Safety, Quality & Environmental Inspection Form CDM Site Set Up

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Facilities

• 1.1 Are site welfare facilities on site

  Yes

  No

  N/A

• 1.2 Are they adequate for the number of operatives

  Yes

  No

  N/A

• 1.3 Are they clean

  Yes

  No

  N/A

• 1.4 Is the Law poster present and filled in

  Yes

  No

  N/A

• 1.5 Is the F10 displayed with relevant parties indicated

  Yes

  No

  N/A

• 1.6 Is there an Emergency plan displayed

  Yes

  No

  N/A

• 1.7 Are there site rules displayed

  Yes

  No

  N/A

• 1.8 Is a fire extinguisher present and in date

  Yes

  No

  N/A

• 1.9 Is a first aid box present including eye wash

  Yes

  No

  N/A

• 1.10 Is an accident book present

  Yes

  No

  N/A

2. Documentation Present in file

• 2.1 Pre-construction Phase Plan

  Yes

  No

  N/A

• 2.2 Construction Phase Plan

  Yes

  No

  N/A

• 2.3 Client RAMS (if applicable)

  Yes

  No

  N/A

• 2.4 Excalon RAMS

  Yes

  No

  N/A

• 2.5 Construction Drawings

  Yes

  No

  N/A

• 2.6 Traffic Management<br> Drawings

  Yes

  No

  N/A

• 2.7 Accreditations

  Yes

  No

  N/A

• 2.8 Correspondence for project

  Yes

  No

  N/A

3. Utility Drawings

• 3.1 Electric

  Yes

  No

  N/A

• 3.2 Gas

  Yes

  No

  N/A

• 3.3 Water

  Yes

  No

  N/A

• 3.4 BT

  Yes

  No

  N/A

• 3.5 Waste Water

  Yes

  No

  N/A

• 3.6 Confirmation of Site Induction

  Yes

  No

  N/A

4. Site Management

• 4.1 Planning/Organisation of project

  Yes

  No

  N/A

• 4.2 Storage of materials

  Yes

  No

  N/A

• 4.3 Parking of company vehicles

  Yes

  No

  N/A

• 4.4 Utilities Mark up present

  Yes

  No

  N/A

• 4.5 Personal Protective Equipment enforced and used

  Yes

  No

  N/A

• 4.6 Footwear

  Yes

  No

  N/A

• 4.7 Visibility Jackets

  Yes

  No

  N/A

• 4.8 Gloves

  Yes

  No

  N/A

• 4.9 Hard hat

  Yes

  No

  N/A

• 4.10 Dust Masks

  Yes

  No

  N/A

• 4.11 Goggles

  Yes

  No

  N/A

• 4.12 Management of Signing & Guarding

  Yes

  No

  N/A

• 4.13 Information Boards

  Yes

  No

  N/A

• 4.14 Spill kits & Disposable bins

  Yes

  No

  N/A

• 4.15 De-watering/correct procedure carried out

  Yes

  No

  N/A

5. Documentation for known Hazards

• 5.1 NG Gas notification of works adjacent to system

  Yes

  No

  N/A

• 5.2 Line Search

  Yes

  No

  N/A

• 5.3 Overhead Line RAMS

  Yes

  No

  N/A

• 5.4 Permit to Dig (if required)

  Yes

  No

  N/A

• 5.5 Permit for Hot Works (if required)

  Yes

  No

  N/A

6. Overall

• 6.1 Does team manager portray correct attitude and understanding towards safety, quality & environmental aspects for the project

  Yes

  No

  N/A

• Inspected by

  Sign

• Project Manager

  Sign

• Select date

  Date

• Summary Log

• Audit Reference