Site Safety Inspection Form 1.5

• Conducted on

  Date

• Prepared by

• Project Name & Location

General H&S Documentation

• All relevant employees signed up to relevant safety brief / RAMS

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Temporary Works (TW) - Embankment monitoring - Site manager confirms all inspections of embankments are up to date

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Temporary Works Coordinator confirms the embankments, excavations and other temporary works are as per the design and inspections are up to date.

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Competency evidence in place according to employees duties

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PTS cards available and in date

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• RRV Plant and equipment inspection complete

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PEM Equipment / Material On & Off sheet (bucket list) forms are being completed correctly

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Dispatch & Catch - DAC1 form completed for any unacompanied movements.

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

Compound Set Up

• Is the correct information displayed on noticeboard? E.g.: • Safety Policy • HSWA poster • Employer’s Liability • Safety Bulletins • NI10 form (contractors)

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Is the site access and egress suitable?

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Is the site security adequate e.g. fencing, locked access gates etc.

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Is site housekeeping adequate?

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Is site traffic parking/management adequate?

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Fire risk asseement and controls in place

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• 1st Aiders and kit in place

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Welfare facilities suitable

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• COSHH controls in place, spill kit available

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

PICOP Precautions

• PICOP possesses valid competency card

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PICOP certificate details in place

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PICOP protection arrangements in place

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PICOP in possession of the current Weekly Operation Notice 'WON'

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• PICOP wearing appropriate armband

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

ES Precautions

• ES possesses valid competency card

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• ES certificate details complete

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• ES protection arrangements in place - marker boards at least 100m from possession protection, 100m between multiple ES worksites and 100m from the work location

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• All TSCs signed in with ES

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• ES in possession of the current Weekly Operation Notice 'WON'

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• ES wearing appropriate armband

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

Personal Protective Equipment (PPE)

• Safety boots, hard hats (with lights), orange high visibility clothing and safety gloves worn by employees

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

Worksite review

• Access point parking safe and not presenting a problem for other road users

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• TSC possesses valid competency card

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• TSC present and overseeing the works

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• TSC brief complete for the works and recorded

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Person in Change completed PEM / TSC sheet as appropriate

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Pedestrian controls are being followed

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Plant and vehicle movement are being carried out safely

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Loading / Unloading operations are being carried out safely

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Supervisor confirms a Permit to Dig is in place for the area being excavated

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Supervisor confirms the area being excavated has been CAT scanned and they are satisfied all necessary precautions have been taken to prevent cables from being damaged.

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Measures are in place to protect all identified services and known locations are highlighted by spray paint marking on the ground throughout the extents of the required area in advance of breaking ground

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Plant movement and trailer loading / unloading operations are carried out in a safe manner

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• RRVC(s) are maintaining exclusion zones around their designated RRV to ensure no one is endangered by the RRV movements

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Leading edge protection is in place surrounding the excavation

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Trench support system is in place for any excavation where persons are required to enter

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Worksite lighting levels are sufficient

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• The works are being carried out in a safe manner

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

Other Observations

• Point 1

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Point 2

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

• Point 3

  Select - 0 - extremely poor compliance - advised to stop this task pending a full review -1- critical non-conformance identified - action taken immediately before works recommenced -2- serious non-conformance(s) identified - management to review prior to similar works being carried out -3- minor non-conformance(s) identified - no impact on works -4- agreed safe systems of works being implemented -N/A-

  • - 0 - extremely poor compliance - advised to stop this task pending a full review
  • -1- critical non-conformance identified - action taken immediately before works recommenced
  • -2- serious non-conformance(s) identified - management to review prior to similar works being carried out
  • -3- minor non-conformance(s) identified - no impact on works
  • -4- agreed safe systems of works being implemented
  • -N/A-

Site Management Sign off

• Has there been any accidents or incidents within the works period - record the site managers response

  Yes

  No

  N/A

• Provide details of any accident or incident -

• I confirm I have had the contents of this report explained to me and that I am satisfied as the senior person on site any remedial actions , agreed time frames and the line is safe and clear for the passage of trains.

• Name/Role/Employer

  Sign