Safety Health & Environmental Operational Inspection Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Safe systems of work

• 1.1 Work Instruction

  Yes

  No

  N/A

• 1.2 Utility Drawings

  Yes

  No

  N/A

• 1.3 Risk Assessment & Method Statement

  Yes

  No

  N/A

• 1.4 Daily site specific R.A

  Yes

  No

  N/A

• 1.5 Permits & Authorisations

  Yes

  No

  N/A

• 1.6 Safety Team Pack

  Yes

  No

  N/A

• 1.7 Banksman

  Yes

  No

  N/A

• 1.8 Lone working

  Yes

  No

  N/A

• 1.9 HSG47 (mark up/trial holes)

  Yes

  No

  N/A

• 1.10 GS6

  Yes

  No

  N/A

• 1.11 Other

  Yes

  No

  N/A

2. Tools and Equipment

• 2.1 Plant

  Yes

  No

  N/A

• 2.2 Inspection/Defect book

  Yes

  No

  N/A

• 2.3 CAT & Genny

  Yes

  No

  N/A

• 2.4 Cutting & breaking

  Yes

  No

  N/A

• 2.5 Lifting & Excavating

  Yes

  No

  N/A

• 2.6 Hand tools

  Yes

  No

  N/A

• 2.7 Electrical equipment/tools

  Yes

  No

  N/A

• 2.8 Vehicle & Trailer (Livery/Logo)

  Yes

  No

  N/A

• 2.9 Fire extinguisher

  Yes

  No

  N/A

• 2.10 Ladders & Steps

  Yes

  No

  N/A

• 2.11 Excavator

  Yes

  No

  N/A

• 2.12 Other

  Yes

  No

  N/A

3. Personal Protective Equipment

• 3.1 Worn in accordance with R.A

  Yes

  No

  N/A

• 3.2 Condition/Company Image

  Yes

  No

  N/A

• 3.3 Storage

  Yes

  No

  N/A

• 3.4 Flame Retardant

  Yes

  No

  N/A

• ENW Logo

  Yes

  No

  N/A

4. Welfare

• 4.1 Water and eating facilities

  Yes

  No

  N/A

• 4.2 Toilets & cleaning facilities

  Yes

  No

  N/A

• 4.3 First aid kit

  Yes

  No

  N/A

• 4.4 Emergency arrangements

  Yes

  No

  N/A

• 4.5 Other

  Yes

  No

  N/A

• 4.6 Other

  Yes

  No

  N/A

5. Environmental considerations

• 5.1 Included in R.A

  Yes

  No

  N/A

• 5.2 Accidental release arrangements

  Yes

  No

  N/A

• 5.3 Waste management

  Yes

  No

  N/A

• 5.4 Constraints map

  Yes

  No

  N/A

• 5.5 Spill kits/ Drip trays

  Yes

  No

  N/A

6. COSHH

• 6.1 COSHH Assessments

  Yes

  No

  N/A

• 6.2 Labelled

  Yes

  No

  N/A

• 6.3 Storage & Use

  Yes

  No

  N/A

• 6.4 Other

  Yes

  No

  N/A

• 6.5 Other

  Yes

  No

  N/A

7. Site Specific considerations

• 7.1 NRSWA (Traffic Management)

  Yes

  No

  N/A

• 7.2 Excavation Operations (trench support?)

  Yes

  No

  N/A

• 7.3 Noise and Vibration

  Yes

  No

  N/A

• 7.4 Working near or under OHL

  Yes

  No

  N/A

• 7.5 Working at Height

  Yes

  No

  N/A

• 7,6 Scaffolding

  Yes

  No

  N/A

• 7.7 Confined Spaces

  Yes

  No

  N/A

• 7.8 Manual handling & Lifting operations

  Yes

  No

  N/A

• 7.9 General Housekeeping

  Yes

  No

  N/A

• 7.10 Dust Suppression

  Yes

  No

  N/A

• 7.11 Other

  Yes

  No

  N/A

CDM Requirements

• 8.1 Induction (all operatives & visitors)

  Yes

  No

  N/A

• 8.2 SSRA Completed and Quality

  Yes

  No

  N/A

• 8.3 RAMS Briefed out to al & signed

  Yes

  No

  N/A

• 8.4 Permit to Dig

  Yes

  No

  N/A

• 8.5 Barrier Checks

  Yes

  No

  N/A

• 8.6 Other

  Yes

  No

  N/A

• 8.7 Other

  Yes

  No

  N/A

9. Training & Competency

• 9.1 ID Card

  Yes

  No

  N/A

• 9.2 Authorisations

  Yes

  No

  N/A

• 9.3 Relevant Cards/Certificates

  Yes

  No

  N/A

• 9.4 First Aid Trained

  Yes

  No

  N/A

• Inspected by

  Sign

• Signature

  Sign

• Date

  Date

• Summary Log

• Audit Reference