Title Page
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Site / Project Name
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Site / Project Address
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Principal Contractor
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Person in Charge of Site / Project
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Conducted On
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Completed By
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Company Contact on Site
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Brief Description of the Works
Health & Safety Inspection
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Health and Safety Documentation (Policy, Insurances, HSL Poster, F10)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Safe System of Work Documentation (RAMS, COSHH)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Health and Safety Communication (Briefings, Inductions, Toolbox Talks, Notices, Signage)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Statutory Inspection Report and Documentation (Through Examination, Scaffold Inspection etc)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Temporary Works (Co-Ordinator, Arrangements, Register)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Welfare Arrangements (Condition, Cleanliness, Availability)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Emergency Arrangements (First Aid Provisions, Fire Precautions)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Operatives PPE / RPE
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Occupational Health (Noise, Dust, Manual Handling, HAV's)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Asbestos
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Housekeeping, Material Storage and Waste Management
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Site Set Up Arrangements (Traffic Management Plan, Segregation, Access, Site Security, Fencing)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Lifting Operations (Plan, Equipment, Accessories, Training)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Works at Height
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Plant and Equipment (Selection, Guarding, Conditions, Use)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Portable Tools and Equipment (Selection, Guarding, Conditions, Use)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Electrical Equipment, Tools, PAT Records
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Accidents / Incidents / Near Misses (Reporting Procedure, Recent Occurrences)
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
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Other
- Meeting Industry Standard
- Advice
- Hygiene Concern
- Non-Conformance
- Potential for injury
- Serious Breach
- Not Seen at the Time of Visit
- Not Applicable
- Principal Contractor
Completion
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Completed by (Name and Signature)
