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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Name of Operatives on Site
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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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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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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Plant on site
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Water suppression available and being used?
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Any PPE issued?
Traffic Management
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Are drawings available on site?
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Signage in place (suitable and sufficient as per TM plan)?
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Barriers in place (suitable and sufficient as per TM plan, clipped together, sand bags, correct support)?
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Diversions in place (suitable and sufficient as per TM plan, pedestrian diversions, temp areas)?
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Cones in place (suitable and sufficient as per TM plan, correct spacing)
Quality of Work
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Overall quality of work.
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Completed works at the time of visit.
Signed Off
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Name and signature of Supervisor/Operative on site
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Name and signature of Inspector