Title Page

  • Cluster ID/ Project

  • Location
  • Inspection Date

  • Inspected By

  • Workers/Subcontractors Inspected?

  • Is a Permit in Place?

  • What is the permit reference?

Documentation

  • Is the site-specific risk assessment complete and sufficient?

  • Photo of site-specific risk assessment

  • Are all operatives appropriately trained?

  • Photo of Streetworks, NOPS and other training records

  • Is the Job information sufficient?

  • Are the utility stats sufficient and in-date?

  • Have the customers been informed of the work?

PPE

  • Is appropriate PPE being worn?

  • Photo evidence of PPE being worn on site

  • Is appropriate RPE being worn?

  • Photo evidence of RPE being worn on site

  • Is PPE/RPE in good condition?

  • Is PPE/RPE storage suitable?

Traffic Management

  • Do the works impact the carriageway/ footway?

  • What Traffic Management setup is present?

  • Is the TM setup suitable?

  • Photos of TM setup

  • Is a pedestrian management system in place?

  • Photos of pedestrian management setup

Vehicles, Trailers, Plant and Equipment

  • Are all vehicles and trailers roadworthy?

  • Photo evidence of non-roadworthy vehicle

  • Are all items fit for purpose and within inspection/calibration dates?

  • Photo evidence of in date calibrations and inspections. e.g (GDU, CAT & Genny)

  • Additional Photos

Emergency Equipment

  • In-date dry powder fire extinguisher present and suitable?

  • Spill kit(s) available and suitable?

  • First aid kit available and suitable?

  • Eye wash kit available and suitable?

Waste Management and Environmental Protection

  • Are the Waste Management procedures acceptable?

  • Are Pumping-out practices acceptable?

  • Are drains adequately protected?

  • Tree/ Hedge risks adequately managed?

  • Wildlife risk adequately managed?

  • Local facility risks adequately managed?

  • Additional Photos

Welfare

  • Appropriate welfare facilities / provisions in place?

  • Welfare facilities in good condition?

  • Additional Photos

Quality

  • Surface Type

  • Type of Work being completed

  • Is apparatus being laid to the correct depth?

  • Is the apparatus protected during the installation?

  • Warning tape laid at correct distance above the apparatus?

  • Reinstatement carried out in accordance with SROH?

  • Verges, ditches and drainage courses reinstated to their original profile?

  • As laid profile flush with the surrounding surfaces? Tolerance of +/- 6mm

  • Edge depression acceptable? (Does not exceed 10mm over a continuous 100mm length in any direction?

  • Surface crowning within intervention limits?

  • Proximities adhered to and incorporated into the reinstatement?

  • Issues Log

  • Additional Photos

  • Is apparatus being installed correctly?

  • What scope of works are the operatives undertaking?

  • Is SLG in use? Is it sufficient for the scope of works?

  • Has pre climb checks been completed and the pole labelled?

  • Has the PIANOI ID label been installed on the pole?

  • Has the ladder been set-up correctly with ladder pads and URAT?

  • Has the ladder been inspected and tagged with up to date inspection tags?

  • Have all harnesses been inspected before use and tagged with up to date inspection tags?

  • Issues Log

  • Additional Photos

  • Is SLG in use? Is it sufficient for the scope of works?

  • Is a GDU in use if working in a UG environment?

  • Is the GDU calibration in date?

  • Are the correct lifting keys in use?

  • Has all apparatus been installed and labelled correctly?

  • Do the operatives have the correct PPE/ RPE for the scope of works?

  • Issues Log

  • Additional Photos

  • What scope of works are the operatives undertaking?

  • Is SLG in use? Is it sufficient for the scope of works?

  • Has pre climb checks been completed and the pole labelled?

  • Has the PIANOI ID label been installed on the pole?

  • Has the ladder been set-up correctly with ladder pads and URAT?

  • Has the ladder been inspected and tagged with up to date inspection tags?

  • Have all harnesses been inspected before use and tagged with up to date inspection tags?

  • If using a MEWP is the LOLER information on the vehicle?

  • Is the MEWP in good working order with no defects?

  • Issues Log

  • Additional Photos

  • Is SLG in use? Is it sufficient for the scope of works?

  • Is a GDU in use if working in a UG environment?

  • Is the GDU calibration in date?

  • Are the correct lifting keys in use?

  • Has all apparatus been installed and labelled correctly?

  • Do the operatives have the correct PPE/ RPE for the scope of works?

  • Issues Log

  • Additional Photos

  • Have all harnesses been inspected before use and tagged with up to date inspection tags?

  • Is PPE sufficient for the task in hand?

  • Is Specialist PPE in use? i.e. chainsaw trousers, face visors, gloves

  • Are all plant and machinery in good working order?

  • If using a MEWP is the LOLER information on the vehicle?

  • Is the MEWP in good working order with no defects?

  • Issues Log

  • Additional Photos

  • Is PPE sufficient for the task at hand?

  • Are the operatives using SLG where applicable?

  • Do the operatives have a calibrated, functional and charged GDU?

  • Do the operatives have access to hand wipes for cleaning?

Summary

  • Summarise the key findings of the visit including good points, areas for improvements etc...

  • Were all issues rectified during the visit?

  • Overall how would you classify the outcome of this audit?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.