WJ Worksite Inspection Form

• Inspection Location.

• Inspector.

• Client / Site

• Conducted on

  Date

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 1.2 - Are there any outstanding actions?

  Select Yes No N/A

  • Yes
  • No
  • N/A

2. First Aid Arrangements.

• Is there a nominated first aider/appointed person?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the First aider hold a copy of their certification?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has the First aider been identified?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has the nominated person access to nearest hospital details?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are the First aid facilities adequate and available at all times?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• When was the first aid kit checked last?

1. Controller of Site Safety.

• Is there a safe work pack for the work being undertaken?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have you had a COSS/SWL Brief?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the COSS/SWL in possession of their certification/passes?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the Safe Work Pack a cyclical/non cyclical pack?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have all staff signed onto the safe work pack?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has the safe work pack been authorised, verified and signed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the safe work pack include the emergency arrangements?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Name of the COSS/SWL.

• Safe Work Pack Number.

3.0 - Fire Prevention.

• 2.1 - Is there an evacuation plan displayed and available to all employees?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 2.2 - Are there adequate evacuation/fire assembly points in place?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 2.3 - Are there adequate fire Extinguishers in place for the type of material used?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 2.4 - When was the last date of service for the fire extinguishers?

• 2.8 - Are their adequate direction notices for fire exits?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 2.10 - Are all fire exits clear of obstructions?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 2.11 - What system is in place for raising the Fire alarm?

  Select Yes No N/A

  • Yes
  • No
  • N/A

3.0 - General Lighting

• Is their adequate lighting for access and egress?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 3.2 - Is there any lighting that will cause an issue with running trains?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 3.3 - Are all vehicles(including welfare vehicles) parked so that their lights do not cause a distraction to train drivers?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 3.4 - Is there any emergency exit lighting and is it operable?

  Select Yes No N/A

  • Yes
  • No
  • N/A

4.0 - Access and Egress.

• Are the authorised access points being used?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• |Is the site access/egress safe and secure?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has any Heras fencing used been checked for security and usability?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is there a site register for visitors/staff?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 4.2 - Entry and walkways kept clear?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 4.3 - Walkways adequately and clearly marked?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 4.6 - Are liquid spills removed quickly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 4.9 - Are footpaths in good condition?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 4.11 - Is the loading area clean and tidy?

  Select Yes No N/A

  • Yes
  • No
  • N/A

5.0 - Work tools and equipment.

• Are any calibrated tools in use calibrated and in date?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 5.3 - Are there any damaged hand tools in use?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are any tools, being used correctly and safely?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the correct PPE being used for the tools in use?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 5.4 - Are there any damaged power tools in use?

  Select Yes No N/A

  • Yes
  • No
  • N/A

6.0 - Rubbish Removal

• 6.1 - Are there bins located at suitable points around site?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 6.2 - Are the bins waste emptied/collected regularly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is all rubbish segregated into the correct receptacles?

  Select Yes No N/A

  • Yes
  • No
  • N/A

WPP/SWP/Task Briefing Sheets.

• Is there a WPP/TBS for the work being undertaken?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the WPP/TBS being followed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do all staff understand the task to be undertaken?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Section of the TBS checked

• Issues raised from the checking of the TBS.

Welfare.

• Has adequate site accommodation including messing facilities been provided?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If No, What has been provided?

• Are the facilities clean and tidy?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are the facilities easily accessible to all staff?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is there adequate facilities for seating, boiling water, and areas to prepare and eat food?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do the facilities have adequate heating and lighting?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have suitable toilets been provided and are they clean and tidy?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are there suitable means for staff to wash and dry their hands?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is their hot and cold running water?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• How is foul water discharged (into drain or kept)

• Are their adequate facilities for changing and drying wet clothes?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is drinking water provided?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is drinking water suitably and adequately identifiable?

  Select Yes No N/A

  • Yes
  • No
  • N/A

Rail.

• Do all staff have a valid and in date Sentinel Card?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Sample 1 PTS card and record findings?

