Title Page

  • Operative(s) Names

  • Manager

  • Job Number

  • Vehicle Registration

  • Site Address
  • Conducted on

  • Conducted by

1.0 Documentation

  • 1.1. Has a task specific Risk Assessment been conducted, with all hazards identified and sufficiently mitigated?

  • 1.2. Have all required permits been issued (e.g. permit to break ground) and environmental permissions been obtained for the works being conducted?

  • 1.3. Are full utility drawings available and in a suitable format (electric, water, sewer, gas, telecoms)?

  • 1.4. Is a CBUL Health and Safety Document Van Pack available on site?

  • 1.5. Have operatives including members of the supply chain received a CBUL Health and Safety induction?

  • 1.6. Are in date certificates of thorough inspection available for all lifting equipment and accessories?

  • 1.7. Is a temporary works design available for all temporary works on site? Is it approved for construction? Has a temporary works register been completed?

  • 1.8. Is the current task covered by the CBUL 'core' RAMS?

  • 1.9. Have operatives including members of the supply chain got an in date Southern Water ID card?

2.0 Site Set-Up

  • 2.1. Are sufficient traffic management arrangements in place as per the NRSWA approved code of practice?

  • 2.2. Is signing, lighting and guarding suitable and of a good condition? (Barriers must be clipped and heras panels double clipped, in suitable feet).

  • 2.3. Is people and plant interface adequately controlled, with pedestrians adequately segregated?

  • 2.4. Is the general housekeeping of the site of a good condition, with slip, trip and fall hazards removed?

  • 2.5. Are materials and equipment suitably stored within designated areas?

  • 2.6. Are materials and waste materials suitably stored and segregated?

3.0 Site Safety

  • 3.1. Have all excavations got adequate edge protection and/or sufficient means to prevent falls?

  • 3.2. Is there adequate space on site with sufficient access and egress arrangements?

  • 3.3. Are there sufficient welfare arrangements on site, with facilities suitably clean?

  • 3.4. Have all located utilities been identified via trial holes and sufficiently marked? Are exposed utilities adequately supported?

  • 3.5. Is excavation support sufficient and installed as per the temporary works design?

  • 3.6. Have all excavations and other temporary works been inspected by a competent individual?

4.0 Equipment Checks

  • 4.1. Are all tools and equipment suitable and in a good condition?

  • 4.2. Is full 5 Point PPE worn and in good condition, by all on site?

  • 4.3. Is a calibrated CAT and Genny available on site?

  • 4.4. Is a suitable and calibrated gas monitor available on site?

  • 4.5. Have all required machine checks been completed, with records kept?

  • 4.6. Have operatives connected their CAT to the CAT manager app and downloaded their data?

5.0 Sign Off

  • Are there any additional comments or observations?

  • Auditor Signature

  • Operative Signature

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.