TM Field Companion

Before starting any new document ensure to refer to previous visits/interactions to identify any outstanding actions that may need to be carried forward. Any progress should be recognised and praised.

• Engineer details (**payroll number must be included**)

• Prepared by

• Conducted on

  Date

• Visit Type

  Select HomeSafe RTW Customer Visit Damage Claim Investigation Coaching Equipment Inspection 121 ROD

  • HomeSafe
  • RTW
  • Customer Visit
  • Damage Claim
  • Investigation
  • Coaching
  • Equipment Inspection
  • 121
  • ROD

TM RISK ASSESSMENT

• Are there any hazards?

  Yes

  No

• Hazard type

  Select Traffic Ground Third Party Weather

  • Traffic
  • Ground
  • Third Party
  • Weather

• Are hazards controllable?

  Yes

  No

• Details

• Visit type

  Select HomeSafe RTW Customer Visit Damage Claim Investigation Coaching Equipment Inspection 121 ROD

  • HomeSafe
  • RTW
  • Customer Visit
  • Damage Claim
  • Investigation
  • Coaching
  • Equipment Inspection
  • 121
  • ROD

HOMESAFE

• Job No

• Job type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Observation

  Announced

  Unannounced

• Is the Engineer working safely on arrival?

  Yes

  No

• Risk Assessment

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Manual Handling

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• PPE

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Damage Awareness

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Working at Height

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Ladder type

  Select No Ladder Step/ Combi Single Section Double Section Triple Section CAT DAT SAT (inc rope access) Access Ladder (inc flat roof working)

  • No Ladder
  • Step/ Combi
  • Single Section
  • Double Section
  • Triple Section
  • CAT
  • DAT
  • SAT (inc rope access)
  • Access Ladder (inc flat roof working)

• How was Combi- ladder used?

  A Frame (0 extension)

  A Frame (2 rung extension)

  A Frame (3 rung extension)

  A Frame (4 rung extension)

  Triple extension ladder

• Additional record of findings (Equipment set up and description of job as was carried out. Highlight positive aspects of work witnessed)

• Add pictures to support observation (inc RAMS forms if applicable)

  Media

• Additional HomeSafe on this visit

• Job No

• Job type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Risk Assessment

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Manual Handling

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• PPE

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Damage Awareness

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Working at Height

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Ladder type

  Select No Ladder Step/ Combi Single Section Double Section Triple Section CAT DAT SAT (inc rope access) Access Ladder (inc flat roof working)

  • No Ladder
  • Step/ Combi
  • Single Section
  • Double Section
  • Triple Section
  • CAT
  • DAT
  • SAT (inc rope access)
  • Access Ladder (inc flat roof working)

• How was Combi- ladder used?

  A Frame (0 extension)

  A Frame (2 rung extension)

  A Frame (3 rung extension)

  A Frame (4 rung extension)

  Triple extension ladder

• Additional record of findings (Equipment set up and description of job as was carried out. Highlight positive aspects of work witnessed)

• Add pictures to support observation (inc RAMS forms if applicable)

  Media

• Additional HomeSafe on this visit

• Job No

• Job type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Risk Assessment

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Manual Handling

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• PPE

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Damage Awareness

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Working at Height

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Ladder type

  Select No Ladder Step/ Combi Single Section Double Section Triple Section CAT DAT SAT (inc rope access) Access Ladder (inc flat roof working)

  • No Ladder
  • Step/ Combi
  • Single Section
  • Double Section
  • Triple Section
  • CAT
  • DAT
  • SAT (inc rope access)
  • Access Ladder (inc flat roof working)

• How was Combi- ladder used?

  A Frame (0 extension)

  A Frame (2 rung extension)

  A Frame (3 rung extension)

  A Frame (4 rung extension)

  Triple extension ladder

• Additional record of findings (Equipment set up and description of job as was carried out. Highlight positive aspects of work witnessed)

• Add pictures to support observation (inc RAMS forms if applicable)

  Media

• Additional HomeSafe on this visit

• Job No

• Job type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Risk Assessment

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Manual Handling

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• PPE

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Damage Awareness

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Working at Height

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Ladder type

  Select No Ladder Step/ Combi Single Section Double Section Triple Section CAT DAT SAT (inc rope access) Access Ladder (inc flat roof working)

  • No Ladder
  • Step/ Combi
  • Single Section
  • Double Section
  • Triple Section
  • CAT
  • DAT
  • SAT (inc rope access)
  • Access Ladder (inc flat roof working)

• How was Combi- ladder used?

