Xylem Water Solutions site audit

• Document No.

• Xylem Water Solutions

• Conducted on

  Date

• Prepared by

• Location
  Address

• Names of operators on site

Site/Situation

• 1) Have operatives signed into the site register?

  Yes

  No

  N/A

• 2) Is TM set up to site requirements of Chapter 8?

  Yes

  No

  N/A

• 3) NRSWA, will any person on footpath/road from any direction understand what is happening and what is expected of them?

  Yes

  No

  N/A

• 4) Are all vehicles parked safely without causing unnecessary obstruction?

  Yes

  No

  N/A

• 5) Is the work area protected by a physical barrier ( cones, roping, boards, plastic barriers)?

  Yes

  No

  N/A

Scope of works

• Type of plant

  Select pump station septic tank treatment plant other

  • pump station
  • septic tank
  • treatment plant
  • other

• Before photo

  Media

• After photo

  Media

• Condition

• Depth ( measured in metres)

• Width ( measured in metres)

• Length ( measured in metres)

Equipment

• 8) Is safety equipment relevant for this site/in calibration/ dated correctly

  Yes

  No

  N/A

• 13) If fire extinguisher is present, is it inspected and in date?

  Yes

  No

  N/A

• 14) If trailer is being used to transport equipment, has a light board been fitted? Has a safety chain been used? Are items on the trailer securely placed?

  Yes

  No

  N/A

• 15) Expanding manhole grid/barrier

  Yes

  No

  N/A

• 16) Gas monitors

  Yes

  No

  N/A

• 17) Tripod and winch

  Yes

  No

  N/A

• 18) Harness and lanyard

  Yes

  No

  N/A

• 19) Communication equipment available ( phones or radios)

  Yes

  No

  N/A

H&S E&Q

• 21) Is the working area clean and tidy?

  Yes

  No

  N/A

• 22) Is there suitable PPE for all staff on the site (hard hat, visor, goggles, overalls, hi viz, safety boots, gloves)?

  Yes

  No

  N/A

• 23) Is PPE in good condition and being worn at time of audit?

  Yes

  No

  N/A

• 24) Have crew received IWJS induction and if required induction by client?

  Yes

  No

  N/A

• 25) Do crew have correct training for work being carried out?

  Yes

  No

  N/A

• 26) Has dynamic risk assessment been completed and is it relevant and adequate for the work being carried out?

  Yes

  No

  N/A

• 27) Have operatives been briefed on the works being undertaken and is there a relevant method statement available?

  Yes

  No

  N/A

• 28) Is the site safety file/gang pack available and up to date and are contents understood?

  Yes

  No

  N/A

• 30) Welfare facilities - are they clean and good working order?

  Yes

  No

  N/A

Vehicle

• 6) Cleanliness - bodywork

  Yes

  No

  N/A

• 10) Awareness of vehicle weight and height

  Yes

  No

  N/A

• 11) Tax disc

  Yes

  No

  N/A

• 12) O license disc

  Yes

  No

  N/A

Documents

• 13) Transfer note

  Yes

  No

  N/A

• 14) Work pack / work instruction

  Yes

  No

  N/A

• 15) Permit to work / permit to enter CS

  Yes

  No

  N/A

• 17) Identity cards

  Yes

  No

  N/A

• 19) NRSWA red book

  Yes

  No

  N/A

• 20) Leptospirosis card

  Yes

  No

  N/A

Stock list

• Are an appropriate number of the correct cones available?

  Yes

  No

  N/A

• Are correct jetting nozzles available, stored correctly and in good order?

  Yes

  No

  N/A

• Are appropriate hand tools available ?

  Yes

  No

  N/A

• Is spillage kit available?

  Yes

  No

  N/A

• Carrying chapter 8 ?

  Yes

  No

  N/A

• Are suitable hand cleansing materials available ?

  Yes

  No

  N/A

• Digital camera?

  Yes

  No

  N/A

• Signature.

  Sign

• Comment.

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Auditors signature

  Sign

• Employees signature

  Sign

• Employees signature

  Sign