SSOW Pack

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Auditor

• Sentinel Card No

• Location

• Select date

  Date

Staff

Role

SSOW Planner

• Name

Responsible Manager

• Name

COSS

• Name

Possession Planner (if applicable)

• Name

SSOW Pack

Site Location

• Findings

Job Number

• Findings

Dates of works

• Findings

Methods of protection

• T3 / LB / LB+AP / Fenced / SW / COSS+1

Checked by SSOW planner (Line Blockage)

• Findings

Authorised by responsible manager

• Findings

Verified by COSS

• Findings

Hazard Directory

• Findings

Sectional Appendix

• Findings

Signal Diagrams

• Findings

Quality Map

• Findings

Nearest Hospital

• Findings

Location Plan

• Findings

RT9909 / COSS Briefing

Items

Date & Time Completed

• Findings

Location

• Findings

Contacting the signaller

• Findings

Access Arrangements

• Findings

Hazards

• Findings

Limits of the working area

• Findings

AC or DC Lines

• Findings

Safe system of works

• Findings

Fenced

• Findings

Site Warden

• Findings

Signatures / Name

• Add signature

  Sign

Line Blockages

Item

Ref Number

• Findings

Location

• Findings

Protecting Signals

• Findings

RT3181

• Findings

GZAC No

• Findings

General Arrangements

• Findings

Will the work affect the safety of the line

• Findings

Type of additional protection

• Findings

Blocking The line

• Findings

Granting authority

• Findings

Level crossing arrangements

• Findings

Additional protection

• Findings

Permission to share blockage

• Findings

Change of COSS / PC

• Findings