Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Auditor
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Sentinel Card No
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Location
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Select date
Staff
Role
SSOW Planner
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Name
Responsible Manager
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Name
COSS
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Name
Possession Planner (if applicable)
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Name
SSOW Pack
Site Location
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Findings
Job Number
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Findings
Dates of works
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Findings
Methods of protection
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T3 / LB / LB+AP / Fenced / SW / COSS+1
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Add media
Checked by SSOW planner (Line Blockage)
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Findings
Authorised by responsible manager
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Findings
Verified by COSS
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Findings
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Add media
Hazard Directory
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Findings
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Add media
Sectional Appendix
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Findings
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Add media
Signal Diagrams
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Findings
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Add media
Quality Map
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Findings
Nearest Hospital
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Findings
Location Plan
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Findings
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Add media
RT9909 / COSS Briefing
Items
Date & Time Completed
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Findings
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Add media
Location
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Findings
Contacting the signaller
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Findings
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Add media
Access Arrangements
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Findings
Hazards
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Findings
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Add media
Limits of the working area
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Findings
AC or DC Lines
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Findings
Safe system of works
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Findings
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Add media
Fenced
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Findings
Site Warden
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Findings
Signatures / Name
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Add signature
Line Blockages
Item
Ref Number
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Findings
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Add media
Location
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Findings
Protecting Signals
RT3181
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Findings
GZAC No
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Findings
General Arrangements
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Findings
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Add media
Will the work affect the safety of the line
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Findings
Type of additional protection
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Findings
Blocking The line
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Findings
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Add media
Granting authority
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Findings
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Add media
Level crossing arrangements
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Findings
Additional protection
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Findings
Permission to share blockage
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Findings
Change of COSS / PC
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Findings
