*Trial Template* SHE : Health & Safety Site Assurance Audit

• Site conducted

  Select

• 

Document Reference Number

• OHSF-PR-08-01-01 Version 1 Revision 0 Dated 01/04/2022

• (Format:- City name - Job Pack / PN Number) E.g Aberdeen S12345 Always insert City name and Job Pack / PN number if known

• CityFibre Holdings Ltd, 15 Bedford St, London, WC2E 9HE

• Date and Time

  Date

Location

• Complete location on tracker
  Address

Contractor

• Who is the principle contractor?

  Select

• What is the name of the principle contractor?

• Please send an email to iAuditor.support@cityfibre.com detailing the contractor name and city.

• If you are auditing a sub-contractor, please provide the organisation name.

Reference materials (Streetworks Code of Practice etc.)

• Code of Practice (Red Book)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/safety-at-streetworks.pdf

• SROH/R (Reinstatement specification Highways/Road)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/SROF%20Scotland.pdf

• CDM Code of Practice
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/l153(1).pdf

• CityFibre Fibre Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SFI01%20-%20Fibre%20Specification.docx?d=wc41be78482c44d1eb56b968a21e799cf

• Code of Practice (Red Book)
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/safety-at-streetworks.pdf

• Specification for Reinstatement
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/sroh.pdf

• CDM Code of Practice
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/l153(1).pdf

• CityFibre - Fibre Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SFI01%20-%20Fibre%20Specification.docx?d=wc41be78482c44d1eb56b968a21e799cf

• CityFibre Civils Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SCI01%20Civils%20Specification%20FINAL.DOCX?d=wd74a900ece7f4ea7a299ef8fe7e99a04

• Contractor Monitoring Risk Assessment
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/3.%20%20OHSM%20Risk%20Assessments/OHSF%E2%80%93PR-03-01-019%20RA%20Monitoring%20Contractor%20Work%20Sites.doc?d=wc53e3603bd7a41198b86334459838ff2

• CityFibre Civils Specification Document
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/Compliance%20Department%20Folders/IAuditor%20Reference%20Matrials/CF-NOD-SCI01%20Civils%20Specification%20FINAL.DOCX?d=wd74a900ece7f4ea7a299ef8fe7e99a04

• Contractor Monitoring Risk Assessment
  https://cityfibreholdings.sharepoint.com/IMS/OHSMS/Shared%20Documents/3.%20%20OHSM%20Risk%20Assessments/OHSF%E2%80%93PR-03-01-019%20RA%20Monitoring%20Contractor%20Work%20Sites.doc?d=wc53e3603bd7a41198b86334459838ff2

Supervision

• Is there adequate, competent 'supervision' of the site activities?

  Yes

  No

  N/A

• Is there a supervisor on site?

  Yes

  No

  N/A

• Do you know who your Principle Contractor supervisor is and do you know how to contact them?

  Yes

  No

  N/A

• Has your supervisor visited the site in the last 24 hours?

  Yes

  No

  N/A

• Do you know where your NRSWA supervisor is?

  Yes

  No

  N/A

Documentation

• Has suitable Site Risk Assessment been conducted for the current operations?

  Yes

  No

  N/A

• Have all operatives signed the Risk Assessment or is there evidence of briefing?

  Yes

  No

  N/A

• Are Method Statements in use and applicable?

  Yes

  No

  N/A

• Are COSHH Assessment and Safety Data Sheets Available for all hazardous substances held on site?

  Yes

  No

  N/A

• Are utility drawings onsite and available?

  Yes

  No

  N/A

• Are utility drawings in date? (ordinarily 28 days from date of issue)

  Yes

  No

  N/A

• Is the F10 displayed/available on site?

  Yes

  No

  N/A

• Are HAVs being recorded?

  Yes

  No

  N/A

• Has the use of high-vibration tools been minimised?

  Yes

  No

  N/A

Noticing & Competence

• Are NRSWA Noticing / TTRO's in place, displayed and valid?

  Yes

  No

  N/A

• Have Streetworks personnel got the relevant NRSWA Cards and plant certificates available for inspection?

  Yes

  No

  N/A

• List Names of operatives sampled, separated by a comma.

• After talking to the workers have they been provided with everything required in order to do the job safely and succeed?

  Yes

  No

  N/A

• Are site First Aiders Qualified?

  Yes

  No

  N/A

• Is First Aid Kit Stocked suitably for the work being carried out and content in date? For guidance see INDG214, Q4

  Yes

  No

  N/A

Fire

• Are Fire Extinguishers available, charged, in date and in useable condition? (N/A if not required in CPP)

  Yes

  No

  N/A

Welfare

• Are drinking water and vessels made available to the operatives?

  Yes

  No

  N/A

• Are washing facilities available (including warm water, sink, soap & hand towels) available in conjunction with the Build Partner CPP (Construction Phase Plan)?

  Yes

  No

  N/A

• Are toilet facilities available in conjunction with the Build Partner CPP (Construction Phase Plan)?

  Yes

  No

  N/A

• Are suitable facilities on site or at a hub location for resting, drying PPE, warming food etc available in conjunction with the Build Partner CPP (Construction Phase Plan)?

  Yes

  No

  N/A

PPE

• For the following PPE options, please confirm they are in good condition and readily available when needed.

• Full Hi-Vis (Tabard & Trousers)

  Yes

  No

  N/A

• Safety Boots

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Dust Mask

  Yes

  No

  N/A

• Ear Defenders

  Yes

  No

  N/A

• Is PPE being worn correctly and appropriate for the works being conducted?

