Title Page

  • Prepared By

  • Conducted On

  • Location
  • Operatives On Site

Worksite & Documentation

  • RAM'S Completed For The Task Being Carried Out & if applicable Point of Work Risk Assessment (POWRA) completed and staff<br>briefed and signed on to POWRA?

  • Pre Works Checklist Completed

  • Site visitor record on site?

  • Work pack / Van pack available on site?

  • Housekeeping on site is good / site clean and tidy?

  • Vehicles / vans and trailers parked safely, not causing an<br>obstruction to other road users or pedestrians?

  • NRSWA Supervisor / Operative on site with Unit 2 - signing,<br>lighting and guarding and other competencies for works<br>being underaken?

  • Red Book (Safety at Street Works and Road Works ACOP)<br>available on site?

  • Are signs positioned correctly, secured, clean and in good condition?

  • Sufficient barriers in place and in good condition?

  • Barriers adequately secured / clipped together and prevented<br>from blowing over with sandbags?

  • Appropriate safety zones in place and maintained?

  • Has a pedestrian walkway been provided where required?

  • Courtesy board in place, clean, easily readable and contains<br>relevant information (i.e. correct permit number, emergency<br>phone number etc.)?

  • GDU switched on and being used correctly and in calibration?

First Aid

  • First aider(s) identified and on site?

  • First aid box available on site, Including eyewash, adequately stocked and in date?

  • Are operatives aware of the incident / near miss reporting procedure and emergency arrangements (evacuation, fire, accident etc) in place and relevant to the site?

PPE & Safety Equipment

  • Correct PPE For The Task Carried Out?

  • PPE 6 monthly checked (Harness, Hard Hat, Ladders Etc)?

  • Hand/wet wipes available of site for staff to clean hands?

  • Flame Retardent PPE warn on Civils Works?

Enviroment

  • Are all materials, including waste stored within the work area

  • Is waste, including materials, contaminated soils, silts and<br>water disposed of correctly?

  • Are recovered ropes properly collected and disposed off?

  • Is a Spill Kit readily available?

  • Fire extinguisher readily available and tested and in date?

Power Tools

  • Power Tool Check (Check Quantum Owned Equipment) (Take Photos Showing The Condition Of Equipment and S/No) (Inc Batteries)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.