  A Frame (0 extension)

  A Frame (2 rung extension)

  A Frame (3 rung extension)

  A Frame (4 rung extension)

  Triple extension ladder

• Additional record of findings (Equipment set up and description of job as was carried out. Highlight positive aspects of work witnessed)

• Add pictures to support observation (inc RAMS forms if applicable)

  Media

• Additional HomeSafe on this visit

• Job No

• Job type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Risk Assessment

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Manual Handling

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• PPE

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Damage Awareness

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Working at Height

  HomeSafe

  Unsafe

  Not Witnessed

• WHAT? (what was Safe/ Unsafe?)

• WHY? (why did the Engineer do it this way?)

• HOW? (how was this recognised/ refined/ rectified?)

• Ladder type

  Select No Ladder Step/ Combi Single Section Double Section Triple Section CAT DAT SAT (inc rope access) Access Ladder (inc flat roof working)

  • No Ladder
  • Step/ Combi
  • Single Section
  • Double Section
  • Triple Section
  • CAT
  • DAT
  • SAT (inc rope access)
  • Access Ladder (inc flat roof working)

• How was Combi- ladder used?

  A Frame (0 extension)

  A Frame (2 rung extension)

  A Frame (3 rung extension)

  A Frame (4 rung extension)

  Triple extension ladder

• Additional record of findings (Equipment set up and description of job as was carried out. Highlight positive aspects of work witnessed)

• Add pictures to support observation (inc RAMS forms if applicable)

  Media

RTW

• Type of absence

  Short Term Sickness

  Long Term Sickness

  Paid/Authorised Absence

  Unpaid/Unauthorised Absence

• First day of absence

  Date

• Last day of absence

  Date

• Absence reason

  Select Alcohol/ Drug addition Allergy Asthma (excl work related) Blood disorder Breast problems Cancer/ Tumors Chest/ Respiratory problems Cold/ Cough/ Flu/ Influenza Dental Diabetes/ Thyroid/ Endocrine Disease of nervous system Ear/ Nose/ Throat condition Epilepsy or Neurological Eye problem Gastrointestinal problems Gynae including period pains Headache/ Migraine Heart/ BP/ Cirulatory Infectious disease Kidney/ Bladder problem Non work Injury/ Burn/ Fracture/ RTA Non work Musculoskeletal problem Non work Back/ Disc problem Occupational Asthma Occupational Dermatitis Pregnancy related Scheduall Sickness code Stess/ Anxiety/ Depression (non work) Stess/ Anxiety/ Depression (work related) Swine flu Unknown cause Vertigo/ Dizziness/ Insomnia Virus Work Injury/ Burn/ Fracture/ RTA Work related Musculoskeletal problem Work related Back/ Disc problem Other

  • Alcohol/ Drug addition
  • Allergy
  • Asthma (excl work related)
  • Blood disorder
  • Breast problems
  • Cancer/ Tumors
  • Chest/ Respiratory problems
  • Cold/ Cough/ Flu/ Influenza
  • Dental
  • Diabetes/ Thyroid/ Endocrine
  • Disease of nervous system
  • Ear/ Nose/ Throat condition
  • Epilepsy or Neurological
  • Eye problem
  • Gastrointestinal problems
  • Gynae including period pains
  • Headache/ Migraine
  • Heart/ BP/ Cirulatory
  • Infectious disease
  • Kidney/ Bladder problem
  • Non work Injury/ Burn/ Fracture/ RTA
  • Non work Musculoskeletal problem
  • Non work Back/ Disc problem
  • Occupational Asthma
  • Occupational Dermatitis
  • Pregnancy related
  • Scheduall Sickness code
  • Stess/ Anxiety/ Depression (non work)
  • Stess/ Anxiety/ Depression (work related)
  • Swine flu
  • Unknown cause
  • Vertigo/ Dizziness/ Insomnia
  • Virus
  • Work Injury/ Burn/ Fracture/ RTA
  • Work related Musculoskeletal problem
  • Work related Back/ Disc problem
  • Other

• Please state reasons

• Is the absence work related?

