Site Diary and Risk Assessment Form

• Site Address
  Address

• Operatives Names

• Permit Number

• Weather Conditions

  Good

  Fair

  Poor

  N/A

• Date

  Date

Items

• Does the work location carry any additional risks, near a school, hospital, crossing?

  Yes

  No

  N/A

• Is the work area free of slips and trip hazards?

  Yes

  No

  N/A

• Has a pre-used check been carried out on all plant that is being used?

  Yes

  No

  N/A

• Is the area free from any risks to the general public?

  Yes

  No

  N/A

• Is ALL signing, lighting and guarding to the SSWRW Code Of Practice (Red Book)?

  Yes

  No

  N/A

• Is there at least 1 person on site with a NRSWA accreditation to do the work?

  Yes

  No

  N/A

• Is ALL relevant PPE in good condition?

  Yes

  No

  N/A

• Is the material storage safe and site security adequate?

  Yes

  No

  N/A

• Do the Operatives have the appropriate accreditation for the work to be undertaken?

  Yes

  No

  N/A

• Is a suitable safety zone in place to undertake lifting operations?

  Yes

  No

  N/A

• Is ALL the necessary safety equipment on site and operatives are trained to use the equipment?

  Yes

  No

  N/A

• Are Health and Safety Risks, Manual Handling, HAVS, Noise and Dust etc ALL covered?

  Yes

  No

  N/A

• Are COSHH assessments available for products on site?

  Yes

  No

  N/A

• Are general Risk Assessments available for reference?

  Yes

  No

  N/A

• Have the following environmental risks been managed? Tree Roots, segregation of materials, water courses etc.

  Yes

  No

  N/A

• Is a craft manual available on site?

  Yes

  No

  N/A

• Completed by:

  Sign

Pre-Start Checks

• Utility prints that cover the entire work area?

  Yes

  No

  N/A

• Calibrated and in date CAT & Genny available and in good working order?

  Yes

  No

  N/A

• Operative trained in the use of the CAT & Genny?

  Yes

  No

  N/A

• Utilities identified and marked with suitable chalk?

  Yes

  No

  N/A

• Insulated tooling and flame retardant clothing/ PPE being used/ worn onsite?

  Yes

  No

  N/A

• Has the site been left tidy and free from hazards?

  Yes

  No

  N/A

• Has the SLG been set up and left in place where required?

  Yes

  No

  N/A

• Is a 4 head GDU available onsite?

  Yes

  No

  N/A

• Has a gas test been completed?

  Yes

  No

  N/A

• Was the gas test positive?

  Yes

  No

  N/A

Completion checks

• Has the backfill been placed in line with the HAUC specification for reinstatement?

  Yes

  No

  N/A

• Has the surface material been laid under the right conditions?

  Yes

  No

  N/A

• Has the surface material been laid at the correct depth?

  Yes

  No

  N/A

• Has any remedial work been identified?

  Yes

  No

  N/A

Signatures:

• Name & Signature:

  Sign

• Name & Signature:

  Sign

• Name & Signature:

  Sign

• Name & Signature:

  Sign

Visitor to site:

• Name & Signature:

  Sign