TSC Supervised Shift Report

• Track Safety Coordinator (TSC)

• Learner Name:

• Conducted on (Date and Time)

  Date
• Location
  Address

Pre-Work Checklist

• Wearing Full PPE? (Photograph of individual in PPE)

  Yes

  No

  N/A

• Specialist PPE required?

  Yes

  No

  N/A

• PTS Card present and in date with TSC competency? (Photograph of card)

  Yes

  No

  N/A

• Have they been briefed and signed the RAMS (Photograph of documents)

  Yes

  No

  N/A

• Are they fit and well and capable of carrying out the works?

  Yes

  No

  N/A

• Briefed and signed any tool box talks?

  Yes

  No

  N/A

• Are they carrying the relevant paperwork to carry out the SSOW?

  Yes

  No

  N/A

• Are the wearing the TSC armband and on display?

  Yes

  No

  N/A

• Have they checked all individuals PTS cards in their work group and ensure they are all fit to work?

  Yes

  No

  N/A

Observations and Questions T3 possession

• Has the TSC been briefed by the site manager and signed in (photograph of sign in and task briefing sheet)

  Yes

  No

  N/A

• Has the TSC been briefed by the ES and signed in to the worksite?

  Yes

  No

  N/A

• Has the TSC completed the correct paperwork and has all the relevant documents to carry out their duties? PEMS, TSC, WON etc.?

  Yes

  No

  N/A

• Has the TSC given a brief to all those in the work group?

  Yes

  No

  N/A

• Is the brief suitable, relevant to the worksite and contains all of the information required?

  Yes

  No

  N/A

• Is the TSC wearing the correct armband and on display?

  Yes

  No

  N/A

• Do they have adequate communication method? Phone etc?

  Yes

  No

  N/A

• Can they list the hazards of the worksite? (please list what they have identified)

  Yes

  No

  N/A

• Do they know the method of warning?

  Yes

  No

  N/A

• Do they know where the position of safety is?

  Yes

  No

  N/A

• Has the TSC shown awareness of their own safety as well as those in their group?

  Yes

  No

  N/A

• Has the TSC shown awareness of RRV movements?

  Yes

  No

  N/A

• Has the TSC continually monitored the worksite for hazards?

  Yes

  No

  N/A

• Has the TSC handed back the worksite to the ES, checked the area is clear and all tools and equipment has been taken off track?

  Yes

  No

  N/A

• Has the PEM form been signed off?

  Yes

  No

  N/A

• If any issues arose during the shift, did the TSC follow the required protocols and procedures, e.g. incident reporting?

  Yes

  No

  N/A

• Did the TSC ask any questions relevant to his/her duties? if so please list below and the answers you gave in return?

  Yes

  No

  N/A

• Did you have to correct any actions by the TSC, or step in on any safety critical aspects during the supervised shift of the TSC? If yes, please detail the actions taken and the results of the same.

  Yes

  No

  N/A

Completion

• Reference Guide:
  • Look at the total score above and select the relevant overall rating:
  
  Pass: 75%-100%
  Further development required: >75%

• Recommendations / Overall Competency Assessment Rating

  Passed

  Further development required

  Not satisfactory performance

• Supervisor (Full Name and Signature)

  Sign

• Learner (Full Name and Signature)

  Sign

Supervisor feedback and notes

• undefined