  Yes

  No

• Details

• Was this a linked absence?

  Yes

  No

• Details

• Did Engineer visit a GP during their absence?

  Yes

  No

• Is this absence over 7 days?

  Yes

  No

• In line with the company absence policy if the absence is over 7 days the employee must provide a 'Fit to Work' certificate in order for a full return to work.

• Has a 'Fit to Work' note been provided?

  Yes

  No

• Add any pictures of 'Fit To Work' certificates

  Media

• Is this absence over 7 days?

  Yes

  No

• In line with the company absence policy if the absence is over 7 days the employee must provide a 'Fit to Work' certificate in order for a full return to work.

• Is the Engineer currently on any medication?

  Yes

  No

• Details of medication

• Number of absences in rolling 12 months?

  Select 0 (first absence) 1 2 3 4 5 6 7 8 9 10+

  • 0 (first absence)
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10+

• How many?

• Percentage absence in rolling 12 months?

  0 - 1.59%

  1.6 - 3.59%

  3.6 - 5.59%

  5.6 - 8.49%

  8.5% +

• Has this absence triggered further action?

  Yes

  No

• Process Triggered?

  Informal Discussion

  Attendance Hearing

• Absence Ref Guide

  

• Occupational Heath referral required?

  Yes

  No

• Date of referral/ planned referral

  Date

• Additional information

• If the returning Engineer has been off 28 days or more please refer to the RTWL in the first instance before a full return to work

• Reason for Absence

• Any follow up considerations?

Reopen Visit Type and include 'ROD' if required

CUSTOMER VISIT

• Job No

• Customer Visit type

  Engineer on site

  Post engineer visit

• Has a HomeSafe observation been completed?

  Yes

  No

• Reason for no HomeSafe observation

• Customers additional services

  Select On Demand Sky Go Remote Record Active 'My Sky'

  • On Demand
  • Sky Go
  • Remote Record
  • Active 'My Sky'

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

• Additional 'Customer Visits' on this visit

• Job No

• Has a HomeSafe observation been completed?

  Yes

  No

• Reason for no HomeSafe observation

• Customers additional services

  Select On Demand Sky Go Remote Record Active 'My Sky'

  • On Demand
  • Sky Go
  • Remote Record
  • Active 'My Sky'

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

• Additional 'Customer Visits' on this visit

• Job No

• Has a HomeSafe observation been completed?

  Yes

  No

• Reason for no HomeSafe observation

• Customers additional services

  Select On Demand Sky Go Remote Record Active 'My Sky'

  • On Demand
  • Sky Go
  • Remote Record
  • Active 'My Sky'

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

• Additional 'Customer Visits' on this visit

• Job No

• Has a HomeSafe observation been completed?

  Yes

  No

• Reason for no HomeSafe observation

• Customers additional services

  Select On Demand Sky Go Remote Record Active 'My Sky'

  • On Demand
  • Sky Go
  • Remote Record
  • Active 'My Sky'

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

• Date of Engineer visit

  Date

Customer Q&A

• Did the Engineer arrive within the set ETA?

  Yes

  No

• Did the Engineer keep you updated?

  Yes

  No

• Did the Engineer go through the job with you before starting?

  Yes

  No

• Comments

• Did the Engineer go through the job after completion?

  Yes

  No

• Comments

• Was there anything more the Engineer could've done for you?

  Yes

  No

• Comments

• Did the visit enhance your perception of Sky?

  Yes

  No

• Comments

• As a business was there anything more we could've done for you?

  Yes

  No

• Comments

• Additional comments about the visit

• Add pictures to support findings

  Media

• Evidence of H&S usage?

  Yes

  No

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Is further investigation required?

  Yes

  No

• Why not?

• Explanation of findings

• Add pictures to support findings

  Media

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

Reopen Visit Type and include 'ROD' if required

• Additional 'Post Checks' on this visit

• Job no

• Date of engineer visit

  Date

Customer Q&A

• Did the engineer arrive within the set ETA?

