Information

  • Engineer details (inc payroll no)

  • Prepared by

  • Conducted on

  • Job No

  • Location

TM RISK ASSESSMENT

TM RISK ASSESSMENT

  • Are there any hazards?

  • Are hazards controllable?

  • Details

  • Visit type

HOMESAFE

  • Job type

  • Observation

  • Is the engineer working safely?

  • Risk Assessment

  • Details

  • Manual Handling

  • Details

  • PPE

  • Details

  • Damage Awareness

  • Details

  • Ladder type

  • 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

  • What's unsafe?

  • Add media

Change 'Visit Type' to include ROD and continue

  • After ROD - Further Actions?

RTW

  • First day of absence

  • Last day of absence

  • Absence reason

  • Is the absence work related?

  • Was this a linked absence?

  • Did engineer visit a GP during their absence?

  • Number of absences in rolling 12 months?

  • How many?

  • Occupational Heath referral required?

  • Add any pictures of 'Fit To Work' certificates

  • Additional information

Reopen Visit Type and include 'ROD' if required

CUSTOMER VISIT

  • Customer Visit type

  • Has a HomeSafe observation been completed?

  • Reason for no HomeSafe observation

  • Customers additional services

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

  • Add pictures to support findings

  • Job no

  • Date of engineer visit

Customer Q&A

  • Did the engineer arrive within the set ETA?

  • Did the engineer keep you updated?

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

  • Comments

  • Did the engineer go through the job after completion?

  • Comments

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

  • Comments

  • Did the visit enhance your perception of Sky?

  • Comments

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

  • Comments

  • Additional comments about the visit

  • Evidence of H&S usage?

  • Job Type

  • Is further investigation required?

  • Why not?

  • Explanation of findings

  • Add pictures to support findings

  • Job Type

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

  • Add pictures to support findings

Reopen Visit Type and include 'ROD' if required

DAMAGE CLAIM

  • Date of engineer visit

  • Explanation of damage

  • Is further action required?

  • Add pictures to support findings

Reopen Visit Type and include 'ROD' if required

INVESTIGATION

  • Explanation of investigation (Reasons and findings)

  • Add pictures to support investigation

  • Is the engineer present?

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

  • 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

  • Pre visit comments

  • Coach on site observations/ comments

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

  • Follow up details (if required)

EQUIPMENT TAGGING

Harness/ Cows Tail Life - 7 years from FIRST USE or 10 years from date of manufacture

  • Harness

  • Harness Serial no/ Date

  • Cows Tail

  • Cows Tail Serial no/ Date

Kermantle Rope/ Retractable Safety Line Life - 5 years from FIRST USE or 10 years from manufacture

  • 15M Rope

  • 15M Rope Serial no/ Date

  • 10M Rope

  • 10M Serial no/ Date

  • 5M Rope

  • 5M Serial no/ Date

  • Retractable Safety Line

  • Retractable Safety Line Serial no/ Date

  • Rope Grab

  • Reusable Eyebolts

  • Continuous Loop Webbing Sling

  • Adjustable (ratchet) Webbing Strap

  • 10M Blue Strap with Ratchet

  • Karibeeners

Chimney Strop Life - 8 years from FIRST USE

  • Chimney Strop

  • Chimney Strop Serial no/ Date

  • Soft Slings (part of chimney kit)

  • Microlite

  • Ladder Mate

  • Ladder Spike

  • Gravel Bag

  • Cones X2

  • Crawl Boards X2

Hard Hat Life - 5 years

  • Hard Hat

  • Hard Hat date

  • Ladders

  • Step Ladder/ Combi Ladder

  • CAT Ladder

  • Ear Protection

  • Knee Pads

  • Manual Handling Gloves

  • Hi-Viz Vest

  • Dust Masks

  • Boots

  • SPECIALIST ENGINEER

DAT/ SAT Only

  • 50M Rope

  • 50M Rope Serial no/ Date

  • Rocker

  • Rocker Serial no/ Date

  • 30M x 7mm Static ACC. Cord

  • Axel Belay Device

  • Wire Rope Slings

  • Delta Maillon

  • Pulley Blocks (fixed sheave)

  • RGH16 Harness (life same as DTH)

  • RGH16 Serial no/ Date

  • Silverstar Helmet

  • Silverstar Helmet Serial no/ Date

  • 8 Rung Extension Ladder

  • Ladder Clamp

  • Conservatory Bearer Bar X2

  • CAMP 30ltr Kit Bag

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

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.

ITEM DROP OFF/ PICK UP

  • Details of item

  • Is engineer working safely?

  • Is further investigation required?

  • Why?

Reopen Visit Type and include 'ROD' if required

  • Add pictures to support document

121

  • Reason for 121

  • Current NPS YTD

  • Current revisit KPI % YTD

  • Details

Reopen Visit Type and include 'ROD' if required

  • Add pictures to support 121

ROD

  • Reason for ROD

  • Time and date of incident

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

  • TM

  • Engineer

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

  • Has this ROD resulted in a suspension from duty? (last ROD page only)

  • 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 -

  • 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 GHR.

  • TM

  • Engineer

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)

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.