  Yes

  No

  N/A

• Is the CityFibre logo on the contractors PPE? (N/A if flame retardant PPE is required)

  Yes

  No

  N/A

• Is there suitable storage for PPE in the vehicles provided?

  Yes

  No

  N/A

• Is flame retardant PPE being worn by those undertaking excavations?

  Yes

  No

  N/A

• Is dust suppression being used during cutting activities?

  Yes

  No

  N/A

Barriers & Work Area

• Are Traffic / Pedestrian Segregation Barriers fitted, supported by suitable bases, linked together and enclosing all sides of the site?

  Yes

  No

  N/A

• Is all the working equipment contained within the barriered work area (Including spoil)?

  Yes

  No

  N/A

• Is spoil stored in appropriate area(s)? (Environmental considerations ie away from water courses & drainage)

  Yes

  No

  N/A

• Is work area of a suitable size to operate safely?

  Yes

  No

  N/A

• Have all excavation works taken place as advised by the NJUG tree protection zone?

  Yes

  No

  N/A

Traffic Management

• Is Traffic Management required?

  Yes

  No

• Is Traffic Management set up in accordance with Plan and assessment?

  Yes

  No

  N/A

• Is Traffic Management suitable for location and in good working condition?

  Yes

  No

  N/A

Signing Lighting & Guarding

• Are CityFibre approved Courtesy Boards displayed and do they contain correct information? (0800 083 6160 Number)

  Yes

  No

  N/A

• Are Advanced warnings signs in correct sequence, distance and suitably fixed to prevent being blown down or out of position?

  Yes

  No

  N/A

• Is the natural light, or temporary lighting (as in DRA), adequate for the works being carried out?

  Yes

  No

  N/A

Footways

• Are alternative pedestrian arrangements required? (i.e. Pedestrian re-routing, narrowing of walkway, road crossing)

  Yes

  No

• Are footway covers / boards in good condition, appropriately fitted and free of trip hazards?

  Yes

  No

  N/A

• Are pedestrian diversion routes clearly marked, visible, and correctly fitted?

  Yes

  No

  N/A

• Are footway closed signs in use?

  Yes

  No

  N/A

• Is the pedestrian walkway the correct width? (At least 1.2m)

  Yes

  No

  N/A

• Is there a safe method for pedestrians to avoid the road / carriageway whilst passing works?

  Yes

  No

  N/A

• Are carriageway trench boards suitable and fixed where in use?

  Yes

  No

  N/A

HSG47

• Are utility markings suitable and clearly visible?

  Yes

  No

  N/A

• Are insulated tools being used where required?

  Yes

  No

  N/A

• Are cable avoidance tool and genny readily available, and being used prior to breaking ground and at correct intervals?

  Yes

  No

  N/A

• Are operatives using CAT and genny trained and competent?

  Yes

  No

  N/A

• Is CAT and genny equipment calibrated and in good working order?

  Yes

  No

  N/A

• Please input the calibration/service date.

  Date

Other Plant & Equipment (excluding CAT and Genny)

• Are other Plant and Equipment required on site at time of audit?

  Yes

  No

  N/A

• Are Plant / Equipment etc in good operational order and being used correctly (clean, usable, beacons, safety pins etc)?

  Yes

  No

  N/A
Add information on other Plant / Equipment (excluding CAT and Genny)

• Please enter the name/type of the equipment.

• Please input the calibration/service date.

  Date

House Keeping

• Are excavated materials removed from the side of the excavation?

  Yes

  No

  N/A

• Are contaminated materials stored away from grass verge?

  Yes

  No

  N/A

• Are tools stored safely?

  Yes

  No

  N/A

• Are materials (reinstatement/excavated) stored correctly within the confines of the site/compound?

  Yes

  No

  N/A

• Are plant, fuelled tools and fuel cans being stored on plant pads?

  Yes

  No

  N/A

• Is the site swept clean after completion?

  Yes

  No

  N/A

• Is all plant attended whilst running?

  Yes

  No

  N/A

• Are vehicle keys stored outside of the vehicle when not in use?

  Yes

  No

  N/A

• Is duct stored correctly/safely?

  Yes

  No

  N/A

• Is there sufficient protection to prevent falls from height? (including on vehicles where required)

  Yes

  No

  N/A

• Is COSHH stored with appropriate labels and in approved containers?

  Yes

  No

  N/A

• Is there a site appropriate spill kit available for any environmental issues, fuel leaks etc

  Yes

  No

  N/A

Defects

• Are there any Streetworks Defects / Issues that have not been rectified at the completion of Site Visit?

  Yes

  No

• Please ensure you have informed all relevant parties of the defect(s) identified.

Good Practice

• Are there any exceptionally good safety behaviours or standards of work being exhibited?

  Yes

  No

• Who would you like to highlight?

  Contractor / Gang

  Individual

  Other

• If answer is other, please specify.

• Please name the group / individual you would like to highlight

• Which category best describes the good practice?

  Select

• Please describe the category of the work being recognised.

• Please give a description of the practice you have observed and would like recognised.

All personnel conducting site audits and inspections must ensure that all findings are recognised by the lead contractor representative on site (they do not have to agree the findings but must acknowledge your audit).

• Contractor Signature of recognition of findings

  Sign

• Auditor Signature

  Sign

• Please ensure all actions have been assigned where required.