  Yes

  No

• Did the engineer keep you updated?

  Yes

  No

• Did the Engineer to through the job with you before starting?

  Yes

  No

• Comments

• Did the Engineer go through the job after completion?

  Yes

  No

• Comments

• Was there anything more the Engineer could've done for you?

  Yes

  No

• Comments

• Did the visit enhance your perception of Sky?

  Yes

  No

• Comments

• As a business was there anything more we could've done for you?

  Yes

  No

• Comments

• Additional comments about the visit

• Add pictures to support findings

  Media

• Evidence of H&S usage?

  Yes

  No

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Is further investigation required?

  Yes

  No

• Why not?

• Explanation of findings

• Add pictures to support findings

  Media

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

Reopen Visit Type and include 'ROD' if required

• Additional 'Post Checks' on this visit

• Job no

• Date of engineer visit

  Date

Customer Q&A

• Did the Engineer arrive within the set ETA?

  Yes

  No

• Did the Engineer keep you updated?

  Yes

  No

• Did the Engineer to through the job with you before starting?

  Yes

  No

• Comments

• Did the Engineer go through the job after completion?

  Yes

  No

• Comments

• Was there anything more the Engineer could've done for you?

  Yes

  No

• Comments

• Did the visit enhance your perception of Sky?

  Yes

  No

• Comments

• As a business was there anything more we could've done for you?

  Yes

  No

• Comments

• Additional comments about the visit

• Add pictures to support findings

  Media

• Evidence of H&S usage?

  Yes

  No

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Is further investigation required?

  Yes

  No

• Why not?

• Explanation of findings

• Add pictures to support findings

  Media

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

Reopen Visit Type and include 'ROD' if required

• Additional 'Post Checks' on this visit

• Job no

• Date of Engineer visit

  Date

Customer Q&A

• Did the Engineer arrive within the set ETA?

  Yes

  No

• Did the Engineer keep you updated?

  Yes

  No

• Did the Engineer to through the job with you before starting?

  Yes

  No

• Comments

• Did the Engineer go through the job after completion?

  Yes

  No

• Comments

• Was there anything more the Engineer could've done for you?

  Yes

  No

• Comments

• Did the visit enhance your perception of Sky?

  Yes

  No

• Comments

• As a business was there anything more we could've done for you?

  Yes

  No

• Comments

• Additional comments about the visit

• Add pictures to support findings

  Media

• Evidence of H&S usage?

  Yes

  No

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Is further investigation required?

  Yes

  No

• Why not?

• Explanation of findings

• Add pictures to support findings

  Media

• Job Type

  Select Service Install Install (multi-screen) MHO MHO (multi-screen) Other

  • Service
  • Install
  • Install (multi-screen)
  • MHO
  • MHO (multi-screen)
  • Other

• Record of findings (Quality of work, Customer satisfaction etc)

• Add pictures to support findings

  Media

Reopen Visit Type and include 'ROD' if required

DAMAGE CLAIM

THIS IS A STAND ALONE FORM AND SHOULD NOT BE USED ALONG SIDE ANY OTHER SECTION OF THIS DOCUMENT

Job Details

• Incident Number

• Date of Incident

  Date

• Location of Incident

• Customer Details

Engineer Details

• Engineer

• Tech Number

• Team Number

Person completing report

• Prepared by

• Date of TM site visit

  Date

Liability

• Do we accept liability?

  Yes

  No

• Record Of Findings Full details giving reason for denying or accepting liability with photographic evidence including report and clearly stating liability accepted/ denied

• Were there any witnesses?

  Yes

  No

• Witness details if not the person reporting the incident (only required if not the customer)

Photographs & Drawings

• Add pictures to support findings

  Media

• Add drawing to support findings (if required)

  Drawing

• Add drawing to support findings (if required)

  Drawing

Corrective Actions

• Has the person reported been made aware of the incident?

  Yes

  No

• H&S Dept notified?

  Yes

  No

• Is further investigation required?

  Yes

  No

• Who will carry out further investigation?

• Has incident report been completed on SOLARS?

  Yes

  No

• What corrective action has been taken to prevent a recurrence?

Customer

• What action has been agreed with customer?

