Title Page

  • Contract Number

  • Job Number

  • Location
  • Date of inspection

  • Prepared by

  • Team Supervisor

  • Additional personnel on site

  • Brief description of work activity

  • Client

TSC - Work site

  • TSC Name

  • TSC possess valid competency card

  • TSC wearing appropriate armband

  • TSC briefing book completed correctly

  • Plant Equipment Materials (PEM) form completed

  • TSC possess WON

  • Correct PPE worn

PTS

  • All staff possess valid PTS competency card or TVP?

  • PTS staff received TSC brief and it is understood

  • All staff wearing correct PPE

ES

  • ES Name

  • ES possess valid competency card

  • ES wearing appropriate armband

  • Engineering supervisors certificate completed correctly

  • All TSCs signed in with ES

  • Plant Equipment Materials (PEM) form completed

  • Authority to start work received from PICOP

  • ES possess WON

  • Worksite marker boards (if required)

  • Worksite marker boards at least 100m from possession protection

  • Worksite marker boards at least 100m between worksites

  • Is the ES aware of any RRV/Engineering train(s) affecting the worksite?

  • Has the ES checked and cleared the worksite before lifting the marker boards

  • Has the ES lifted the worksite marker boards and communicated correctly with the PICOP to hand back the worksite?

  • ES wearing correct PPE

Rail Mounted Plant Compliance

  • RRVO possess valid competency card and authority to work card

  • Pre-use inspections carried out for all RRVs by the RRVO & countersigned by RRVC?

  • RRVC possess valid competency card

  • Plant Equipment Materials (PEM) form completed

  • Dispatch and Catch form completed (if required)

  • All RRVs have a valid Certificate of Engineering Vehicle Acceptance and a copy is kept in each item of plant?

  • Thorough examination certificates available for all Rail mounted plant?

  • Thorough examination certificates available for all lifting equipment?

  • Are trailers certified?

  • Tools and Equipment have reflective tape or paint and clearly visible? Example: RRV bucket painted?

PICOP

  • PICOP Name

  • PICOP possess valid competency card

  • PICOP wearing appropriate armband

  • Possession arrangements form completed correctly

  • Plant Equipment Materials (PEM) form completed

  • ES granted authority to start work

  • Token taken or three detonators 20m apart at both ends of possession

  • Possession limit indicator board at middle detonator

  • Protection is 400m ahead and rear of protecting signal/points/crossing

  • Hand signaller in appropriate place (if required)

  • PICOP possess WON

  • PICOP wearing correct PPE

Health and Safety

  • Daily Risk Assessment (DRA) available and signed off by all relevant staff?

  • All persons signed in/out of site?

  • Site Managers briefing Instruction completed and briefed to all relevant Safety critical staff in advance of works?

  • All site operatives inducted?

  • Staff appropriately trained for the works they are carrying out?

  • Method Statement & Risk Assessments (RAMS) available and signed by all relevant staff?

  • NI10 form available?

  • Permit to Work in place?

  • Correct PPE being worn? (Behaviour/Compliance)

  • Seat belts being worn when operating plant?

  • Suitable site access and egress?

  • Site security adequate? E.g. fencing, locked gates etc.

  • Housekeeping adequate? (Slips, trips, falls, adequate lighting)

  • Traffic management (signing / lighting / guarding) in place where applicable?

  • Excavations safely guarded / battered back?

  • Underground services identified? HSG47

  • Weekly inspection of excavations completed?

  • Overhead lines protected? GS6

  • Is there an appropriate lift plan in place?

  • Work at height properly planned?

  • Aluminium tower fit for purpose and appropriate inspections carried out?

  • Scaffolding fit for purpose and appropriate inspections carried out?

  • Work on or near water properly planned?

  • Measures in place to manage and control temporary works safely?

  • Asbestos Refurbishment & Demolition Survey Report / Register available?

  • Are toolbox talks being carried out weekly?

  • Are good catches being recorded?

Kit & Equipment

  • Tools and Equipment have reflective tape and clearly visible?

  • Weekly LOLER inspections completed?

  • Weekly PUWER inspections completed?

  • Thorough examination certs (TEC) available for all plant & equipment?

  • Thorough examination certs (TEC) available for all lifting equipment?

  • Daily plant inspections completed?

  • CAT & Genny available and calibrated?

  • Fire fighting equipment available?

  • First Aid Kit (FAK) & Eye Wash stations available?

  • Trained first aider on site and known to workers?

  • Welfare facilities in place and adequate?

  • Portable Appliance Testing (PAT) in place and up to date?

  • Any hazards that require immediate intervention not stated above?

  • Please state below any other observations identified on site

  • Please state below any other observations identified on site

  • Please state below any other observations identified on site

Environmental

  • All hazardous substances stored correctly? e.g. drip trays

  • All hazardous substances labelled correctly?

  • Spill kits available?

  • Waste disposed of correctly?

  • Dust and noise controls in place?

  • COSHH Assessments available?

  • Please state any other observations identified on site

Quality

  • Quality of works to an acceptable standard?

  • Company insurance policy available and in-date?

  • Company forms used in line with ISO procedures?

  • Company procedures adhered too?

  • Sub-contractors used for the works approved in line with company procedure?

  • Verification sub-contractor has implemented a modern slavery policy and were not in place has agreed to work under ACPL policy?

Signature

  • Add signature

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