Title Page
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Cluster ID/ Project
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Location
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Inspection Date
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Inspected By
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Workers/Subcontractors Inspected?
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Is a Permit in Place?
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What is the permit reference?
Documentation
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Is the site-specific risk assessment complete and sufficient?
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Photo of site-specific risk assessment
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Are all operatives appropriately trained?
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Photo of Streetworks, NOPS and other training records
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Is the Job information sufficient?
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Are the utility stats sufficient and in-date?
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Have the customers been informed of the work?
PPE
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Is appropriate PPE being worn?
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Photo evidence of PPE being worn on site
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Is appropriate RPE being worn?
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Photo evidence of RPE being worn on site
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Is PPE/RPE in good condition?
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Is PPE/RPE storage suitable?
Traffic Management
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Do the works impact the carriageway/ footway?
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What Traffic Management setup is present?
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Is the TM setup suitable?
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Photos of TM setup
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Is a pedestrian management system in place?
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Photos of pedestrian management setup
Vehicles, Trailers, Plant and Equipment
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Are all vehicles and trailers roadworthy?
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Photo evidence of non-roadworthy vehicle
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Are all items fit for purpose and within inspection/calibration dates?
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Photo evidence of in date calibrations and inspections. e.g (GDU, CAT & Genny)
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Additional Photos
Emergency Equipment
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In-date dry powder fire extinguisher present and suitable?
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Spill kit(s) available and suitable?
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First aid kit available and suitable?
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Eye wash kit available and suitable?
Waste Management and Environmental Protection
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Are the Waste Management procedures acceptable?
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Are Pumping-out practices acceptable?
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Are drains adequately protected?
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Tree/ Hedge risks adequately managed?
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Wildlife risk adequately managed?
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Local facility risks adequately managed?
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Additional Photos
Welfare
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Appropriate welfare facilities / provisions in place?
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Welfare facilities in good condition?
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Additional Photos
Quality
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Surface Type
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Type of Work being completed
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Is apparatus being laid to the correct depth?
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Is the apparatus protected during the installation?
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Warning tape laid at correct distance above the apparatus?
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Reinstatement carried out in accordance with SROH?
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Verges, ditches and drainage courses reinstated to their original profile?
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As laid profile flush with the surrounding surfaces? Tolerance of +/- 6mm
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Edge depression acceptable? (Does not exceed 10mm over a continuous 100mm length in any direction?
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Surface crowning within intervention limits?
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Proximities adhered to and incorporated into the reinstatement?
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Issues Log
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Additional Photos
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Is apparatus being installed correctly?
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What scope of works are the operatives undertaking?
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Is SLG in use? Is it sufficient for the scope of works?
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Has pre climb checks been completed and the pole labelled?
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Has the PIANOI ID label been installed on the pole?
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Has the ladder been set-up correctly with ladder pads and URAT?
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Has the ladder been inspected and tagged with up to date inspection tags?
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Have all harnesses been inspected before use and tagged with up to date inspection tags?
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Issues Log
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Additional Photos
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Is SLG in use? Is it sufficient for the scope of works?
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Is a GDU in use if working in a UG environment?
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Is the GDU calibration in date?
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Are the correct lifting keys in use?
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Has all apparatus been installed and labelled correctly?
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Do the operatives have the correct PPE/ RPE for the scope of works?
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Issues Log
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Additional Photos
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What scope of works are the operatives undertaking?
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Is SLG in use? Is it sufficient for the scope of works?
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Has pre climb checks been completed and the pole labelled?
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Has the PIANOI ID label been installed on the pole?
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Has the ladder been set-up correctly with ladder pads and URAT?
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Has the ladder been inspected and tagged with up to date inspection tags?
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Have all harnesses been inspected before use and tagged with up to date inspection tags?
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If using a MEWP is the LOLER information on the vehicle?
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Is the MEWP in good working order with no defects?
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Issues Log
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Additional Photos
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Is SLG in use? Is it sufficient for the scope of works?
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Is a GDU in use if working in a UG environment?
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Is the GDU calibration in date?
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Are the correct lifting keys in use?
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Has all apparatus been installed and labelled correctly?
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Do the operatives have the correct PPE/ RPE for the scope of works?
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Issues Log
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Additional Photos
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Have all harnesses been inspected before use and tagged with up to date inspection tags?
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Is PPE sufficient for the task in hand?
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Is Specialist PPE in use? i.e. chainsaw trousers, face visors, gloves
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Are all plant and machinery in good working order?
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If using a MEWP is the LOLER information on the vehicle?
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Is the MEWP in good working order with no defects?
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Issues Log
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Additional Photos
Summary
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Summarise the key findings of the visit including good points, areas for improvements etc...
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Were all issues rectified during the visit?
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Overall how would you classify the outcome of this audit?