• Customer Signature

  Sign

Email completed document to claimshandling@bskyb.com

INVESTIGATION

• Explanation of investigation (Reasons and findings)

• Add pictures to support investigation

  Media

• Is the Engineer present?

  Yes

  No

I certify that I attended an investigation meeting and will not disclose to any third party the information discussed at this meeting (other than for the purposes of seeking legal advice). Please note that any breach of this agreement may result in action under the company's disciplinary procedure.

• Engineer

  Sign

• Firstly, thank you for meeting me. Before we go any further you've signed the confidentiality agreement which I remind you means that you cannot discuss the content of this meeting with anyone.
  
  I am currently conducting an investigation and I would like to ask you some questions.
  Please be as open and honest as you can because it's important to me that I am able to gather all the facts.
  You should be aware that the notes from this discussion we have today may be used going forward in any formal process. This means that these notes may be provided to other employees who have been involved in the situation, if necessary to do so.

Reopen Visit Type to include 'ROD'

Reopen Visit Type and include 'ROD' if required

COACHING

• Reason for coaching

  Select NPS Technical Customer Service Quality Safety Other

  • NPS
  • Technical
  • Customer Service
  • Quality
  • Safety
  • Other

• Pre visit comments - What outcome is hoping to be achieved?

• Coach on site observations/ comments

• Engineer comments - What will you take away from today's session?

• Follow up details (if required)

• Review date

  Date

• Add pictures to support

  Media

EQUIPMENT INSPECTION (All inspections are carried out in accordance with the current HS&S Maintenance Schedules)

TAG COLOUR - YELLOW (March/April 2015)

THIS IS A STAND ALONE FORM AND SHOULD NOT BE USED ALONG SIDE ANY OTHER SECTION OF THIS DOCUMENT

Harness/ Cows Tail - These items have a working life (refer to ref guide)

• Harness

  Fit For Use

  Not Fit For Use

• Harness Serial no/ Date of manufacture

• Cows Tail

  Fit For Use

  Not Fit For Use

• Cows Tail Serial no/ Date

Kernmantle Rope/ Retractable Safety Line - These items have a working life (refer to ref guide)

• 15M Rope

  Fit For Use

  Not Fit For Use

• 15M Rope Serial no/ Date

• 10M Rope

  Fit For Use

  Not Fit For Use

• 10M Serial no/ Date

• 5M Rope

  Fit For Use

  Not Fit For Use

• 5M Serial no/ Date

• Retractable Safety Line

  Fit For Use

  Not Fit For Use

• Retractable Safety Line Serial no/ Date

• Rope Grab

  Fit For Use

  Not Fit For Use

Continuous Loop Webbing Sling Life - These items have a working life (refer to ref guide)

• Continuous Loop Webbing Sling

  Fit For Use

  Not Fit For Use

• Continuous Loop Webbing Sling Quantity

• Continuous Loop Webbing Sling Dates

• Adjustable (ratchet) Webbing Strap

  Fit For Use

  Not Fit For Use

• Adjustable (ratchet) Webbing Straps Quantity

• 10M Strap with Ratchet

  Fit For Use

  Not Fit For Use

• Karabiners

  Fit For Use

  Not Fit For Use

• Karabiner Quantity

Chimney Strop Life - These items have a working life (refer to ref guide)

• Chimney Strop

  Fit For Use

  Not Fit For Use

• Chimney Strop Serial no/ Date

Soft Sling Life - These items have a working life (refer to ref guide)

• Soft Slings (part of chimney kit)

  Fit For Use

  Not Fit For Use

• Soft Slings Dates

• Microlite

  Fit For Use

  Not Fit For Use

• Ladder Mate

  Fit For Use

  Not Fit For Use

• Ladder Spike

  Fit For Use

  Not Fit For Use

• Gravel Bag

  Fit For Use

  Not Fit For Use

• Cones X2

  Fit For Use

  Not Fit For Use

• Crawl Boards X2

  Fit For Use

  Not Fit For Use

• 10mm Eyebolts

  Fit For Use

  Not Fit For Use

• 10mm Eyebolt Quantity

• 12mm Eyebolts

  Fit For Use

  Not Fit For Use

• 12mm Eyebolt Quantity

• 20mm Eyebolt

  Fit For Use

  Not Fit For Use

• 20mm Eyebolt Quantity

Hard Hat - This item have a working life (refer to ref guide)

