Staff Field Assessment

Title Page

Document No.
Employee
Conducted on
Location
Prepared by

Assessment Info

Job Number
Assessment Reason
Assessment Type
Location Type
Type of Work
Brief description of work
- Positive
- Negative
- N/A

Appropriate competencies / ID card available and in date (eg. SHEA/CSCS)?
Risk Assessment carried out prior to starting task?
Appropriate PPE in use on task?
Plans/Drawings/info requested?
Third Party services located/marked, prior to starting task?
Safe System of Work incl Trench support installed where appropriate for excavations?
Safe Working - Engineer risk?
Safe Working - Customer/third party risk?
Correct Use of barriers/warning signs?
Appropriate machine selected and used?
Precautions taken to prevent manual handling injuries?
"Volt stick" check on appliance / equipment carried out. (incl adjacent equipment/surfaces)?
230v/110v electrical equipment condition and evidence of test/inspection?
230v/110v electrical equipment in use in an unsafe condition &/or without test evidence?
Equipment calibrated and in date, e.g. multi meter, gas detector, Cable avoidance tool etc?
SOK 34 used to check electrical socket (and checked correct operation)?
Uses personal RCD (and checked correct operation)?
Asbestos safety precautions taken?
Safe System of work for Working at Height followed - Ladders and Access Systems?
All access equipment has been asset tagged or is easily identifiable. Evidence of inspections?
Fall restraint/arrest and harness equipment available, stored safely and fit for purpose?
Safe system of work for confined space entry?
Safe use and maintenance of high pressure water jetting equipment?
Safe system of work for lining and/or CCTV?
All waste handled correctly/removed from site - incl Hazardous materials?
Reinstatement carried out correctly?
Paperwork completed correctly and left with customer?
Incident reporting – if nothing to report does the employee understand the reporting process etc?
Is the Vehicle Safety / Storage in general good condition?
Suitable PPE available and fit for purpose?
Appropriate HS&E documentation available.
Suitable Tools available and in use for the, task incl controls for cross contamination?
Spillage kit available?
Working to Standards?
Overall Attitude towards Safe working

Van

Foot Pedal Condition
PPE Bag
First Aid Kit
Ladder
Jerry Can
Stand pipe bagged with Chlorine tabs
Bursting Disc
Extension Bar
Guide pole
Disinfectant
2 x Barriers in van
Cones in van
Signage on board eg Jetting work
Fire Extinguisher
All Equipment in the van PAT tested
Interchangeable Manhole Keys

Signoff

Assessor - I confirm that the information I have collated is a true representative of my findings, and any failures have been recorded, resolved onsite using the comments box or actions raised for the appropriate member of staff.
Assessed Employee - I confirm that the assessor has provided me with feedback on this assessment. I understand any actions / improvement notices that have been given to me.

Drug Test