Title Page
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Conducted on
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Prepared by
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Location
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Team leaders name:
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Street name:
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Op 1 name:
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Town:
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Op 2 name:
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Work in progress:
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Vehicle reg:
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Subcontractor manager:
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Civils or Jointing team
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Linbrooke manager:
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Person Completing Checks :
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Contract ie LVO/NCS:
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Date of Check:
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Van Check
Have the team completed the SSRA and have all visitors & agents signed on?
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Is a copy of the van pack on site and what date is shown on Risk assessments within?
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Are relevant COSHH statements in Van Pack? And in date?
Do the competencies match the tasks on site (i.e. face fit/abrasive wheels etc CSCS Cat & Genny)?
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Does the vehicle have fitted an in date secured 2kg dry powder fire extinguisher?
Is at a minimum 1 x First Aider on site?
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Is a First Aid kit available and sufficiently stocked and in date where applicable -
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individually wrapped sterile plasters of assorted sizes
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individually wrapped triangular bandages,
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safety pins
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large and medium-sized sterile, individually wrapped, unmedicated wound dressings
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disposable gloves
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Is Eye wash available and in date?
Where dust is being produced, have staff been face fitted and have a FFP3 dust mask available
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Is ear defence available on site if required and in good condition?
Is all PPE in good conditions?
(boots/glasses/coveralls etc) and the correct type for the task?
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If Civils do team have impact Googles available onsite fore use?
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Non-Conformances Details/Actions
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Section/Number
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What was non-conformance
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What did you do about the non-conformance
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Closed –
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Any Required Equipment / PPE?
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Check completed by:
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Signature:
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Operatives name:
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Operatives signature:
