Title Page
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Date:
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Project Name:
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Project Number:
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Project Manager:
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Construction Engineer:
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Contractor Company Name:
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Contractor Contact Name:
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Contractor on-site Representative:
1 Housekeeping & Site Protection
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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
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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
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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
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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
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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
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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).
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6.2 Design issues raised by Contractor
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6.3 Works Instructions issue to contractor (list work instruction numbers)
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6.4 Variations raised by Contractor
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6.5 Works in progress
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6.6 Note the Site Conditions
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6.7 Other
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