Worksite TSC - T3 Mentoring form

• Conducted on

  Date

• Location

• Service Order

• TSC Name

• Mentor Name

• TSC wearing correct PPE including correct armband

  Yes

  No

  N/A

• TSC has a valid PTS card with TSC competency

  Yes

  No

  N/A

• TSC has a fully charged mobile phone in event of emergency

  Yes

  No

  N/A

• TSC is not showing signs of tiredness or fatigue (i.e. excessive yawning, eye rubbing)

  Yes

  No

  N/A

• TSC understands the importance of working safely at all times, complying with the NIR rule book and Health and safety legislation.

  Yes

  No

  N/A

• TSC can set up a SSOW by making the necessary arrangements with the worksite ES.

  Yes

  No

  N/A

• TSC is aware of the individual roles and responsibilities of key personnel in the safe system.

  Yes

  No

  N/A

• TSC can complete the TSC briefing booklet and deliver a clear and concise brief to everyone.

  Yes

  No

  N/A

• TSC checks everyone going on or near the line has a valid PTS card and any other relevant competency.

  Yes

  No

  N/A

• TSC can communicate the SSOW to the working party.

  Yes

  No

  N/A

• TSC can communicate clearly with the worksite ES

  Yes

  No

  N/A

• TSC understands that your working group must not access track until the ES has set up their worksite and they have signed onto the ES form.

  Yes

  No

  N/A

• Understands what lines will be affected by rail mounted machines within the green zone and the limits of the worksite and this must be briefed to the working group

  Yes

  No

  N/A

• TSC can handback the site accordingly and checks that the track is left safe when work is complete, ensuring the track is clear of the working group, plant, materials, tools etc and is safe for the passage of trains.

  Yes

  No

  N/A

• TSC understands the need to sign ES certificate on completion of works.

  Yes

  No

  N/A

Feedback

• Please provide any further observations or feedback below:

Mentoring

• Does the learner require more mentoring?

  Yes

  No

  N/A