Title Page

  • Date:

  • Project Name:

  • Project Number:

  • Project Manager:

  • Construction Engineer:

  • Contractor Company Name:

  • Contractor Contact Name:

  • Contractor on-site Representative:

1 Housekeeping & Site Protection

  • 1.1 Site security fencing

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  • 1.2 Site signage (at all access points)

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  • 1.3 Materials stockpiled safely & protected

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  • 1.4 Site facilities / containers / amenities

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  • 1.5 Overhead assets flagged (protected)

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  • 1.6 Segregation of workplace from public

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2 Personal Protective Equipment

  • 2.1 Helmets / Hard Hats

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  • 2.2 Reflective safety vest

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  • 2.3 Steel capped boots

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  • 2.4 Safety glasses (if required)

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  • 2.5 Flashing light (vehicles & machines)

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3 Trenches & Excavations

  • 3.1 Open excavations flagged & protected

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  • 3.2 Trenches flagged & protected

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  • 3.3 Holes & shafts flagged & protected

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  • 3.4 Edges flagged & protected

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  • 3.5 Safe access into open trench / holes

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  • 3.6 Handrails in place

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4 Environmental Protection

  • 4.1 Silt control fencing correctly installed & maintained

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  • 4.2 Protection of water bodies (straw bales / silt trap)

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  • 4.3 Stormwater inlet protection installed & maintained

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  • 4.4 Perimeter fencing around protected trees (TPZ)

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  • 4.5 Public road cleanliness (mud / dirt)

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  • 4.6 Dust control measures

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  • 4.7 Erosion control measures installed (as required)

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  • 4.8 Noise Management (complying with working hours)

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5 Other

  • 5.1 Evidence of site induction

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  • 5.2 Is traffic management in accordance with the approved TMP

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6 Construction Items

  • 6.1 Hold Points witnessed (list point e.g. proof roll of subgrade, sub-base or base material, pressure test of pipes or pits, ovality testing of pipes, On or Off maintenance inspection).

  • 6.2 Design issues raised by Contractor

  • 6.3 Works Instructions issue to contractor (list work instruction numbers)

  • 6.4 Variations raised by Contractor

  • 6.5 Works in progress

  • 6.6 Note the Site Conditions

  • 6.7 Other

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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.