• Hard Hat

  Fit For Use

  Not Fit For Use

• Hard Hat Type

• Hard Hat Date/ Serial no

• Ladders

  Fit For Use

  Not Fit For Use

• Step Ladder/ Combi Ladder

  Fit For Use

  Not Fit For Use

• CAT Ladder

  Fit For Use

  Not Fit For Use

• Ear Protection

  Fit For Use

  Not Fit For Use

• Ear Protection Type

  In Ear

  Over Ear Cup

• Eye Protection

  Fit For Use

  Not Fit For Use

• Eye Protection Type

  Goggles

  Over Spectacles

  Both

• Knee Pads

  Fit For Use

  Not Fit For Use

• Manual Handling Gloves

  Fit For Use

  Not Fit For Use

• Hi-Viz Vest

  Fit For Use

  Not Fit For Use

• Dust Masks

  Fit For Use

  Not Fit For Use

• Boots

  Fit For Use

  Not Fit For Use

• SPECIALIST ENGINEER

DAT/ SAT Only

• 50M Rope

  Fit For Use

  Not Fit For Use

• 50M Rope Serial no/ Date

• Rocker

  Fit For Use

  Not Fit For Use

• Rocker Serial no

• Safety Ascender/Descender Device

  Fit For Use

  Not Fit For Use

• 30M x 7mm Static ACC. Cord

  Fit For Use

  Not Fit For Use

• Axel Belay Device

  Fit For Use

  Not Fit For Use

• Wire Rope Slings

  Fit For Use

  Not Fit For Use

• Wire Rope Slings Serial nos

• Delta Mailon

  Fit For Use

  Not Fit For Use

• Rope Protecters

  Fit For Use

  Not Fit For Use

• Pulley Blocks (fixed sheave)

  Fit For Use

  Not Fit For Use

• RGH16 Harness (life same as DTH)

  Fit For Use

  Not Fit For Use

• RGH16 Serial no/ Date

• Silverstar Helmet

  Fit For Use

  Not Fit For Use

• Silverstar Helmet Serial no/ Date

• 8 Rung Extension Ladder

  Fit For Use

  Not Fit For Use

• Ladder Clamp

  Fit For Use

  Not Fit For Use

• Conservatory Bearer Bar X2

  Fit For Use

  Not Fit For Use

• CAMP 30ltr Kit Bag

  Fit For Use

  Not Fit For Use

• NOTE - If any items are found to be defective they are to be isolated and replaced as soon as possible.

Engineers Van Safety Check

• Engineers are required to carry out daily and weekly safety checks on their vehicles. From September 2013, to ensure that the engineer is clear about how to carry out these checks, Team Managers should carry out the following as part of the six monthly safety checks.

• Van Registration

• Ask the Engineer to demonstrate how they carry out their daily and weekly checks, using the HS&S Vehicle checklist PDF on their iPads

  Satisfactory

  Unsatisfactory

• Visually check the items alongside the Engineer. If any defects are found record them in the comments section.

  Satisfactory

  Unsatisfactory

• Discuss any items, as appropriate, to test the Engineers understanding.

  Satisfactory

  Unsatisfactory

• Ask the Engineer if they have had any issues in the past six months, and whether these issues have been dealt with. If any issues are outstanding, record in the comments section.

  Satisfactory

  Unsatisfactory

• Where the Engineer shows any areas for improvement, coach accordingly and comment accordingly.

  Satisfactory

  Unsatisfactory

• Comments

• HS&S Vehicle Checks Reference Guide (tick box to view)

• 

ENGINEER DECLARATION: I confirm that by signing below the listed equipment has been issued to and is used by me. That no other equipment is used without authorisation, and a full inspection has been carried out by the HS&S - PPE & Equipment Examiner. I also confirm that I have carried out the vehicle checks in accordance with the Fleet directives.

