Title Page
-
Projects
-
Conducted on
-
Prepared by
-
Location
-
Personnel
Key Information
-
Description of Work:
Site Access
-
Have you got an STW induction card?
-
Card Number:
-
Do you have a valid copy of the customer authorisation for the task?
-
Do you have a copy of the customer safety rules handbook?
-
Are you aware of the closed gate policy?
-
Have you signed in/fobbed in/completed workbook?
Risk Assessments/Method Statements
-
Are the risk assessments/method statements in date?
-
Does the risk assessment cover all hazards where you are working?
-
Is the method statement being followed?
-
Are emergency arrangements in placw/understood?
-
Has a briefing taken place?
-
Has the method statement been signed?
-
Has a dynamic risk assessment been completed at the start of the task?
PPE
-
Do you know the mandatory PPE requirements for customer sites?
-
Are you aware of your responsibility under the PPE Regulations 1992?
-
Wearing hi vis polo shirt/vest (class 3) in good condition?
-
Wearing hard hat/bu,p cap in good condition?
-
Wearing appropriate footwear in good condition?
-
Wearing appropriate gloves in good condition?
-
Wet weather coat available and in good condition?
-
Hearing protection immediately available?
-
Eye protection immediately available?
Specialist PPE
-
Is a safety harness being used?
-
Is the harness in good condition?
-
Is the harness inspected/recorded?
-
Is the harness being used correctly?
-
Is a lanyard in use?
-
Is the lanyard in good condition?
-
Is the lanyard inspected/recorded?
-
Is the lanyard being used correctly?
-
Is a safety line in use?
-
Is the safety line in good condition?
-
Is the safety line inspected/recorded?
-
Is the safety line being used correctly?
-
Are waterproof suits being used?
-
Is the suit in good condition?
-
Are needle resistant gloves being worn?
-
Are the gloves in good condition?
-
Is respiratory apparatus being used?
-
Is the respirtory apparatus in good condition?
-
Is the respiratory apparatus in test?
-
Is the respiratory apparatus being used correctly?
-
Is a gas monitor being used?
-
Is the gas monitor calibrated?
-
Is the gas monitor being used correctly?
Vehicle and Plant
-
Do you have a CPC card available?
-
Do you have appropriate licences for the equipment being used?
-
Is the vehicle in good condition?
-
Do you have a defect book?/using r2c?
-
Have the defect sheets been completed?
-
Have any defects been logged?
-
List any defects highlighted:
-
Has a forward facing camera been fitted?
-
Is the forward facing camera in working condition?
-
Is the camera being used correctly?
-
Has the memory card been formatted?
-
Has the working area been considered for the vehicle/plant/operation?
Hygiene
-
Is a pink leptospirosis/clean water card available?
-
Are hand wipes/antibacterial gel available?
-
Do you have access to washroom/hand dispenser?
First Aid
-
Is a first aid kit available?
-
First Aid Kit Number:
-
Is the first aid kit in date?
-
Is the first aid kit complete?
-
Is the first aid kit stored in an appropriate place?
-
Are you aware that first aid training is available?
Isolation and LOTO
-
Are isolations in place for the task?
-
Are you aware of the LOTO procedure?
-
Are you trained in the isolation procedure?
-
Is a personal safety lock available?
-
Are all isolations locked and tagged?
Overhead Power Lines
-
Are there overhead power lines on site?
-
Are you aware of vehicle/equipment height when working near power lines?
-
Are signs/barriers/cones in use?
-
Are signs/cones/barriers in good condition?
-
Are goal posts in use?
-
Are you aware of the distances to keep equipment from overhead power lines? (15m)
Signage - Working on the Highway
-
Does traffic management apply?
-
Are suitable barriers/signs/cones in use?
-
Are the barriers/signs/cones in good condition?
-
Is the correct PPE being worn? (Class 3)
-
Have you completed streetworks training?
Working at Height
-
Are staff working at height?
-
Are you aware that you are working at height?
-
Is WAH the best solution for the task?
-
Have appropriate control measures been implemented for the task?
-
Are 3 points of contact maintained when entering/exiting a vehicle?
-
Are ladders being used?
-
Are the ladders in good condition?
-
Are the ladders inspected and recorded?
-
Is a scaffold being used?
-
Has the scaffold been erected by a severn trent approved supplier?
-
Is the scaffold inspected and in date?
-
Is a mobile elevated working platform (MEWP) being used?
-
Is the MEWP in test?
-
Is a copy of the certificate available?
-
Has training been undertaken to operate MEWP (provide evidence)
Working with Electrical Equipment
-
Is electrical equipment being used?
-
Have battery powered tools been considered?
-
Are 110v tools being used?
-
Are all electrical tools portable appliance tested?
-
Are electrical tools in good condition?
Confined Spaces
-
Does the task involve confined spaces?
-
Has the operative got in date qualifications?
-
Has the confined spaces been assessed?
-
Has appropriate signage been used?
-
Have all entry procedures been adhered to?
-
Has a rescue plan been arranged and communicated?
-
Are gas monitors being used?
-
Is fixed ventilation being used?
-
Has the fixed ventilation been inspected and in date?
-
Is the fixed ventilation in good condition and in working order?
-
Is portable ventilation being used?
-
Is the portable ventilation sufficient for the task?
-
Has the portable ventilation been inspected?
-
Is the portable ventilation in good condition and in working order?
-
Is breathing apparatus being used?
-
Is the breathing apparatus tested and in date?
-
Is the breathing apparatus in good condition and in working order?
-
Is the breathing apparatus being used correctly?
-
Are escape sets being used?
-
Are the escape sets inspected and in date?
-
Are the escape sets in good condition?
COSHH
-
Are COSHH assessments available?
-
Are COSHH assessments in date?
-
Are there any containers available?
-
Are the containers correctly labelled?
-
Are substances stored correctly?
-
Is the correct PPE available for the substances?
-
Is a spill kit available?
Reporting
-
Are you aware of what to do in an emergency?
-
Do you know how to report hazards/safe acts/accidents/near misses?
-
Are you lone working?
-
Is the lone working procedure being followed?
-
Are you working to the working time policy?
Work Environment
-
Have you undertaken any manual handling training?
-
Is the standard of housekeeping good in the work area?
-
Is the lighting for the work area adequate?
-
Is the ventilation for the work area adequate?
Lifting Equipment
-
Is lifting equipment being used?
-
Are thorough examination certificates available?
-
Is all lifting equipment tagged?
-
Has lifting equipment been inspected?
-
Is lifting equipment in good condition?
-
Is lifting equipment