Worksite Protection Inspection

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Worksite Protection Officer Name?

• RSW number & Expiry?

• Worksite Location?

Pre-Work briefing

• Was the current TFNSW Pre-Work briefing form used?

  Yes

  No

  N/A

• Worksite location shown and is accurate?

  Yes

  No

  N/A

• Briefing date is correct?

  Yes

  No

  N/A

• Scope and site supervisors details shown and accurate?

  Yes

  No

  N/A

• Relevant check boxes on the rear of the briefing used?

  Yes

  No

  N/A

• Emergency assembly point identified?

  Yes

  No

  N/A

• First aid kit location and first aides identified and correct?

  Yes

  No

  N/A

• Are the responsible persons for the control to the identified risks identified and accurate?

  Yes

  No

  N/A

• Are the relevant rail safety hazards identified?

  Yes

  No

  N/A

Worksite Protection Plan

• Was the TFNSW WPP used?

  Yes

  No

  N/A

• Weather entered?

  Yes

  No

  N/A

• Have the network control officer details been recorded?

  Yes

  No

  N/A

• Has the Worksite Protection Plan been signed?

  Yes

  No

  N/A

• PO level correct for the method of Safeworking being applied?

  Yes

  No

  N/A

• Scope of work shown correctly?

  Yes

  No

  N/A

• Authority number entered?

  Yes

  No

  N/A

• Start and finish entered?

  Yes

  No

  N/A

• Has the certificate number been recorded on the WPP?

  Yes

  No

  N/A

• Has the CSN been entered?

  Yes

  No

  N/A

• Protection Officers diary used and all relevant information recorded?

  Yes

  No

  N/A

• Worksite location shown?

  Yes

  No

  N/A

• Safe place shown?

  Yes

  No

  N/A

• Protection shown? (Dets/Clips/Token)

  Yes

  No

  N/A

• Tracks affected or adjacent shown?

  Yes

  No

  N/A

• Access / Egress shown?

  Yes

  No

  N/A

• Emergency Assembly shown?

  Yes

  No

  N/A

• Contract Panel Name?

  MCR

  Swetha

  Skilled

  Infraworks

• When did you last take a LOW?

  Yes

  No

  N/A

• When did you last take a ASB?

  Yes

  No

  N/A

• When did you last take a TOA?

  Yes

  No

  N/A

• When did you last take a TWA?

  Yes

  No

  N/A

• When did you last take a LPA?

  Yes

  No

  N/A

• Comments / Observations / Corrective Actions

• Protection Officer Name?

  Sign

• Person completing inspection?

  Sign