Site Inspection / Staff Surveillance Record

• Site conducted

  Select
• Please select the location off site
  Address

• Client / Contractor

• Date & Time

  Date

1. Site Documentation

• 1.1 Construction Phase Plan (Copy on site, signed off..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.2 Health & Safety Policy (Displayed, signed off)

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.3 F10 (Displayed, up to date..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.4 Emergency Contact List Hospitals etc

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.5 Insurance (ELI) (Displayed, In date..)

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.6 Health & Safety Law Poster (Displayed, sections completed)

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.7 Any dynamic Risk Assessments written up

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.8 Visibility of either WPP(Work package plan)/ TB (Task Brief) / MS (Method Statement)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 1.9 Permits (hot Works, etc in use if a task requires a permit )

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

2. Monitoring

• 2.1 Fire Equipment suitable for environment and in test date, easy to locate

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 2.2 First Aid

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 2.3 Tool Box Talks

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 2.4 Welfare Facilities

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 2.5 Competence

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 2.6 Induction

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• Comments

4. Work Task Performance

• 4.1 PPE (Compliance)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.2 Work at Height (Access, Falls, Edge Protection..)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.3 Housekeeping

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.4 COSHH (Hazardous / Flammable substances)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.5 Security

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.6 Buried / Overhead Services

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.7 Signage

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.8 Electricity (PA Test, Trailing Leads..)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.9 Work Platforms (Towers, Scaffolds, MEWP’s..)

  Safe

  At Risk

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.10 Noise / Vibration (safe use, assessment..)

  Safe

  At Risk

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.11 Excavations (Guarded, exclusion zones, inspected)

  Safe

  At Risk

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.12 Access & Egress Routes (Signed, Clear of obstruction..)

  Safe

  At Risk

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.13 Asbestos (Register, survey, training..)

  Safe

  At Risk

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.14 Manual Handling (Assessment, technique..)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.15 Abrasive Wheels (safe use, PPE, training..)

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.16 LOLER / Lifting (RAMS, lift plan, inspection, TE, competency..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.17 Confined Spaces (permits, RAMS, competency..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 4.18 Plant / Equipment (PUWER..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

5. Environmental / Ecology

• 5.1 WPP / TB / MS (Reference to Environment / Ecological performance)

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 5.2 Waste (In accordance with WPP/TB/MS, segregation, skip ID..)

  Compliant

  Non-Compliant

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 5.3 Ecology (Briefings, habitats, surveys..)

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• Comments

6. Management / Supervision

• 6.1 Is management structure clearly defined and understood?

  Good

  Fair

  Poor

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 6.2 Is a management organogram displayed?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 6.3 Are on-site management meetings held and attended?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 6.4 Are statutory registers completed and supervisor inspections carried-out weekly?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• Comments

7. Surveillance

• 7.1 Does member of staff have the necessary competencies to work on the equipment in their area?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 7.2 Has all new work been carried-out / completed to the requirements of the appropriate standards?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 7.3 Have the correct tools / equipment been used to undertake the work?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• 7.4 Have all Staff carried out HAVS assessment where appropriate?

  Yes

  No

  N/A

• Action

  Select Stop Work Report to Site Manager/Head Office No Action continue with caution

  • Stop Work
  • Report to Site Manager/Head Office
  • No Action continue with caution

• Comments

Inspection & Surveillance Completion

• Name and Signature

  Sign