Survey Inspection

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Previous Report Closed Out

• Select outcome

  Yes

  No

  N/A

Health & Safety Measures

• Risk assessments and method statements

  Yes

  No

  N/A

Permits, permissions, licenses

• Buried services. Confined space. Isolation of services. Work at height.

  Yes

  No

  N/A

Traffic Management Plan

• Is there an approved traffic management plan in place?

  Yes

  No

  N/A

• Have appropriate traffic signs, barriers and warning lights as per the Traffic Signs Regulations and General Directions (TSRGD) been implemented?

  Yes

  No

  N/A

• Pedestrian footpaths are safely diverted or alternative routes have been provided?

  Yes

  No

  N/A

• Are road closures, diversions and pedestrian footpath closures clearly segregated and signposted?

  Yes

  No

  N/A

PPE / Safety Equipment

• PPE Compliance: Site Rules / Work activists. Documented PPE issue and replacement records?

  Yes

  No

  N/A

Underground Services

• HSG47: Guidance: CAT & Genny available and calibrated? Suitably qualified persons? Safe equipment available and in use? Hand digging only permitted within 500mm of services?

  Yes

  No

  N/A

Planning & Notification

• Have SurveyEng coordinated with local authorities and utility companies?

  Yes

  No

  N/A

• Has a street works license been issued? (NRSWA 1991: Section 50: requires the obtaining of a street works license if the work involves placing apparatus in the street)

  Yes

  No

  N/A

• Have the street authority been given advanced notice?

  Yes

  No

  N/A

• Is there evidence of the street authority consenting to the notice?

  Yes

  No

  N/A

• Is there records of the work, including the dates and times of the closures?

  Yes

  No

  N/A

• Have coordination meetings been held with the local authority to discuss the impact of closures and the arrangements for managing traffic?

  Yes

  No

  N/A

• Any part of the street which is broken up or open, or is obstructed by plant or materials used or deposited in connection with the works, is adequately guarded and lit?

  Yes

  No

  N/A

Fire / Flammables / Emergency

• Select Outcome

  Good

  Fair

  Poor

  N/A

First Aid

• Select outcome

  Good

  Fair

  Poor

  N/A

Training & Competency (CSCS, Skills cards, Buried services, Street works, SSSTS, SMSTS)

• Select outcome

  Good

  Fair

  Poor

  N/A

Communication / Consultation / Toolbox Talks

• Daily Activity / Pre-start briefs / Toolbox talks

  Good

  Fair

  Poor

  N/A

Supervision & Instruction

• Adequate supervision of work activities. Evidence of supervisor site inspections.

  Yes

  No

  N/A

Accident / Hazard / Near-miss reporting

• Evidence of process and effective reporting

  Yes

  No

  N/A

Confined Space

• Permit in place and being followed? Rescue equipment available and serviced? Training & competency. Emergency plan.

  Yes

  No

  N/A

Edge Protection

• Select outcome

  Good

  Fair

  Poor

  N/A

Sign off

• Findings have been discussed with Foreman

  Yes

  No

  N/A

• Any comments from Foreman/Supervisor

  Yes

  No

  N/A

• Completed by

  Sign