Safety Critical Inspection Form 603(02)K

• Operative Name:

• Contract number:

• Location:

• Select date

  Date

CERTIFICATIONS

• Code.A/I. Basic track awareness

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.D. Protection M (EH)

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.C. Protection M (TH)

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.K. Protection M (Depots)

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.O. PWT-EH

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.W. PWT-TH

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.X. PWT-TM

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.Y. PWT-D

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.R/S. PWT Demarcation & securing points.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.Q. PWT-PW/SPC Possessions.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.F/L POM (Rail F/Depots L)

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.G. POM (Train Movements)

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.V. Train Master TM-TBTC

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.E. Train Master

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.B/J. LU IWA-Track Depot Competent.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.M. SPC (SoTT).

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.N. Track trolley operator.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.Z. Track trolley controller.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.U. CRID training.

  Yes

  No

  N/A

• Cert number and expiry date.

• Code.FW. Fire Watchman

  Yes

  No

  N/A

• Cert number and expiry date.

• Safety critical ID card

  Yes

  No

  N/A

• Cert number and expiry date.

• LU Access card.

  Yes

  No

  N/A

• Cert number and expiry date.

• LU Medical.

  Yes

  No

  N/A

• Cert number and expiry date.

• DAMSP.

  Yes

  No

  N/A

• Cert number and expiry date.

• Self testing CRID.

  Yes

  No

  N/A

• Cert number and expiry date.

• Manual Handling.

  Yes

  No

  N/A

• Cert number and expiry date.

• Asbestos Aware.

  Yes

  No

  N/A

• Cert number and expiry date.

• First Aider.

  Yes

  No

  N/A

• Cert number and expiry date.

PUBLICATIONS

• Traffic Circular

  Yes

  No

• Issue number:

• NEPA Publications.

  Yes

  No

• NEPA Maps.

  Yes

  No

• Current on/off times.

  Yes

  No

• Current section diagrams.

  Yes

  No

• Engineering Notice.

  Yes

  No

• Logbook

  Yes

  No

• Issue number:

• Possession plan.

  Yes

  No

• Issue number:

Mandatory PPE

• Hi-Vi (CCS Logo)

  Yes

  No

• Other logo (if applicable).

• Safety boots

  Yes

  No

• Timepiece (Correct time)

  Yes

  No

• Type (watch, phone etc).

• Armband type

  Yes

  No

• PM, PWT etc.

• Torch and batteries.

  Yes

  No

Additional PPE.

• Hard hat

  Yes

  No

  N/A

• Eye protection.

  Yes

  No

  N/A

• Ear defenders

  Yes

  No

  N/A

• RPE (Mask)

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Overalls

  Yes

  No

  N/A

• Detonators

  Yes

  No

  N/A

• Horn/whistle/flags

  Yes

  No

  N/A

Works and job details

• Please enter the AREA, FAMILIARITY and the TASK

• Comments / non conformances Priority clearance 1- immediate 2- 24 hours 3- 36 hours 4- specified time scale

• Action by and action date (if applicable).

• Auditee name:

  Sign

• Auditor name:

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