Title Page
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Site Name
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Date
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Client Name
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Permit Number
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Name of Supervisor on Site
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Does the supervisor have copies of cards on site?
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Supervisors cards / certificates / qualifications: attach photograph
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Name of Operatives on Site
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Does the operatives have copies of cards on site?
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Operatives cards / certificates / qualifications: attach photograph
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Photograph of site upon arrival:
Safety Checks
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Are all supervisors on site wearing correct PPE? (Hi-vizibility clothing, Blue and yellow trousers, corporate workwear, safety boots (no rigger boots), glasses ect.
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Attached photograph:
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Are all operatives wearing correct PPE? (Hi-vizibility clothing, safety boots (no rigger boots), corporate workwear, hardhat, gloves, glasses, RPE, ect)
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Attach photograph:
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Is there a First Aid Kit available on site?
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Is there a spill Kit available on site?
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Is there a Fire Extinguisher available on site?
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Is there a trained First Aider on site?
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First Aider name
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Reference numbers of all plant on site
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Is water suppression available and being used?
Traffic Management
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Pedestrian Management: Photograph
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Are drawings available on site?
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Signage in place (suitable and sufficient)?
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Attach photograph:
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Barriers in place (suitable and sufficient, clipped together, sand bags, correct support)?
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Attach photograph:
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Diversions in place (suitable and sufficient, pedestrian diversions, temp areas)?
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Attach photograph:
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Cones in place (suitable and sufficient, correct spacing)
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Attach photograph:
Quality of Work
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What works were being carried out at the time of the visit:
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Overall quality of work.
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Attach photograph:
Signed Off
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Name and signature of Supervisor/Operative on site
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Name and signature of Inspector
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Photograph of site upon departure:
