Information
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Client Name
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Job Address
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NAP/PTW Number
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Shutplan Number
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Conducted on
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Prepared by
Start Card
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Which SHEWMS apply to the work being performed?
- Valve Ops
- Live Traffic
- Confined Space Entry
- Working at Height
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Are there any site specific hazards that aren't captured in the SHEWMS?
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List the hazards and the controls you have applied.
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What controls have been put in place to manage the weather?
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Are any valves located in the road, or any other trafficable area?
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What traffic management is being used?
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STOP work until traffic control is in place. Notify your supervisor if controls are unsuitable or unavailable.
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Are the controls suitable for the works being performed?
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STOP work until suitable traffic control is in place. Notify your supervisor if suitable controls are unavailable.
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Has an emergency assembly point been established and communicated?
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Describe, draw or photograph the assembly point.
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Add drawing
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Add media
Sign on
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By signing, you confirm you have read and agree to all of the above.
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Nominate an assembly point before beginning works.
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Start travel
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Start on-site
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Finish on-site
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Finish travel
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Water off
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Water on
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Was there more than one shift on this job?
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Start travel
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Start on-site
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Finish on-site
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Finish travel
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Client representative sign-off
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Operator sign-off
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Comments
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Additional Photos
