USE WORK RECORD

• Conducted on

  Date

• Prepared by

  Joseph Hammock

  Terence Rees

  Mitchell Marchant

• Client

• Job Number (photograph permit board if applicable)

• Location
  Address

• What is the planned activity?

  UPT

  Linestop

  Pipe cutting

  Insta-Valve insertion

• What is the diameter of the parent main?

• What is the diameter of the outlet?

• What diameter is the main?

• What diameter is the main?

• What diameter is the main?

PRE START SAFETY CHECKS

• Has permission been given for you to enter the site?

  Yes

  No

  N/A

• Have you signed in?

  Yes

  No

  N/A

• Has the Principal Contractor provided a site-specific induction?

  Yes

  No

  N/A

• Are you aware of the Fire and Emergency/Evacuation arrangements?

  Yes

  No

  N/A

• Are you aware of the First Aid arrangements?

  Yes

  No

  N/A

• Has Chapter 8 signing, lighting, guarding and traffic management been established?

  Yes

  No

  N/A

• Has a provision been made for parking and loading/unloading of vehicles safely?

  Yes

  No

  N/A

• Has a safe working area been provided, with segregation of the public and third parties?

  Yes

  No

  N/A

• Is the working area secure, with adequate provision for storage of equipment?

  Yes

  No

  N/A

• Are there adequate emergency escape routes from all areas of the site?

  Yes

  No

  N/A

• Has an adequate risk assessment been prepared for the tasks to be undertaken?

  Yes

  No

  N/A

• Do the RAMS address all the planned tasks and activities?

  Yes

  No

  N/A

• Are CoSHH Assessments available and been briefed?

  Yes

  No

  N/A

• Have the appropriate permits to work been issued by the asset owner (Water Authority)?

  Yes

  No

  N/A

• Have welfare facilities been arranged for the site - suitable for tasks/number of workers?

  Yes

  No

  N/A

• Do you have all the PPE required by the Risk Assessments and any client requirements?

  Yes

  No

  N/A

• Do you have the required skills and training records for the planned tasks?

  Yes

  No

  N/A

• Do you hold all required competency cards applicable to the scope of works?

  Yes

  No

  N/A

• Does the activity require entry into an excavation?

  Yes

  No

• Are the excavation dimensions adequate for the planned activity?

  Yes

  No

  N/A

• Is the excavation shored, supported or battered?

  Yes

  No

  N/A

• Is there a safe and secured method of access and egress?

  Yes

  No

  N/A

• Are barriers in position to prevent people or objects falling into the excavation?

  Yes

  No

  N/A

• Has edge protection, including guard rails and toe-boards been provided?

  Yes

  No

  N/A

• Has the excavation been assigned a confined space classification to NC standards?

  Yes

  No

• Which category of confined space?

  NC1

  NC2

  NC3

• Are all operatives entering the excavation confined space trained?

  Yes

  No

  N/A

• Have Rescue and Emergency Arrangements been established and briefed?

  Yes

  No

  N/A

• Has unauthorised entry to the excavation been prevented?

  Yes

  No

  N/A

• Are plant and materials stored at a safe distance from the excavation?

  Yes

  No

  N/A

• Has the excavation been inspected by a competent person at the start of the current shift?

  Yes

  No

  N/A

HANDOVER

• Was the activity completed as planned?

  Yes

  No

  N/A

• Did the work require a pressure test?

  Yes

  No

• What was the test pressure?

• What was the test duration?

• What was the test result?

  Pass

  Fail

Signed:

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