• Do any staff appear to be affected by drugs or alcohol?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If so, Remove staff from site immediately

• Are all staff working within the 12 hours between shifts and 13 days consecutive procedures?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are all staff briefed and aware of emergency arrangements?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are all site safety notices correct and displayed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do the staff have access to the COSSH assessments?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do the staff have access to the Risk Assessments?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is all COSSH being stored correctly on site?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is all PPE issued being worn correctly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is all PPE being worn clean?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is there any feedback on the adequacy of PPE?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Type and Name of PPE Checked?

• Are manual handling methods being used?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is site access and egress lighting adequate?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is standby lighting available?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are vehicles parked safely and securely?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are spill kits provided for site and where is the location?

• Are there any safety or environmental concerns raised from staff onsite?

• Are there any safety or environmental concerns raised from the site supervisor?

• Do any staff wear contact lenses?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If so, Do they hold a spare pair of glasses?

  Select Yes No N/A

  • Yes
  • No
  • N/A

Behavioural Safety.

• Are individuals undertaking any tasks incorrectly?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are they aware of the correct processes?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has this been reported/identified before?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the individual aware of the correct processes after being informed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the individual wearing the correct PPE for the task?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the individual understand why they need to wear that type of PPE?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the individual need further training?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the training an company or individual need?

• Have any suggestions been provided for improvements and recorded for elevation?

  Select Yes No N/A

  • Yes
  • No
  • N/A

8.0 - Machinery and Plant.

• 8.3 - Guards in good condition?

  Yes

  No

  N/A

• 8.4 - Starting and stopping devices within easy reach of operator?

  Yes

  No

  N/A

• 8.7 - Adequate work space?

  Yes

  No

  N/A

• Is there any plant or machinery being used?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Any plant or machinery is it owned or hired in?

• Have the correct safety precautions been put in place prior to work starting?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the Plant/Machinery in an acceptable condition for working safely?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• When was the plant/machinery last checked/inspected?

• Are all staff wearing the correct PPE for the task being undertaken?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do the individuals using the equipment hold the correct certification?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is all plant and machinery being used/operated correctly and safely?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 8.12 - Operators trained/inducted into the operation of the machines?

  Yes

  No

  N/A

• 8.16 - Are any gas bottles secured?

  Select Yes No N/A

  • Yes
  • No
  • N/A

Wellbeing.

• Are there any signs of individuals struggling with their wellbeing?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has anyone raised any concerns?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Do they know how to manage their own wellbeing?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has anyone asked for additional support?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has a third party mentioned that an individual is struggling?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the individual know what help and support is availalbe?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has the individual been issued with a Personal wellbeing plan and do they know how to use it?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Will the alteration of work/shift patterns aid the individual?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Does the individual require any additional support?

  Select Yes No N/A

  • Yes
  • No
  • N/A

9.0 - Electrical Safety

• 9.4 - is any portable equipment tested and in date?

  Yes

  No

  N/A

• 9.5 - Are there any broken plugs, sockets or switches?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 9.6 - Are there any power leads trailing across walkways?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 9.7 - Are there any frayed or damaged leads being used?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 9.9 - Are all portable power tools in good condition?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 9.10 - Where required are emergency shut-down procedures in place?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Has the ECO been informed of any works in the substation?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are there any works on live equipment?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have the appropriate precautions been taken for any live works?

  Select Yes No N/A

  • Yes
  • No
  • N/A

10.0 - Chemical Safety

• 10.1 - Is there a COSHH assessment Register available?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 10.2 - Are the Material Safety Data Sheets available for all substances?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 10.3 - Have COSHH assessments been completed for all hazardous substances?.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 10.9 - Is the PPE required for the use of the substance being used and available?.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 10.10 - Is adequate ventilation provided?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 10.11 - Are eye washes and showers easily accessed?

  Select Yes No N/A

  • Yes
  • No
  • N/A

11.0 Ladders

• 11.1 - Are all ladders Industrial strength? (Non Household rated, check label.)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 11.2 - Are ladders in good condition?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 11.3 - If used for electrical work are they non conductive? (Wood or fibre glass.)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 11.4 - Used according to instructions?

  Select Yes No N/A

  • Yes
  • No
  • N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

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