Title Page
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Conducted on
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Prepared by
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Location
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Name of SPC
Sentinel Number
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SPC Certification
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TSW035, Medical & D&A
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Signature
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Date
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Name of Mentor
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TSW035
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Mentor Signature
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Line
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Road/s booked with PWT?
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Location
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No of Staff and all relevant certification checks completed.
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Nature of Work
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Reason for Inspection (i.e. Familiarity; Competence; Post Incident, New SPC)
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Site access booking / Signing in procedures / Compliance for Rule Book 10 (if applicable)
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Planning of the work / Planning protection / Safe Access to Track – Rule Book 14 / 16 (if applicable)
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Relevant documentation/Method statements/Risk assessments/SSI/F3333 & SPC Pack
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Consideration of Public / Contractors / Other Work Parties (pre-worksite)
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Movement of Tools / Materials – Manual Handling / Pre Site set up
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Workgroup safety briefing
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Movement to Site / Worksite Set Up including Rule Book 18 (where applicable)
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Compliance Paperwork Entries / Paperwork Organisation.
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Monitoring Worksite arrangements including high risk activity controls (WAH / C.A.T Scan / MEWP)
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Identification of Hazards / Recording and Controlling (Point of Work Risk Assessment)
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Completion of Works / Site clear checks
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Signing out procedures / Paperwork entries post shift – Rule Book 10/14/16 where applicable
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Understanding of incidents / accidents / escalation (questions by competent person)
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Other relevant information / Observations / Comments
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Recommendations
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Reviewed By:
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Signature:
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Date:
