Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Additional team members on-site

  • First and Last Name

  • Has additional team member got PPE?

  • Team member MUST NOT carry out any works and is not to be within any working sites

  • Details of Task

Hazards relevant for work

  • Identify all relevant hazards associated with the work

  • List other ther Hazards identified

  • Other Hazards

Control Measures - identify type of work and relevant controls from the list

General Safety and House-Keeping

  • Control Measures

  • Are there any dangerous or free roaming animals in the property?

  • Identify relevant controls

  • Vulnerable People

  • Identify relevant controls

  • Identify any addition controls you are undertaking

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  • Does the work require any drilling into the customers property?

  • Has a multi detector been used to check for services and studs?

  • If a multi detector hasn't been used, what control measures are in place?

  • If drilling a through hole. Has the exit area been checked for obstacles and cordoned off?

  • Any additional controls you are undertaking?

  • Does the work require access to a loft space?

  • Access available via appropriate means (loft ladder with secure fixing)

  • Ceiling joists are properly boarded

  • Adequate lighting

  • GDU in calibration date and shows it is safe to enter

  • Any additional controls you are undertaking?

  • Does the work involve site set up (Streetworks)

  • Identify relevant controls

  • Other Controls Identified

  • Does the work involve Manual handling activities?

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Does the work involve working in Chambers?

  • Identify relevant controls

  • Identify any addition controls you are undertaking

  • Does the work involve Roding and roping activities

  • Identify relevant controls

  • Identify any additional controls you are undertaking

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  • Does the work involve working at height?

  • Does the work require using ladders?

  • Have ladder checks been carried out before use?

  • Ladder checks must be completed prior to working at height. STOP WORKS and complete checks before continuing

  • Are ladders in use tagged with an in date ladder inspection?

  • Is the correct PPE for WAH available and being used? (Hard Hats, Climbing boots & Gloves)

  • If PPE (Hard hat, Climbing boots & Gloves) are not available/worn - STOP WORKS

  • Is a second engineer required to assist to ensure works completed safely? (Observation/Ladder footing)

  • Is a second engineer on site to be able to assist?

  • If works cannot be completed safely as a lone worker, STOP WORKS and reschedule with 2 engineers

  • Are the weather conditions safe for WAH?

  • Does task involve working at Height from a pole; any Pole issues call the Pole Helpline on 0330 1233304 IF YOUR ANSWER IS NO TO ANY OF THE QUESTIONS RELATING TO POLE CLIMBING DO NOT CLIMB AND CONTACT YOUR SUPERVISOR FOR ADVICE.

  • Birth / Dhobie Mark checked

  • Is there an A558 Pole Test label in place

  • Pole DP Number in place

  • When was the Pole last inspected (State if Pole is new, or label is missing) If required call Pole Help line

  • Pole Depth Checked

  • Hammer Hollow Check Conducted

  • Probe Rot Test Conducted

  • Are existing cables/dropwires above the minimum required height to allow safe climbing? (minimum 5.2m at lowest point if crossing a carriageway) Rods telescopic to be used to check cable heights.

  • Pole checked for physical signs of damage (2/3 pole to be checked)

  • Is climb zone free from hazards

  • Are struts and stays in good condition

  • Ground conditions are suitable for ladder positioning

  • Ladder angle conforms to 1 in 4 ratio and is secured once climber is in position

  • Harness and fall arrest / Fall restraint equipment in serviceable condition and inspected under LOLER requirements

  • Tool bags / tool tethers/Lanyards in use

  • If wind speed is in excess 23mph work to stop and Supervisor be contacted

  • Any other additional controls you are undertaking

  • Does the work involve work on a shared user pole including Low Voltage?

  • Do you have a second person?

  • Please make sure a second engineer attends before you start your climb.

  • Are existing cables/dropwires above the minimum required height to allow safe climbing? (minimum 5.2m at lowest point if crossing a carriageway) Rods telescopic to be used to check cable heights. Rods Telescoping and Gloves IR to be used to measure power line height.

  • Are power cables also at a safe height and is there sufficient spacing between power cables and the route of the span. Rods Telescoping and Gloves IR to be used to measure power line height. (Refer to your glovebox guide)

  • Have you checks pole and identified it contains Low Voltage - remember if you are not sure you MUST not proceed until you are sure it doesn't include any high voltage equipment? Work on poles with High Voltage is not permitted.

  • Are you wearing suitable Flame-retardant overalls and have appropriate insulating gloves for undertaking work?

  • If pole cabling involved have you got suitable Blue fibreglass ladders insulating suitable for electrical work.

  • If using a MEWP does it have and insulated fibreglass bucket (no metal frame)

  • Have you got suitable insulated hand tools and where required battery operated hand drill.

  • Have you identified your ground support person and have you got suitable means of communication throughout the work.

  • Name of person

  • If using MEWP ground support person understands how to lower the MEWP

  • Ground support sign to demonstrate they have been fully briefed and understand the importance of monitoring throughout the work at height process due to increase risk from LV conductors.

  • You have identified the lowest/ nearest electrical conductors to location of work and understand the safe working distance from these.

  • You have identified the lowest neutral or live wire and understand the safe working distance from this.

  • You have considered weather conditions and identified it is safe to proceed.

  • You have considered all environment hazards and other factors and agree it is safe to proceed with the work.

  • Does task involve working at Height from a MEWPs IF YOUR ANSWER IS NO TO ANY OF THE MEWP RELATED QUESTIONS DO NOT USE AND CONTACT YOUR SUPERVISOR FOR ADVICE

  • Vehicle/MEWPs pre use checks conducted

  • MEWPs LOLER certification in date

  • Ground stable and suitable for MEWP set up

  • Operator has relevant training to operate MEWP

  • Work site correctly set up with relevant barriers / cordons in place when required

  • Area around and above work site assessed for electrical and trapping risks

  • Minimum safe distances from High / Low Voltage and Joint User Poles can be maintained

  • Windspeed is below 28mph and verified. (You MUST feel safe to continue)

  • Tool Bags, Lanyards/Tethers used

  • Lanyard and fall arrest/restraint worn and in date certification

  • Rescue plan in place and all individuals of the team are aware of the procedures

  • Any other additional controls you are undertaking

  • Does the work involve Splicing Operations

  • Identify the relevant controls

  • Any other controls you are undertaking

  • Does the work involve Sub Duct Installation

  • Identify the relevant controls

  • Any other controls you are undertaking

  • Does the work involve Blowing Operations

  • Identify the relevant controls

  • Any other controls you are undertaking

  • Are there additional controls required due to weather conditions / light levels

  • Identify relevant controls

  • Add any additional controls you are undertaking

  • Identify any additional controls not previously listed

Sign off Section -POWRA is an important part of any site work and it is essential that everyone is aware of the details of this document and the agreed safe working methods. It is good practice to get everyone involved in POWRA as this ensures engagement and understanding plus can improve quality.

  • All personnel listed on the POWRA understand the hazards and control measures detailed

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • Site Team Member sign to show the have understood POWRA

  • I confirm that the control measures above will be followed and I will ensure everyone site will follow the agreed safe methods of work agreed.

  • APFN Supervisor on site and reviewed POWRA

  • Name

  • Comments

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.