Site Survey 123

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job Reference

  Yes

  No

  N/A

• ELR? Up/Dn

  Yes

  No

  N/A

• Mileage From and To

  Yes

  No

  N/A

• Length / duration of works

  Yes

  No

  N/A

• Work required

  Yes

  No

  N/A

• Pre works photos taken?

  Yes

  No

  N/A

• Is the cellular network adequate?

  Yes

  No

  N/A

• Authorised access points? Near to site of work?

  Yes

  No

  N/A

• Access via third party land (through fence) ?

  Yes

  No

  N/A

• Third party details

  Yes

  No

  N/A

• Has permission been agreed?

  Yes

  No

  N/A

• Are welfare facilities near by?

  Yes

  No

  N/A

• Are parking facilities available? Details .....

  Yes

  No

  N/A

• Can materials be stored locally if so details......

  Yes

  No

  N/A

• Will waste be produced if so what waste and how it is to be disposed of

  Yes

  No

  N/A

• Will dust noise, exhaust fumes be produced? If they are going to be of disturbance how is this going to be managed?

  Yes

  No

  N/A

• Are there any aquatic ecosystems on or near the site of work? If yes what considerations need to be made?

  Yes

  No

  N/A

• Are there signs of pollution

  Yes

  No

  N/A

• Is any traffic management required?

  Yes

  No

  N/A

• Are there any risks to the public or other contractors/ organisations?

  Yes

  No

  N/A

Ecological

• Is there any evidence of protected species?

  Yes

  No

  N/A

• Will work be carried out during the bird nesting season?

  Yes

  No

  N/A

• Is there any visual evidance of nesting birds? If yes note location here.

  Yes

  No

  N/A

• Is the site within or nearby any protected sites? If yes add details including any tree preservation orders, SSSI, SAC etc.

  Yes

  No

  N/A

• Are there any notifiable invasive species present?

  Yes

  No

  N/A

• Will the work be carried out in bird nesting season?

  Yes

  No

  N/A

• Is there evidence of protected sites ie.. T.P.O, SSSI etc

  Yes

  No

  N/A

Sequence Of Works

• List sequence of works here.

  Yes

  No

  N/A

• Any assets that need special consideration?

  Yes

  No

  N/A

Activity Risks

• Use of strimmer?

  Safe

  At Risk

  N/A

• Use of chainsaw?

  Safe

  At Risk

  N/A

• Use of tracked mobile chipper?

  Safe

  At Risk

  N/A

• Use of Road Rail Vehicle

  Safe

  At Risk

  N/A

• Rubbish clearance?

  Safe

  At Risk

  N/A

• Handling materials with sharp edges?

  Safe

  At Risk

  N/A

• Underground services?

  Safe

  At Risk

  N/A

• Slips, trips and falls?

  Safe

  At Risk

  N/A

• Being struck by moving vehicles?

  Safe

  At Risk

  N/A

• Manual handling?

  Safe

  At Risk

  N/A

• Use of disc cutter?

  Safe

  At Risk

  N/A

• Use of mini excavator?

  Safe

  At Risk

  N/A

• Use of skid steer?

  Safe

  At Risk

  N/A

• Use of tracked barrow?

  Safe

  At Risk

  N/A

• Mixing concrete?

  Safe

  At Risk

  N/A

• Installation of barbwire?

  Safe

  At Risk

  N/A

• Spraying herbicide?

  Safe

  At Risk

  N/A

• Others?

  Safe

  At Risk

  N/A

Site Risks

• Personnel being struck by trains?

  Safe

  At Risk

  N/A

• Existing arisings in cess and embankments?

  Safe

  At Risk

  N/A

• Restricted clearences?

  Safe

  At Risk

  N/A

• Third rail present?

  Safe

  At Risk

  N/A

• Overhead live equipment present?

  Safe

  At Risk

  N/A

• Slips, trips falls ie rabbit holes etc?

  Safe

  At Risk

  N/A

• Buried services, cables, pipes being struck when excavating?

  Safe

  At Risk

  N/A

• Passing over power cables pipes or service routes for example troughing routes with heavy plant or machinery?

  Safe

  At Risk

  N/A

• Electrocution from power tools for example 110 volt equipment etc?

  Safe

  At Risk

  N/A

• Litter/ fly tipping for example asbestos, needles, glass etc?

  Safe

  At Risk

  N/A

• Injurious plants present for example hog weed, Blackthorn etc

  Safe

  At Risk

  N/A

• Working at heights?

  Safe

  At Risk

  N/A

• Working near water?

  Safe

  At Risk

  N/A

• Working on a steep cutting or embankment?

  Safe

  At Risk

  N/A

• Plant and vehicle movements present?

  Safe

  At Risk

  N/A

• Health hazards (leptospirosis from rats, asbestos, snakes, etc?)

  Safe

  At Risk

  N/A

• COSHH ( any substances hazardous to health present?)

  Safe

  At Risk

  N/A

• Possible confrontation from members of the public or residents?

  Safe

  At Risk

  N/A

• Others?

  Safe

  At Risk

  N/A

Method of Protection for Working Group From Railway Traffic

• What protection is required to access and egress site of work, i.e. Lookout, site warden etc?

  Yes

  No

  N/A

• What protection is required whilst carrying the work i.e safe guarded green zone, line blockage ect?

  Yes

  No

  N/A