Planned General Inspection Safety & Environment Form.

(F073) Inspection Record

Name of Inspector Location Contractor Date of Inspection Project / Activity Contractor Site Supervisor

When undertaking your inspection, rate each category with a score of between 1 and 10. - 1 to indicate no evidence or a total lack of management control and10 to indicate excellent management systems with good supporting evidence.

If a category, i.e. like scaffolding, is not relevant to the site being inspected, put an X in the N/A.
Items Checked 1. General Documentation
1.1 Have corrective actions from previous inspection been closed out? 1.2 Are accident / incident records and reporting arrangement adequate for the site? 1.3 If applicable, i.e. in a site office, Is there a signed, dated and Network Rail approved Project Construction Phase Plan for the site? - Are high Risk activities identified and do they form part of the plan as per the WPP process.

Rating

N/A

Items Checked 2. Construction Safety

2.1 Scaffolding - Is there evidence that a competent scaffolder has erected the scaffolding? - Is there an approved Form B Is there evidence that it is being inspected regularly by a competent person? Is unauthorised access to the scaffolding being properly controlled? Have hazards associated with the scaffolding been properly addressed trip hazards; scaffolding caps; falling tools, etc. If a free standing mobile tower is used, are all Wheels locked and the base secured? 2.2 Ladders - Are ladders erected and secured correctly? - Are the ladders non-conductive and in good Repair - Are ladders tagged and dated 2.3 Buried Services and Excavations - Is there evidence that buried service Information is kept on site? - Have buried services been identified and Marked out? - Is there a permit to dig system in place and evidence of it being used? - Are barriers in place to prevent people falling Into the excavation? - Have hazards created by weak/unstable excavated areas been addressed by Shuttering/sloping the sides of the excavation? - Is there evidence that persons undertaking CAT scanning is competent to do so? - Is the CAT scanner approved for use and within Calibration date? - What type of CAT scanner is being used?

Rating

N/A

1.4 Are Task Briefing Sheets available on site, signed and approved by the CRE? - Is it appropriate to the task and location? - Is there evidence that the task briefing sheet has been briefed to those on site? - Does it identify all site & task risk controls? - Are site drawings marked up Approved for Construction? 1.5 Are risk assessments available on site? - Is there evidence that those on site are aware of the risks associated with the works?

1.6 Are specific access permits required for the work being undertaken - Have they been issued in accordance with local procedures? 1.7 Does the site have displayed/available and approved F10; HASAW Notice; Emergency contact Details; 1.8 Is there evidence that contractors have undertaken their own site inspections of the site in accordance with their H&S Plan? - What was the date of the last contractor inspection? Date:

2.4 Manual Handling - Is there evidence that manual handling Assessments have been undertaken? - In your opinion are manual handling activities being undertaken correctly? 2.5 Cranes and Hoists - Is there a lifting plan on site? - Is the lifting Supervisor competent? - Is the static lifting equipment marked with a SWL? - Is there evidence that slings and lifting tackle are in date? - Are hazards associated with the lift being adequately controlled Falling loads, interfaces with the operational railway, public entering the lift zone

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Items Checked
2.6 Site Vehicles and Mobile Plant. - Are parking arrangements adequate for site vehicles? - Is mobile plant approved for use on the Infrastructure? - When mobile plant is not in use are keys removed from ignition and is vehicle left in a secure state? 2.7 Health Hazards - Have health hazards been considered? - is exposure to sharps a problem and are ....issues adequately controlled? - Does the contactor have appropriate means for disposing of sharps? - Is exposure to Leptispirosis /psittacosis a problem and is it being adequately controlled?

Rating

N/A

Items Checked 3 General Arrangements (Continued)

3.8 Security and Storage - Is the work site secured to prevent access by Unauthorised personnel? - Are all authorised access points / gates Secured when not in use? Is there safety signage displayed at the site Entrance? Are chemicals / flammable substances, etc adequately stored? 3.9 First Aid - Are arrangements appropriate for site? - Are adequate First Aid Materials on site? - Are there Approved First Aiders on site? 3.10 Tools and Equipment - Are all tools and equipment in good working order? - Are they appropriate for the tasks being undertaken? - Are they insulated as appropriate?

Rating

N/A

2.8 Electrical Plant and Equipment. - Is plant and equipment being operated by competent persons? (Ask for proof of competence) - Is there evidence that a competent person has tested the electrical equipment? - Is all portable electrical equipment operated at a low voltage 110v? - Is all portable electrical equipment tagged to show inspections date requirements?

