Residential Connections/health and safety

• MMC Job Number

• Enable Order Number

• RSP

• Conducted on

  Date

• Prepared by

• Location/Address
  Address

• Technician

• Add signature

  Sign

FAP

• Reseal Required

  Yes

  No

  N/A

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  Media

• Brownfields

• Greenfields

Property Type

• SDU

• MDU

• ROW

CIVILS

• Trench

• Thrust

• Fence Line

• Pro-Active Lead in

• Other

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  Media

• Has there been any variation to scope?

  Yes

  No

  N/A

ETP

• Installed to standard

  Yes

  No

  N/A

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  Media

Internal Cable Install.

• Underfloor Install

• Roof space install

• Back to Back install

• Other

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  Media

• Has there been any variation to scope?

  Yes

  No

  N/A

ITP

• Installed to standard

  Yes

  No

  N/A

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  Media

ONT & RGW

• ONT installed, provisioned & connected correctly

  Yes

  No

  N/A

• RGW installed to RSP standard

  Yes

  No

  N/A

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  Media

Heath and safety

Systems and Facilities

Documents

• 1.1. Onsite H&S rep named in Tailgate?

  Yes

  No

  N/A

• 1.2. SSSP in vehicle?

  Yes

  No

  N/A

• 1.3. Notifiable works? (As per regs) Specifically Asbestos and Overhead Power

  Yes

  No

  N/A

• 1.4. Are approvals in job pack?

  Yes

  No

  N/A

• 1.5. Is there a hazard register?

  Yes

  No

  N/A

• 1.6. Has it been completed for the site updated?

  Yes

  No

  N/A

• 1.7. Accident/Incident register supplied?

  Yes

  No

  N/A

• 1.8. Is the accident register being maintained? Up to date?

  Yes

  No

  N/A

• 1.9. Are accidents/incidents being investigated?

  Yes

  No

  N/A

• 1.10. Is there an up to date competency register?

  Yes

  No

  N/A

2. Hazard Management

• 2.1. T/A for Task?

  Yes

  No

  N/A

• 2.2. Hazardous Substances?

  Safe

  At Risk

  N/A

• 2.3. MSDS Register and MSDS available?

  Yes

  No

  N/A

• 2.4. Is there evidence of toolbox completed daily and at startup?

  Yes

  No

  N/A

• 2.5. Is there evidence of weekly safety inspections or on jobs 3 days or over?

  Yes

  No

  N/A

• 2.7. Is a work permit system used? i.e. Hot works.?

  Yes

  No

  N/A

• 2.8. Are all electrical items current test tagged?

  Yes

  No

  N/A

• 2.9. Are all fall hazards managed effectively/as required?

  Yes

  No

  N/A

• 2.10. Is there a site specific emergency plan?

  Yes

  No

  N/A

• Yes

  No

  N/A

• 2.11. Additional hazards observed?

  Safe

  At Risk

  N/A

• 2.12. Additional hazards observed?

  Safe

  At Risk

  N/A

3. Training

• 3.1. First aider current certificate?

  Yes

  No

  N/A

• 3.2. Inductions held?

  Yes

  No

  N/A

• 3.3. Induction register up to date?

  Yes

  No

  N/A

• 3.4. Are there arrangements to induct visitors?

  Yes

  No

  N/A

• 3.5. Is the induction procedure site specific?

  Yes

  No

  N/A

4. Personal Protective Equipment PPE

• 4.1. Has mandatory PPE been specified?

  Yes

  No

  N/A

• 4.2. Is other PPE worn when required?

  Yes

  No

  N/A

• 4.3. Is other PPE in good condition?

  Yes

  No

  N/A

• 4.4. Other - is first aid kit and extinguisher available and up to date?

  Yes

  No

  N/A

5. Hazardous Manual Tasks

• 5.1. Lack of identification hazardous tasks, electrical high voltage chemicals

  Safe

  At Risk

  N/A

• 5.2. T/A's being followed. Check at least one task

  Safe

  At Risk

  N/A

• 5.3. Manual handling as per requirements?

  Safe

  At Risk

  N/A

6. Traffic Management

• 6.1. Is there TMP on site?

  Yes

  No

  N/A

• 6.2. Has the TMP been approved by the local authority?

  Yes

  No

  N/A

• 6.3. Has the TMP set up been followed as per documentation?

  Yes

  No

  N/A

• 6.4. Is the TMP supervised by a qualified STMS

  Yes

  No

  N/A

• 6.5. Is there a traffic controller on site?

  Yes

  No

  N/A

• 6.6. If no TMP required is the temporary construction zone plan been set up properly?

  Yes

  No

  N/A

7. Electrical Hazards

• 7.1. Unsafe Electrical leads? (Damaged, out of test date or untested.)

  Safe

  At Risk

  N/A

• 7.2. Lack of RCD protection?

  Safe

  At Risk

  N/A

• 7.3. Contact with underground assets?

  Safe

  At Risk

  N/A

• 7.4. Contact with overhead electrical lines?

  Safe

  At Risk

  N/A

• 7.5. Overloading outlets?

  Safe

  At Risk

  N/A

• 7.6. Electrical equipment near water?

  Safe

  At Risk

  N/A

• 7.7. Electrical equipment near flammables.?

  Safe

  At Risk

  N/A

• 7.8. Electrical equipment near chemicals that could cause damage?

  Safe

  At Risk

  N/A

• 7.9. Electrical leads that may be damaged from contact with moving machinery parts or metal structures?

  Safe

  At Risk

  N/A

• 7.10. Lack of lock-out/tag-out (LOTO) procedures for electrical equipment?

  Safe

  At Risk

  N/A

8. Additional Hazards

• 8.1. Items in vehicles adequately secured when not in use?

  Safe

  At Risk

  N/A

• 8.2. No loose clothing items or jewellery?

  Safe

  At Risk

  N/A

• 8.3. Small tools being used safely and approved?

  Safe

  At Risk

  N/A

• 8.4. Wheel chock in use as required?

  Safe

  At Risk

  N/A

• 8.5. Phone use and media players/radios within policy

  Safe

  At Risk

  N/A

9. Environmental Hazards

• 9.1. Lack of/or inadequate environment management plan (EMP)?

  Safe

  At Risk

  N/A

• 9.2. Lack of/or inadequate, dust suppression system.

  Safe

  At Risk

  N/A

• 9.3. All services identified?

  Safe

  At Risk

  N/A

• 9.4. Lack of/or inadequate systems to prevent constraints entering storm water drains?

  Safe

  At Risk

  N/A

• 9.5. Spill kit available?

  Safe

  At Risk

  N/A

Corrective Actions

• Enter any corrective action that will be undertaken

Sign off

• Onsite representative signature

  Sign

• Auditors signature

  Sign

Summary

• Install completed to standard?

  Yes

  No

  N/A

• Work completed as per scope?

  Yes

  No

  N/A

• Any damage to property?

  Yes

  No

  N/A

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  Media

• CCR completed & signed?

  Yes

  No

  N/A

• QA passed

  Yes

  No

  N/A

• If Failed is there work to be rectified?

  Yes

  No

  N/A