Title Page

  • CONDUCTED ON

  • ELECTRICAL WORKER NAME

  • SAFETY OBSERVER NAME

  • TRAFFIC CONTROLLERS NAMES

  • SITE CONDITIONS

  • HAVE ALL MEMBERS OF THE WORK GROUP SIGNED ONTO THE RISK ASSESSMENT AND APPLICABLE SWMS FOR THE WORK

POLE INSPECTION

    POLE INSPECTION
  • STREET ADDRESS
  • CONDUCTED ON

  • POLE NUMBER

  • CAN POLE BE SAFELY ACCESSED?

  • WHY CAN THE POLE NOT BE ACCESSED?

  • PHOTO OF ENTIRE POLE

  • PHOTO OF POLE NUMBER

  • RECORD LUMINAIRE TYPE/SIZE

  • IS THE RATE 3 LABEL AND POLE ID LABEL VISIBLE?

  • WHICH LABEL NEES TO BE REPLACED?

  • CHECK LUMINAIRE TIGHT/LEVEL CONNECTION TO OUTREACH

  • HAS THE ISSUE BEEN RECTIFIED

  • WHAT IS THE ISSUE

  • CLEAN/WIPE DOWN LUMINARE FITTING

  • REPLACE PE CELL

  • CONFIRM OPERATION OF FITTING

  • CONFIRM ALL LED MODULES WORKING

  • HOW MANY LED'S ARE NOT WORKING?

  • PHOTO OF COMPLETED WORKS

  • ARE THERE ANY ABNORMALITIES?

  • HAS THE SITE BEEN LEFT NEAT AND TIDY, HAS THE POLE HATCH BEEN SECURED, HAVE SWITCHBOARDS BEEN CLOSED?

  • ANY OTHER THINGS TO REPORT?

  • PLEASE PROVIDE DETAILS

COMPLETION

  • HAVE ALL POLES BEEN CLOSED UP, HATCH SCREWS SECURED AND SWITCHBOARDS BEEN CLOSED AND LOCKED?

  • ARE ALL LIGHTS /CIRCUITS BACK ON?

  • HAS ANYTHING BEEN TAGGED OUT / MADE SAFE THAT REQUIRES FURTHER ATTENTION?

  • HAVE ALL TRAFFIC CONTROL DEVICES BEEN REMOVED FROM SITE?

  • HAS ALL WASTSE BEEN REMOVED FROM SITE?

  • HAVE ANY INCIDENTS OR NEAR MISSES OCCURED?

  • Add signature

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