Title Page
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Assessment Date
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Job Number
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Engineer Number
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Franchise Number
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Assessor Name
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Assessor Pay Number
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Un/Announced Assessment
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Assessment Reason
- Normal
- High Risk Assessment
- Support & Monitoring
- Compliant
- ERA
- Interim Assessment
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Assessment Type
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Network
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Location
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Brief Description Assessment Task
Site Standards
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1. Appropriate competencies / ID card available and in date (eg. SHEA/CSCS/ECS)
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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2. Risk Assessment carried out prior to starting task
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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3. Appropriate PPE in use on task
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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4. Plans/Drawings/info requested
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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5. Third Party services located/marked, prior to starting task
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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6. Safe System of Work incl Trench support installed where appropriate for excavations
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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7. Safe Working - Engineer risk
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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8. Safe Working - Customer/third party risk
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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9. Use of barriers/warning signs
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide detail/evidence
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10. Appropriate machine selected and used.
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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11. Precautions taken to prevent manual handling injuries
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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12. "Volt stick" check on appliance / equipment carried out. (incl adjacent equipment/surfaces)
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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13. 230v/110v electrical equipment condition and evidence of test/inspection
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide detail/evidence
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14. 230v/110v electrical equipment in use in an unsafe condition &/or without test evidence
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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15. Equipment calibrated and in date, e.g. multi meter, gas detector, Cable avoidance tool etc
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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16. Safe Isolation Kit complete and available (lock off kit)
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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17. Safe Isolation carried out
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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18. Uses personal RCD
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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19. Asbestos safety precautions taken.
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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20. Safe System of work for Working at Height - Use of Steps incl Loft Access
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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21. Safe System of work for Working at Height - Ladders and Access Systems
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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22. All access equipment has been asset tagged or is easily identifiable. Evidence of inspections
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23. Fall restraint/arrest and harness equipment available, stored safely and fit for purpose.
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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24. Safe system of work for confined space entry
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25. Safe use and maintenance of high pressure water jetting equipment
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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26. Safe system of work for lining and/or CCTV
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27. All waste handled correctly/removed from site - incl Hazardous materials
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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28. Reinstatement carried out correctly
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CREATE AND ASSIGN ACTION
- ACTION CREATED
- ACTION NOT NECESSARY - SEE NOTES
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Provide details/evidence
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29. Paperwork completed correctly and left with customer.
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30 Incident reporting - covered under UPK if nothing to report
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31. Vehicle safety, Safe Storage, and general condition
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32.Suitable PPE available and fit for purpose if PPE required and not in use see element 3
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33. Appropriate HS&E documentation available
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34. Spillage kit available
Overall attitude towards safe working
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Please follow the advice given in the guidance notes to gauge the operatives overall attitude to safe working. Record which score is appropriate by entering the number (between 1-5) in the overall attitude towards safe<br>working box.
Review
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Job Address
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Operative
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Line Managers Name
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Vehicle Registration
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Job Number
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Assessor
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Comments ( What went well with the assessment)
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Details of Elemental Failure(s) (Refer to question number)
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Details of Coaching Given to Engineer (refer to question number)
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Agreed improvement action with Engineer &/or Franchisee (by who and when)
Details of equipment (not available or unsatisfactory condition or PAT test outstanding)
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Type of instrument
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Available Y/N
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Make & Model
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Serial No
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PAT Due Date
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Faulty
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Comments on Assessment (Managers Attention)
