Title Page
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Site conducted
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Contract Number
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Job Number
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Location
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Date of inspection
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Prepared by
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Team Supervisor
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Additional personnel on site
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Brief description of work activity
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Client
TSC - Work site
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TSC Name
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TSC briefing book completed correctly
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TSC possess valid competency card
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TSC wearing appropriate armband
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TSC possess WON
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Correct PPE worn
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Plant Equipment Materials (PEM) form completed
TSC - T2 Protection
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TSC Name
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T2 protection form completed correctly
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TSC briefing booklet completed correctly
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TSC possess valid competency card
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T-COD placed
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Red light placed in the five foot and clearly visible
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Suitable lookout protection placed (if required)
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TSC possess WON
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Correct PPE worn
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TSC wearing correct armband
PTS
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All staff possess valid PTS competency card or TVP?
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PTS staff received TSC brief and it is understood
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All staff wearing correct PPE
Lookout
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Lookout possess valid competency card
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Lookout wearing appropriate armband
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Lookout kit contain all items - flag/horn/whistle/light etc.
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Lookout mobile phone turned off
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Lookout(s) wearing correct PPE
PICOP
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PICOP Name
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Token taken or three detonators 20m apart at both ends of possession
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Possession limit indicator board at middle detonator
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Protection is 400m ahead and rear of protecting signal/points/crossing
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Hand signaller in appropriate place (if required)
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PICOP possess valid competency card
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PICOP possess WON
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PICOP wearing appropriate armband
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Possession arrangements form completed correctly
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ES granted authority to start work
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PICOP wearing correct PPE
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Plant Equipment Materials (PEM) form completed
ES
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ES Name
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Worksite marker boards (if required)
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Worksite marker boards at least 100m from possession protection
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Worksite marker boards at least 100m between worksites
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ES possess valid competency card
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ES possess WON
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ES wearing appropriate armband
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Engineering supervisors certificate completed correctly
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Authority to start work received from PICOP
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All TSCs signed in with ES
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Is the ES aware of any RRV/Engineering train(s) affecting the worksite?
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Has the ES checked and cleared the worksite before lifting the marker boards
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Has the ES lifted the worksite marker boards and communicated correctly with the PICOP to hand back the worksite?
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ES wearing correct PPE
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Plant Equipment Materials (PEM) form completed
Rail Mounted Plant Compliance
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All RRVs have a valid Certificate of Engineering Vehicle Acceptance and a copy is kept in each item of plant?
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Thorough examination certificates available for all Rail mounted plant?
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Thorough examination certificates available for all lifting equipment?
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Are trailers certified?
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Pre-use inspections carried out for all RRVs by the RRVO?
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RRVO possess valid competency card and authority to work card
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RRVC possess valid competency card
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Dispatch and Catch form completed (if required)
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Plant Equipment Materials (PEM) form completed
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Tools and Equipment have reflective tape or paint and clearly visible? Example: RRV bucket painted?
Health and Safety
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Daily Risk Assessment available and signed off by all relevant staff?
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Site Managers briefing Instruction completed and briefed to all relevant Safety critical staff in advance of works?
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Has all persons signed in/out of site?
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Has all relevant operatives completed the contract induction?
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Method Statement & Risk Assessments available and signed by all relevant staff?
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Relevant permit in place?
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Weekly LOLER inspections completed?
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Weekly PUWER inspections completed?
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Daily plant inspections completed?
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Plant Equipment Materials (PEM) form completed?
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Tools and Equipment have reflective tape and clearly visible?
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Thorough examination certs available for all plant & equipment?
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CAT & Genny available and calibrated?
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Thorough examination certs available for all lifting equipment and correct tag in place?
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Is there an appropriate lift plan in place?
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Is Portable Appliance Testing in place and up to date?
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Traffic management in place where applicable?
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Housekeeping adequate?
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Is site security adequate? E.g. fencing, locked gates etc.
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Is there suitable site access and egress?
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Suitable fire fighting equipment available?
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Suitable first aid box and eye wash stations available?
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Is there a suitably trained first aider on site and known to workers?
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Excavations safely cordoned off / battered back?
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Work at height properly planned?
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Scaffolding fit for purpose and appropriate inspections carried out?
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Aluminium tower fit for purpose and appropriate inspections carried out?
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Work on or near water properly planned?
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Measures in place to manage and control temporary works safely?
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Staff appropriately trained for the works they are carrying out?
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Are welfare facilities in place and appropriate?
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Correct PPE being worn? (Behaviour/Compliance)
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Is toolbox talks being carried out weekly?
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Is good catches being recorded?
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Any hazards that require immediate intervention not stated above?
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Please state below any other observations identified on site
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Please state below any other observations identified on site
Environmental
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All hazardous substances stored correctly? e.g. drip trays
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All hazardous substances labelled correctly?
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Spill kits available?
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Waste disposed off correctly?
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Dust and noise controls in place?
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COSHH Assessments available?
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Please state any other observations identified on site
Quality
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Company forms used in line with ISO procedures?
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Quality of works to an acceptable standard?
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Company procedures adhered too?
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Sub-contractors used for the works approved in line with company procedure?
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Verification sub-contractor has implemented a modern slavery policy and were not in place has agreed to work under ACPL policy?
Closing Summary
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