Title Page

  • Site Location/ ELR and Mileage

  • Weather conditions

  • Conducted on

  • Prepared by

  • On behalf of :

  • Site Hours

  • Any lost time/hours

  • Possession Start time or Shift time

  • Possession End Time or Shift time

Planned Works V Actual

  • Planned

  • Actual Work

  • If Shortfall, reason why

  • Reason for delay to task

Resources

  • Members of staff on site

  • What Welfare is being used

Plant & Equipment

  • RRV's /Plant / Attachments and Van's

  • Small Plant

  • Breakdowns

  • Lost time on plant down

  • Equipment suitable for the works

  • Lighting sufficient for the task

Photos

  • Photos

Any Issues

  • Technical Queries

Inspections

  • Is lighting Sufficient for the task

  • House Keeping

  • Welfare

  • First Aid kits on site

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Defects

  • Defects found

Close Calls / Good Working Practices

  • Close call / Good Working Practices

  • Comments

Signatures

  • AIW Representative

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.