Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Operatives on Site

  • Please select all operatives present on site.

Inspection report (documentation)

  • If applicable have all operatives been inducted to site with evidence available?

  • If applicable are live permits to work in place?

  • Please select which permits the works falls under

  • Have all operatives signed up to the most recent version of RAMS with evidence available?

  • Do all operatives have the relevant cards & qualifications for the works which they are undertaking?

  • Is there a current copy of the Streetworks safety book ACOP available?

PPE

  • Are all operative wearing the required mandatory and task specific PPE

  • Is the PPE worn in good condition?

  • Is any RPE required for the works being undertaken?

  • If half face masks are worn have they been face fit tested to ensure suitability?

Inspection report (on-site)

  • Has the work area been suitably cordoned off?

  • Is suitable and sufficient signage in place?

  • If required have suitable and sufficient traffic management controls been erected?

  • Are the correct tools being used and do they appear to be in good repair?

  • Is there suitable and sufficient lighting in work area, access egress & escape routes?

  • Is the work area and access egress & escape routes free of slip & trip hazards?

  • Is there suitable and sufficient fire extinguishing media within the close vicinity?

  • If applicable, are sharp bins available and ready for use?

  • Have waste materials been stored / disposed of appropriately?

  • Have any unprotected holes / drops been covered or suitably cordoned off?

  • Is there a competent first-aider on site?

  • Do the on-site operatives have access to suitable and sufficient welfare facilities?

Works at height (ladders, stepladders & hop-ups)

  • Are ladders, stepladders or hop-ups being used to complete this works?

  • Have all ladders, stepladders & hop-ups present been inspected prior to use and do they have a current record of inspection displayed dated within the last 7 days?

  • Has the user completed work at height training?

  • Take a visual inspection, is the equipment being used free of damage?

  • Take a visual inspection, is the equipment being used free of damage?

  • Has the user completed work at height training?

  • Take a visual inspection, is the equipment being used free of damage?

  • Take a visual inspection, is the equipment being used free of damage?

Works at height (MEWPS)

  • Are MEWPS being used to complete this works?

  • Has a pre-use inspection of the MEWP been competed with no defects identified?

  • Does the operator hold relevant qualification to deem themselves as competent?

  • Does the MEWP hold a current LOLER record of thorough examination and is it available for viewing?

  • Are employees clipped on using a safety harness and lanyard?

  • Has a pre-use inspection of the safety harness been undertaken and has does it hold a current LOLER record of thorough examination (6 monthly inspection).

  • Are employees clipped on using a safety harness and lanyard?

  • Does the MEWP hold a current LOLER record of thorough examination and is it available for viewing?

  • Does the operator hold relevant qualification to deem themselves as competent?

  • Does the MEWP hold a current LOLER record of thorough examination and is it available for viewing?

  • Are employees clipped on using a safety harness and lanyard?

  • Has a pre-use inspection of the safety harness been undertaken and has does it hold a current LOLER record of thorough examination (6 monthly inspection).

  • Are employees clipped on using a safety harness and lanyard?

  • Does the MEWP hold a current LOLER record of thorough examination and is it available for viewing?

  • Are employees clipped on using a safety harness and lanyard?

  • Has a pre-use inspection of the safety harness been undertaken and has does it hold a current LOLER record of thorough examination (6 monthly inspection).

  • Are employees clipped on using a safety harness and lanyard?

  • Has a pre-use inspection of the safety harness been undertaken and has does it hold a current LOLER record of thorough examination (6 monthly inspection).

Excavations

  • Are any excavations required for the completion of this works?

  • Has a Cat & Genny been used by a competent persons to identify underground services?

  • If scans have not been completed to identify underground services excavations must not commence.

  • Have all identified utilities been marked prior to the ground being broken?

  • If utilities have not been marked the excavation must not commence.

  • Does the excavation have the potential to collapse?

  • Have suitable and sufficient controls been implemented to mitigate the risk of collapse?

  • Additional controls must be implemented to mitigate the risk of collapse prior to works continuing.

Confined spaces

  • Is access required to any confined spaces for the completion of this works?

  • Is this a NC1 or NC2 confined space entry?

  • Is all relevant documentation in place for a confined space entry?

  • Site is to be made safe and work must stop immediately.

  • Is there a top man present?

  • Is the entry man wearing the correct PPE?

  • Is there a tripod or winch onsite and has this been inspected?

  • Is there a tripod or winch onsite and has this been inspected?

  • Is the top man aware of what to do in the case of an emergency?

  • Is all relevant documentation in place for a confined space entry?

  • Site is to be made safe and work must stop immediately.

  • Is there a top man present?

  • Is the entry man wearing the correct PPE?

  • Is the top man aware of what to do in the case of an emergency?

  • Is the entry man wearing the correct PPE?

  • Is the entry man wearing the correct PPE?

  • Is there a tripod or winch onsite and has this been inspected?

  • Is there a tripod or winch onsite and has this been inspected?

Inspection Report (Vehicles & Emergency Supplies)

  • Has a pre-start check of the vehicle been completed?

  • Is the vehicle free of damage?

  • Has equipment and materials stored within the vehicle been well managed to allow for easy access?

  • If applicable are work vehicles fitted with the required hi-visibility chevrons & beacons?

  • Are work vehicle fitted with suitable and sufficient first-aid supplies which have not expired?

  • Does the vehicle hold suitable and sufficient fire extinguishing media?

Environmental

  • Is a spill kit readily available?

  • Is there a water testing kit available in the vehicle?

Sign-off page

  • Please sign to confirm that all statements made were accurate at the time of inspection.

  • Additional comments

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.