Title Page

  • Personal Track Safety

  • Learner Name:

  • Conducted on (Date and Time)

Pre-Work Checklist

  • Wearing Full PPE? (Photograph of individual in PPE)

  • Specialist PPE required?

  • PTS Card present and in date? (Photograph of card)

  • Have they been briefed and signed the RAMS (Photograph of documents)

  • Have they been briefed by the TSC?

  • Are they fit and well and capable of carrying out the works?

Observations and Questions

  • Has the Learner signed in with the TSC (photograph of TSC book)

  • Did the learner pay attention to the TSC briefing?

  • What is the line speed?

  • Can they list the hazards of the worksite? (please list what they have identified)

  • Do they know the method of warning?

  • Do they know where the position of safety is?

  • Has the learner shown awareness of their own safety?

  • Has the learner shown awareness of RRV's?

  • Has the learner avoided walking on the sleepers?

  • Has the learner adhered to exclusion zones of RRV's or on track plant?

  • Has the learner shown good listening skills?

  • Has the learner demonstrated overall acceptable behavior whilst working on or near the line?

  • Has the learner asked any relevant questions to clarify the works being undertaken?

  • Has the learner used all tools and equipment as per method procedures?

Completion

  • 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

  • Supervisor (Full Name and Signature)

  • Learner (Full Name and Signature)

Supervisor feedback and notes

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