Title Page

People On Site And Site Location

  • Location
  • Audited by

  • Audit conducted on

  • Contractor on site

  • Job Number

  • Template Name

  • Business Area

  • Select your department

  • Select your department

  • Workstream working on

  • Vehicle Reg

  • Team Leader

  • Operative 2

  • Operative 3

  • Operative 4

Initial Site Observations

  • Is Site Active

  • Audit Date

  • Work description

  • Unsafe condition, act or omission very likely to cause a significant accident giving reason to stop work Immediately or is the site set up in a safe manner, ensuring the crew's safety and members of the public have been taken into consideration. Please take photos to show set up.

  • All Ops' carrying ID Cards and Leptospirosis (RAT) card

  • PTD forms available and if applicable have they been signed

  • Do crew have calling cards

Health & Safety, Equipment & TM

  • Risk assessment completed & understood, visitors inducted/briefed and signed on to SSRA

  • At the time of the audit was a safe system of work being practised

  • All Ops' have their training cert's on site and in date(Take Photo Evidence)

  • All Ops' have the correct and relevant PPE as required to carry out the task and is in use

  • All crew members First Aid trained and have adequately stocked first aid box and eye wash

  • Eye protection available and in use (jetting visors, safety glasses, goggles)

  • The team is aware of the process for reporting accidents, customer complaints, close calls

  • Crew aware of Manual Handling techniques and prevention

  • Both Company and Client van packs in date and includes generic risk assessements and COSHH assessemnets

  • TM specific controls relevant to working in the Highway in place and being observed. (Chap 8, Traffic Lights, Road Closure)

  • Work areas are suitably signed, lighted and guarded

  • Task specific signage displayed

  • Are any temporary openings i.e, manholes/shafts etc adequately protected

  • Has suitable access and egress from the site been provided

  • Where applicable are overhead services controlled

  • All work equipment and tools in good condition and fit for purpose

High Pressure Water Jetting & CCTV Surveying

  • Leader hose fitted and all hoses free from damage

  • Correct jetting heads in use

  • Correct skids for camera availble, in use

  • Where required gas detectors calibrated and charged, gas test carried out and results recorded. Charging unit available on site

  • Do crew have a Cat & Genny and are trained and capable of using it ?

  • Pollution prevention controls in place (drains and watercourses protected, spill kit available, secondary containment available where required)

  • Plant service records available for inspection

  • Evidence all relevant electrical equipment has been inspected/tested

Confined Space

  • Op's hold correct training cert's for the confined space entry & Top Man, and they are capable of using Safety Equipment?

  • Sufficient lighting in place within the confined space

  • Full Safety kit available/escape set, Calibrated & in date ?

  • Work at height/falls from height

  • Ladders & Step Ladders if in use at all are fit for purpose, secured safely and tagged

Patching & Relining inc. Re-rounding

  • Do all crew members understand the correct mixing guidelines for any chemicals they are carrying ?

  • Are all Air Hoses free from damage, any noticable kinks

  • Rerounding operation set up correctly and crew have the necessary waste bags for Asbestos

  • Chemicals/flammable liquids securely stored away from sources of ignition and labelled, drip bund in use

  • Protection against scolding in place Hot Cure works

  • Suitable ventillation in place for the task

  • Scaffold & other temporary work platforms tagged with set up date

Vehicle

  • Vehicle daily check sheet completed

  • Vehicle externally and internally clean, cab free from clutter, bodywork acceptable standard, livery applied

  • Sufficient TM to perform current days tasks

  • Storage secured, area free from hazards

  • Drivers licence in accordance with vehicle and trailer legal requirement

  • Keys removed from vehicle, stored securely

  • Vehicle visibly within the legal weight limit

  • Lights working including flashing roof beacon, lenses clean and undamaged

  • Tyres visibly within legal limits

  • Windowscreen free from damage/cracks, driver has clear vision.

  • Is vehicle height displayed

Excavation Works in highway and/or private property

  • Have the works been adequately planned including liaison with the highway authority permit /notice in place, PTD signed

  • PPE being used as per the Operatives RAMS, Site rules and COSHH assessments

  • Do crew have a Cat & Genny and are trained and capable of using it ?

  • Utility plans on site and up to date and all service's clearly identified

  • Work areas are suitably signed, lighted and guarded

  • Appropriate number of NRSWA qualified operatives on site (certificates in place)

  • is Heras fencing in place where needed and double clipped

  • All machinery, plant and spoil within the barriers

  • All plates / footway boards secured appropriately for the location and correctly maintained

  • Where applicable are HAVS calculations available

  • Working at height controls in place as per RAMS and SSRA

  • Is shoring in place where needed and to satisfactory standard

  • A Business Open as Usual Sign is in place at either end of the works where there are businesses present

  • Spoil correctly separated and stored safe distance from excavation.

Environmental, Hygiene & Welfare

  • Adequate supply of fresh water

  • Adequate washing facilities available i.e soap, wipes, hand towel etc

  • If any specific environmental controls are in place, are these considered as adequate

  • Has provision been made for the disposal of site waste

  • Chemicals/flammable liquids securely stored away from sources of ignition and labelled, drip bund in use

  • The storage of Hazardous substances (COSHH) is adequately controlled

  • Client specific standpipe available and correct storage for standpipe being used

  • Hydrant key and hydrant location list available, correct hydrant being used

  • Chlorine tablets available and chlorine solution labelled and dated

  • Spill Kit available

Customer and third party management

  • Are permit/customer information boards displayed, with correct details

  • Access to shops and houses being maintained. Pedestrian and vehicular access satisfactory

  • Members of the public and any 3rd parties adequately protected

  • Are overshoes available if needed

Good Practices

  • Do you want to capture Good Practices?

Review Status

  • Do you want to assign review status?

  • Please select a status type

Sign Off

Contractor Sign Off

  • Contractor Rep Comments

  • Contractor Signature

Auditors Sign off

  • Auditor's Comments

  • Auditor's Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.