific RA - SSSI.

  Yes

  No

  N/A

• Adjacent Land Use

  Yes

  No

  N/A

Technical requirements - Consideration

• Existing Utility STATS available or requested

  Yes

  No

  N/A

• Site Specific CPP information sent to WSO

  Yes

  No

  N/A

• Are any Specific Site Rules Required

  Yes

  No

  N/A

• Out of hours access only

  Yes

  No

  N/A

• Permits to work Required

  Yes

  No

  N/A

• Emergency Arrangements (Nearest Hospital)

• Welfare placement agreed/proposed

  Yes

  No

  N/A

• Welfare Arrangements (Nearest Toilets)

• Gas Routine Operation (RO) or Non-Routine Operation (NRO)

  Routine Operation (RO)

  Non-Routine Operation (NRO)

• Cat & Genny Survey

  Yes

  No

  N/A

• Trial Holes Required

  Yes

  No

  N/A

• Location of Specific Area for Unloading

  Yes

  No

  N/A

• Materials Storage/Security/Access Arraingments

  Yes

  No

  N/A

• Work carried out on 3rd Party Premises

  Yes

  No

  N/A

• Is site access and egress satisfactory

  Yes

  No

  N/A

• Extraction/Ventilation to G5 required

  Yes

  No

  N/A

• Shoring Design

  Yes

  No

  N/A

• Mechanical Lifting Devices

  Yes

  No

  N/A

• Handrail/Edge Protection

  Yes

  No

  N/A

• Signs/Barriers

  Yes

  No

  N/A

• Traffic Lights

  Yes

  No

  N/A

• Containment & Removal of Spoil

  Yes

  No

  N/A

• Temporary electric hookup points required

  Yes

  No

  N/A