PTS Supervised Shift Report

• Personal Track Safety

• Learner Name:

• Conducted on (Date and Time)

  Date

Pre-Work Checklist

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

  Yes

  No

  N/A

• Specialist PPE required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Have they been briefed by the TSC?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Observations and Questions

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

  Yes

  No

  N/A

• Did the learner pay attention to the TSC briefing?

  Yes

  No

  N/A

• What is the line speed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Do they know the method of warning?

  Yes

  No

  N/A

• Do they know where the position of safety is?

  Yes

  No

  N/A

• Has the learner shown awareness of their own safety?

  Yes

  No

  N/A

• Has the learner shown awareness of RRV's?

  Yes

  No

  N/A

• Has the learner avoided walking on the sleepers?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Has the learner shown good listening skills?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Passed

  Further development required

  Not satisfactory performance

• Supervisor (Full Name and Signature)

  Sign

• Learner (Full Name and Signature)

  Sign

Supervisor feedback and notes

• undefined