121

• Reason for 121

  Select Praise/ Reward NPS Revisits Customer Service Technical Business Update Safety DriveSafe Personal Matter Other

  • Praise/ Reward
  • NPS
  • Revisits
  • Customer Service
  • Technical
  • Business Update
  • Safety
  • DriveSafe
  • Personal Matter
  • Other

• Current NPS YTD

  Select Below 65 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

  • Below 65
  • 65
  • 66
  • 67
  • 68
  • 69
  • 70
  • 71
  • 72
  • 73
  • 74
  • 75
  • 76
  • 77
  • 78
  • 79
  • 80
  • 81
  • 82
  • 83
  • 84
  • 85
  • 86
  • 87
  • 88
  • 89
  • 90
  • 91
  • 92
  • 93
  • 94
  • 95
  • 96
  • 97
  • 98
  • 99
  • 100

• Current revisit KPI % YTD

  Select Over 5 4.1 - 5 3.1 - 4 2.1 - 3 1.1 - 2 0.1 - 1 0

  • Over 5
  • 4.1 - 5
  • 3.1 - 4
  • 2.1 - 3
  • 1.1 - 2
  • 0.1 - 1
  • 0

• Details

• Tick box to open dialogue

• TM

• Engineer

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• Tick for more text boxes

• TM

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• Add pictures to support 121

  Media

• Agreed actions (if any to be reviewed)

ROD

• Reason for ROD

• Time and date of incident

  Date

• TM

• Engineer

• TM

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• TM

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• TM

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• Tick for more text boxes

• TM

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• Add media to support ROD

  Media

If more text boxes are needed please start a new ROD form

• Is further action required? (Last ROD page only)

If this is a breach of H&S the incident is required to be reported on SOLARS as a 'Near Miss'

• Has this ROD resulted in a suspension from duty?

  Yes

  No

• For the reasons discussed today you are now suspended from the work place on full pay until these matters can be fully investigated. In the first instance you will be suspended until -

  Date

• This matter will be kept confidential. If necessary your colleagues will be informed that your absence is for personal reasons.
  
  In the meantime we may need to talk to you about this issue during your suspension so you should be available for contact and to attend meetings if necessary during your normal working hours. You will be advised of the outcome of the investigation as soon as possible.
  
  Should you for any reason need to speak to one of your work colleagues or to come into your place of work you should contact me in the first instance for prior authorisation.
  
  If you would like any advice or guidance in relation to company polices or processes during your period of suspension please contact ER.

• Case Justification Form

• Please note to ensure we are operating efficiently there are mandatory parts of this form that need to be completed before submitting.
  Please review all information has been provided before submitting.

• Employee Business Area/ Dept

• Investigation Manager

• Investigation Manager Contact Number

• Details of reason for investigation (please detail the reason you started an investigation, summarise the discussion of each meeting and other findings)

• Summary of findings and recommendations (please detail the specific reason why you believe there is a cases to answer)

• CHECKLIST OF DOCUMENTATION
  
  MANDATORY DOCUMENTATION REQUIRED

• Investigation notes and relevant witness statements (Please ensure all customer details including names and addresses are removed before submitting. *It is preferable to use job numbers as a reference

• FOR HEALTH AND SAFETY CASES

• Photographs (eg - Photograph for job number xxxxxxxxx. Point of interest ie - The eyebolt has not been drilled (explain what the photograph refers to). Please write job numbers on the photographs)

• MFT print out/ paper risk assessment (If information is required from the risk assessment)

• HomeSafe Records (Please ensure records are dated, page numbers on each page and job numbers)

• Post Checks (Please ensure all have job numbers and dates on pages)

• Training Records (Detailing H&S training. This can be obtained by emailing Training Planning and providing employee name and ID number)

• FOR DRILLING CASES

• Relevant Policy (Please detail the policy which the investigation relates to eg - Disciplinary Policy)

• Current Sanction Details (If applicable, please detail any current sanction)

• Suspension Start Date or Extension Date

  Date

• Disciplinary Details

• Venue

• Date and Time

  Date

• Chair Name and Contact Number

• TM

  Sign

• Engineer

  Sign

Email a copy of this document to: admin.laserfiche@bskyb.com, yourself and your Regional Manager. Ensure you enter the engineers payroll number in the subject line. Your copy can be stored in your iBooks on your iPad for future reference (see iAuditor 'how to' for support)