Section A
Complete SECTIONS A&B of this report. If further action or another person is needed to fix the problem, complete the appropriate details in Section B. insert the category reference from section A (e.g. HEAD PROTECTION is 2A and REPETITIVE MOTIONS Is 3E), if making any comments about either Safe or Unsafe acts or Corrective Actions.

Job Number, Method Statement Number / Revision /

1. Check That All Personal Have

A) All relevant competencies .

B) All mandatory / Task specific / PPE requirements and fit for purpose .

C) Received a SPC Task briefing and PM briefing (where applicable ) before work commences .

2. Access / Egress, Loading / Unloading, Parking Arrangements, Storage and Housekeeping

A) Have the Access and Egress for plant and staff arrangements been clearly defined within the MST ?

B) Has suitable provision been made for parking vehicles ?

C) Have noise barriers been provided to minimise disruption to local residents / general public ( where applicable ) ?

D) Are there suitable exclusion zones to protect the general public from all TP operational works ( including deliveries ) ?

E) Are the walking routes to / from sites suitable and as planned ?

F) Are all materials being stored neatly and storage licences are in place and in date ?

G) Is there a good housekeeping in place and supervised ( including safe walking routes ) ?

3. Environmental : Observe Whether The Staff Are Considering The Environment

A) Vehicle / Plant engines turned off when not in use .

B) Noise levels being considered when working near residential homes .

C) Are there drips trays and spill kits available and used ( where applicable ) ?

4. Tools and Equipment : Check Where Tools Are Used, They Are

A) Correct type for the job, used correctly and in a safe condition .

B) Do the operatives have the right certification to use the tools ?

5. Welfare Arrangements

A) Is there adequate provision of food / drink for all staff, and are they using the designated welfare facilities ?

B) Is there adequate provision of toilet facilities available for staffs working on site ?

6. Work Briefing & Mandatory Documentation

A) Is there a Site File on site with an up to date MST, Risk Assessment, Working Instructions / Packages, Permits and Licences ?

B) Are the Site access control delivering ( briefings ) and site security ( checking PPE ) carrying out their relative duties ?

C) Is the procedure for reporting Accidents / Incidents via the use of IRF forms readily available ? Are there Close Call Cards available on site ?

7. Plant & Machinery

A) Are the planned lifts as per the Lifting Plan, with the compatible type of plant being used ?

B) Does the Plant have all of the required documentation ( i.e. Engineering Acceptance Certificate, Examination Certificate, Permits To Lift - covering the activities that are being carried out ) ?

C) Has certified staffs implemented Exclusion Zones to segregate people from plant operations ( including "Spotters" where applicable ) ?

D) Are all components of the Plant / Machinery correctly assembled and compatible as per manufacturers manuals ?

8. Site Specific Considerations ( Including First Aid and Fire Points )

A) Is there availability of First Aid equipment and in good condition ? Have First Aiders been appointed to cover the worksite ?

B) Is there availability of Fire Points ( In good condition and in date ) ? Are certified Fire Watch persons available ?

C) Are control measures being implemented for the following tasks - Noise / Dust / Working at Height / HAVS ?

D) Is the site lighting adequate ?

E) Have all site specific hazards been identified in the MST/ Risk Assessment ?

F) Have all key assets have been identified and adequately protected ?

G) Are there any interfaces with other work sites and adequate exclusion zones in place ?

9. Protection and Emergency Arrangements

A) Have the Possession / Isolation limits detailed within the MST and been briefed / understood ?

B) Are the Emergency Arrangements clearly described within MST ?

C) Are the Evacuation Route and the Staff Assembly Point free from obstructions with clearly defined walking routes ?

Safe acts observed


SECTION B: Unsafe acts observed


Actions resulting from the SSOW Audit.

Action required.

Final sign off when outstanding actions have been complete or no actions required.
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.