Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Contractor

  • Contractor Details

  • Site Contact Person

  • CGL Rail Sponsor/Manager

  • Shift Configuration

  • Asset Area

  • Engineering Maintenance Task

  • Description of Task

  • Track Maintenance Task

  • Description of Task

  • Lifts or Escalators Maintenance Task

  • Description of Task

  • Communications Activity

  • Description of Task

  • Premises Activity

  • Description of Task

  • Signalling Maintenance Activity

  • Description of Task

  • Power Supplies Activity

  • Description of Task

  • Work Area

Authorisations and Approvals

  • Designated PICOW

  • Follow-up Action

  • Details of Observation

  • Track Awareness Cards

  • Follow-up Action

  • Details of Observation

  • Authority to Work

  • Follow-up Action

  • Details of Observation

  • Staff Sign On

  • Follow-up Action

  • Details of Observation

  • Safety Briefing

  • Follow-up Action

  • Details of Observation

  • RAMS

  • Follow-up Action

  • Details of Observation

  • Permit to Work

  • Follow-up Action

  • Details of Observation

Site Requirements

  • Site Setup

  • Follow-up Action

  • Details of Observation

  • Housekeeping

  • Follow-up Action

  • Details of Observation

  • Marker Boards

  • Follow-up Action

  • Details of Observation

  • Continuous barriers

  • Follow-up Action

  • Details of Observation

  • Worksite Lighting

  • Follow-up Action

  • Details of Observation

  • Material Storage

  • Follow-up Action

  • Details of Observation

  • Tester Prover

  • Follow-up Action

  • Details of Observation

  • Vehicle Safety

  • Follow-up Action

  • Details of Observation

  • Environmental

  • Follow-up Action

  • Details of Observation

  • Tools, Plant & Equipment

  • Follow-up Action

  • Details of Observation

  • First Aid

  • Follow-up Action

  • Details of Observation

  • Fire Extinguishers

  • Follow-up Action

  • Details of Observation

Human Factors

  • Behaviours & Attitudes

  • Follow-up Action

  • Details of Observation

  • Fatigue Management

  • Follow-up Action

  • Details of Observation

  • Communication & Teamwork

  • Follow-up Action

  • Details of Observation

  • Instruction & Supervision

  • Follow-up Action

  • Details of Observation

  • Training & Competencies

  • Follow-up Action

  • Details of Observation

  • Quality of Workmanship

  • Follow-up Action

  • Details of Observation

  • PPE

  • Follow-up Action

  • Details of Observation

  • Accident Reporting Knowledge

  • Follow-up Action

  • Details of Observation

Activities & Hazards

  • Working at Heights

  • Follow-up Action

  • Details of Observation

  • Lifting Operations

  • Follow-up Action

  • Details of Observation

  • Confined Spaces

  • Follow-up Action

  • Details of Observation

  • Manual Handling

  • Follow-up Action

  • Details of Observation

  • Chemical Hazards

  • Follow-up Action

  • Details of Observation

  • Noise, Fumes & Dust

  • Follow-up Action

  • Details of Observation

  • Hot Works

  • Follow-up Action

  • Details of Observation

  • Digital Devices

  • Follow-up Action

  • Details of Observation

  • Slips, Trips & Falls

  • Follow-up Action

  • Details of Observation

  • Electrical Hazards

  • Follow-up Action

  • Details of Observation

  • RRV Movements

  • Follow-up Action

  • Details of Observation

  • Overhead Hazards

  • Follow-up Action

  • Details of Observation

  • Mechanical Hazards

  • Follow-up Action

  • Details of Observation

Safe System of Work

  • Hazard Identification

  • Follow-up Action

  • Details of Observation

  • Effective Site Specific Controls

  • Follow-up Action

  • Details of Observation

  • Third Party Controls

  • Follow-up Action

  • Details of Observation

Quality of Work (where applicable)

  • Photographic Evidence

  • Follow-up Action

  • Details of Observation

  • Root cause of failure documented

  • Follow-up Action

  • Details of Observation

  • Defect rectification satisfactory

  • Follow-up Action

  • Details of Observation

  • Temporary fixes and/or return dates effectively communicated

  • Follow-up Action

  • Details of Observation

  • Parts to be sourced recorded effectively

  • Follow-up Action

  • Details of Observation

  • Assets left in a safe and functional condition

  • Follow-up Action

  • Details of Observation

  • PPM or Task Schedule delivered and appropriate documentation completed

  • Follow-up Action

  • Details of Observation

Comments, Notes or Commendations

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.