Information
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Route
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Conducted on
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Completed by
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Location
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Team Members
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Line Manager
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Any Sub-contractors on Site
Site Details
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ELR
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Start Mileage
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End Mileage
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Brief Description of Works
1. General Documentation
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Is the White Board displayed, correctly filled in & briefed out?
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Are TB completed, briefed out & signed and WPP on site?
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Are the Life Saving Rules displayed?
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Is the Construction Phase Plan available on site?
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Are Work Permits in place and being adhered to?
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Is the QTS Transient Site File available and up to date?
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Is the SSOWP/SWP on site, correctly completed & briefed out?
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Has the Signing In (Fatigue Management) Register been completed?
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Are relevant COSHH forms on site?
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Are relevant Risk Assessments available on site?
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Are relevant Noise & HAV forms on site?
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Have the Weekly TBT & Safety Bulletins been briefed out this week?
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Any comments
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Overall - General Documentation
- Good
- Acceptable
- Unacceptable
- Not Applicable
2. Site Safety
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Are fire extinguishers on site and in date?
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Are safe access and egress routes known and clear?
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Are First Aiders appointed and easily identified?
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Is a First Aid box available at the worksite?
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Do all Ops have their PTS and Competency Cards on them?
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Are materials stored safely?
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Is fuel labelled and stored correctly?
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Is there adequate storage on site?
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Is the general site tidiness to a good standard?
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Is any task lighting in good order and adequate for task?
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Are barriers in place and in good order?
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Have unprotected surface cables been identified and clearly marked with spray?
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Is the worksite well organised and free from Slip, Trip & Fall hazards?
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Are exclusion zones being implemented?
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Any Comments
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Overall - Site Safety
- Good
- Acceptable
- Unacceptable
- Not Applicable
3. PPE
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Is PPE in good order, present and suitable for the task?
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Are all Ops wearing appropriate Eye Protection?
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Is appropriate Hand Protection being worn?
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Is appropriate Ear Protection available?
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Is wet weather PPE available?
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Is appropriate IRATA/Climbing equipment available?
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Are harnesses and fall restraint equipment available?
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Is the worksite well organised and free from Slip, Trip & Fall hazards
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Any comments
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Overall - PPE
- Good
- Acceptable
- Unacceptable
- Not Applicable
4. Plant/Equipment Safety
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Do all plant/equipment operatives have the appropriate certification with them?
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Are all plant certificates available on site?
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Have all Pre-start checks been completed and recorded?
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Is an appropriate ALO Plan in place?
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Are all tools and equipment in good condition, serviced and PAT tested?
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Is an appropriate Lift Plan in place?
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Any comments
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Overall - Plant/Equipment Safety
- Good
- Acceptable
- Unacceptable
- Not Applicable
5. Protecting the Public
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Is appropriate Site Fencing in place?
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Are Footpath Closures in place?
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Is Traffic Management in place?
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Are the Public segregated from the works?
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Any comments?
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Overall - Protecting the Public
- Good
- Acceptable
- Unacceptable
- Not Applicable
6. Working at Height
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Are the Ops working safely at height?
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Are exclusion zones set up for lowering cut material?
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Is all WAH equipment in date and certificates available?
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Are lineside assets suitably protected?
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Is a rescue plan in place and a designated Op on site to implement it?
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Any comments
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Overall - Working at Height
- Good
- Acceptable
- Unacceptable
- Not Applicable
7. Railway SSOW
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Is the SSOW appropriate for the work and implemented correctly?
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Was a SSOW Briefing given?
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Is a Sectional Appendix, Signal Diagram and Hazard Directory available on site?
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Is the Line Speed & Direction of Travel known by all Ops?
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Any comments
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Overall - Railway SSOW
- Good
- Acceptable
- Unacceptable
- Not Applicable
8. Environmental & Waste Management
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Has a Bird Nesting Survey been completed?
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Have any invasive weeds been identified and demarcated?
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Have any protected species been identified and appropriate measures been implemented?
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Have Pre-notification Letters been sent for excessive noise or nuisance works?
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Are appropriate consents in place and available on site?
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Has Waste been produced?
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Disposal method - carrier, processor details or to specification on-site?
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Are spill kits and plant nappies at the worksite?
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Are the Ops aware of the Spillage Procedure and have a copy on site?
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Is effective prevention of water/ground pollution in place?
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Any comments?
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Overall - Environmental & Waste Management
- Good
- Acceptable
- Unacceptable
- Not Applicable
9. Behavioural Safety & Culture
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Is staff behaviour & discipline good?
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Have emerging hazards been identified and recorded correctly?
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Are the Ops aware of the Work Safe Procedure?
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Are the Ops aware of who to report an Accident or Incident to? And when?
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Have any Close Calls been identified by the Ops?
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Describe (incl. Infrastructure or Site Safety/Behavioural)
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Have any Close Calls been identified by you but not identified by the Ops?
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Describe (incl. Infrastructure or Site Safety/Behavioural)
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Are the Ops knowledgable in relation to the Life Saving Rules?
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Any comments?
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Overall - Behavioural Safety & Culture
- Good
- Acceptable
- Unacceptable
- Not Applicable
10. Welfare
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Are welfare facilities available on site?
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Are site welfare facilities clean & tidy?
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Transient Sites - Are welfare facilities identified and the address listed on the Task Brief?
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Is adequate site security in place?
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Any comments
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Overall - Welfare
- Good
- Acceptable
- Unacceptable
- Not Applicable
11. Quality Assurance
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Has the work been carried out to the clients specification?
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Are ongoing site checks satisfactory?
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Are all products used to the correct specification?
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Has spraying been undertaken and recorded?
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Are site records being maintained (Electronic Site Report)?
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Have non-conformances been addressed satisfactorily?
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Any comments
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Overall - Quality Assurance
- Good
- Acceptable
- Unacceptable
- Not Applicable
Report Received by/completed by
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Overall comments
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Completed by
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Auditor Signature
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Team Leader
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Received by signature