Reinstatement Audit

• Site Address:
  Address

• Project Reference :

• Date of Inspection:

  Date

• Contract:

  Select

• Inspected by:

  Select

• Team Leader:

  Select

• Street works No:

• Drivers License No.

• Driver CPC No.

• Mate(s):

  Select

• Street works No(s):

• Mate(s):

  Select

• Street Works No(s):

• Brief Description of Work:

  Select

TOOLS & EQUIPMENT

• Are fire extinguishers in a satisfactory<br>condition and deployed/ready for use where<br>required?

  Yes

  No

• Available tooling and equipment is calibrated<br>and in good condition and there is evidence that a<br>regular inspection has been undertaken and<br>recorded?

  Yes

  No

• Is the vehicle in a satisfactory<br>condition providing secure storage and safe<br>access/egress?

  Yes

  No

• Has the daily vehicle check been completed?

  Yes

  No

• If the vehicle a HGV, is the O License Sticker placed clearly in the window?

  Yes

  No

  N/A

• Are all wheel markers aligned on HGV?

  Yes

  No

  N/A

• Has the daily trailer check been completed?

  Yes

  No

AVAILABILITY OF DOCUMENTATION

• Can the Operatives provide evidence of<br>competency to carry out the work activity?

  Yes

  No

  N/A

• Have risk assessments been undertaken<br>where required? (including any additional site<br>specific hazards)

  Yes

  No

  N/A

• Does the Operative have access to the PPL Portal and recent Engineering & Safety<br>Bulletins?

  Yes

  No

  N/A

• Are up to date H codes available and can the<br>operative demonstrate where to input on the<br>system?

  Yes

  No

  N/A

• Does at least one person hold a NRSWA<br>Card?

  Yes

  No

  N/A

• Does Each Member have a PPL,<br>Cadent/Clancy ID Card?

  Yes

  No

  N/A

• Does all staff hold EUSR Cards

  Yes

  No

  N/A

USE OF PPE

• Is appropriate PPE being used/available for<br>the work activity? Minimum requirements: Safety<br>Helmet, Glasses, High Impact Google, Hi Vis,<br>Overalls, Safety Footwear, Gloves and Hearing<br>Protection.

  Yes

  No

• Do both team members have "press to check" dust mask?

  Yes

  No

• Are all team members clean shaven excluding grabs?

  Yes

  No

  N/A

ON SITE SAFETY

• Have the Reinstatement or Grab team signed in to the Engineering teams Risk Assessment?

  Yes

  No

• Has effective customer liaison taken place?<br>(i.e. emergency safety advice KICK etc.) Have team got customer cards?

  Yes

  No

• Is sufficient welfare and first aid equipment<br>available and fit for purpose?

  Yes

  No

• Are site vehicles and/or mechanical plant<br>parked/operated and controlled in a safe manner?

  Yes

  No

• Are hazardous substances managed and<br>stored correctly and are spill kits and drip trays<br>available where required?

  Yes

  No

• Has impact on the environment been<br>considered and have appropriate controls been<br>put in place? (this includes actions taken to protect<br>the customers property)

  Yes

  No

  N/A

• Are No Smoking signs displayed where<br>required?

  Yes

  No

  N/A

• Does the grab team have fluorescent tape on the gantry fall arrest arm?

  Yes

  No

  N/A

• Is the fall arrest bar engaged whilst the hiab crane is being operated?

  Yes

  No

  N/A

• Has the HAV’s exposure been recorded?

  Yes

  No

  N/A

SIGNING, LIGHTING & GUARDING

• Adequacy of advance warning of works and<br>understanding of requirements. [+End sign]?

  Yes

  No

  N/A

• Pedestrians protected from site and able to<br>pass work site safely?

  Yes

  No

  N/A

• Safety zone requirements identified and set up<br>correctly? Including your Vehicle.

  Yes

  No

  N/A

• Road Plate skid resistant, suitable for<br>excavation, correct overlap, secured in place and<br>not presenting a hazard?

  Yes

  No

  N/A

BACKFILL & REINSTATEMENT

• Has all excess water been removed from<br>excavation?

  Yes

  No

  N/A

• Are the surface coarse layers constructed to<br>the required depths?

  Yes

  No

  N/A

• Has correct backfill material been used?

  Yes

  No

  N/A

• Are the backfill/reinstatement material tickets<br>available?

  Yes

  No

  N/A

• Is the bituminous material at the correct<br>temperature?

  Yes

  No

  N/A

• Has an appropriate gas marker tile/tape been<br>used?<br>

  Yes

  No

  N/A

• Are boxes chambers vertical, is lid level with<br>final surface and the chamber clear?

  Yes

  No

  N/A

• Have all excessive saw cuts/edges been<br>sealed correctly?

  Yes

  No

  N/A

• Have specialist surfaces/road markings/street<br>furniture been replaced (anti skid etc)?

  Yes

  No

  N/A

• Has modular work been replaced<br>correctly/pointed and free from damage?

  Yes

  No

  N/A

• Have any fixing points for excavation<br>boards/road plates and barholes been reinstated?

  Yes

  No

  N/A

• Is the final reinstatement free from adjacent<br>cracking and undermining?

  Yes

  No

  N/A

SUMMARY

• Additional Comments:

• Corrective Actions:

• Inspection Completed By:

  Sign

• Team Leader Signed:

  Sign