Title Page
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Personal Track Safety
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Learner Name:
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Conducted on (Date and Time)
Pre-Work Checklist
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Wearing Full PPE? (Photograph of individual in PPE)
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Specialist PPE required?
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PTS Card present and in date? (Photograph of card)
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Have they been briefed and signed the RAMS (Photograph of documents)
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Have they been briefed by the TSC?
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Are they fit and well and capable of carrying out the works?
Observations and Questions
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Has the Learner signed in with the TSC (photograph of TSC book)
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Did the learner pay attention to the TSC briefing?
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What is the line speed?
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Can they list the hazards of the worksite? (please list what they have identified)
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Do they know the method of warning?
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Do they know where the position of safety is?
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Has the learner shown awareness of their own safety?
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Has the learner shown awareness of RRV's?
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Has the learner avoided walking on the sleepers?
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Has the learner adhered to exclusion zones of RRV's or on track plant?
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Has the learner shown good listening skills?
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Has the learner demonstrated overall acceptable behavior whilst working on or near the line?
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Has the learner asked any relevant questions to clarify the works being undertaken?
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Has the learner used all tools and equipment as per method procedures?
Completion
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Reference Guide:
• Look at the total score above and select the relevant overall rating:
Pass: 75%-100%
Further development required: >75% -
Recommendations / Overall Competency Assessment Rating
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Supervisor (Full Name and Signature)
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Learner (Full Name and Signature)
Supervisor feedback and notes
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