4 Contractor Staff
4.1 Safety Brief - When did staff last receive a safety brief/tool Box talk? - Is there evidence of the safety brief/ toolbox talks taking place? - What was the date & topic of the last safety brief/toolbox talk?

3 General Arrangements
3.1 Welfare Facilities - Have adequate toilets/washing/drying facilities been provided? - Is welfare in line with current Network rail GuidanceNR/PRC/MPI/CP0036 3.2 Fire Arrangements - Is there appropriate fire fighting equipment on Site? - Are extinguishers tested and in date? - Is there a Fire Assembly Point clearly marked on site? - Are contractors adhering to the No Smoking Policy? - Are no smoking areas clearly marked and being adhered to, where appropriate? - Are Fire Doors and escape routes clear of Obstacles and tripping hazards? 3.3 Site Tidiness - Are tools, plant and equipment put away after use? - Are on site materials adequately stored so that they do not block walking routes? 3.4 Housekeeping - How clean is the site?

4.2 Hazard Awareness - Are staff on site aware of the main hazards Associated with their work? - Aware of Worksafe Procedure? 4.3 Method of Work - Is it in accordance with Work Package Plans, Risk assessment, briefing. 4.4 PPE - Is PPE branded/approved for use and being worn in accordance with requirements? - Is PPE to current standard? - Has PPE been considered for night time work 4.5 Competence. - Are contractor staff in possession of proof of competence certification for the task they are undertaking ?

Working on site

5.1 Signing In - Have all staff received site induction? - Have all site personnel received the safety arrangements brief and signed the Appropriate documentation? 5.2 Sample Check Validity of Two PTS Cards 1.Name: Sentinel Number: 2 Name: Sentinel Number:

3.5 Lighting and Heating - Are they adequate for environment? 3.6 Access, Egress and Walkways. - Are walking routes kept tidy and free from obstruction? 3.7 Work Activities. - Are they being undertaken safely? 5.3 Check Validity of COSS Card? 1.Name: Sentinel Number:

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Items Checked 5 Working On or Near the Line.

5.4 RIMINI Plan - Has one been produced? - Is it appropriate? 5.5 Green Zone Working - Has the Green Zone, been correctly defined, controlled and maintained? - If in a fenced green zone, is the fencing Adequate? - If a Site Warden is used are they clear as to the role they are performing? 5.6 Red Zone Working. - Has an approved Red Zone Working risk Assessment been completed? - Are staff aware of their position of safety? - Have Lookouts / Hand signalmen been appointed? - If yes, have they got the correct Equipment and are identifiable? 5.7 T(ii) H. - If the T(ii)H was planned, is it in accordance with the published details? - Has the Signaller been contacted and details suitably communicated?

Rating

N/A
-

Items Checked 7 Railway & Public safety

7.1 Public Safety - Is work being adequately controlled so that members of the public are not put at risk by it? 7.2 Operational Safety - Is the operational infrastructure protected for example is the OHLE protected from accidental strike by lifting equipment

Rating

N/A

8 Environment
8.1 Waste Management - Is site waste being properly controlled? - Is it segregated? - Is there evidence of waste being removed by a licensed carrier? 8.2 Noise /lightning & Vibration - Is noise/lighting and vibration being adequately Controlled? - Was a Section 61 consent required for the site, and if so, was one applied for? 8.3 Fumes and Dust

- If fumes or dust is an issue on site is it being properly controlled?

8.4 Pests - Are pests (e.g. rats) a site issue and are they being controlled? 8.5 Oil Spills - Could water pollution due to an on site oil spill be an issue? - Are spill kits present on site? - Are spill kits appropriate? - Have personnel received spill kit training?

6 Possessions and Isolations

6.1 Check Validity of PICOP Certificate Name: Sentinel No:

6.2 T(iii) Documentation - Is it complete - Is it accordance with the details published in the WON 6.3 Site Limits - Are the site limits demarcated in accordance with the T(iii) documentation? - Are staff aware of the limits

8.6 Crime and Vandalism - Is the site a crime and vandalism hotspot? - Are security arrangements appropriate? - Are tools and equipment locked away after use? 8.7 Fly Tipping - Is the site tidy? - Is fly tipping an on site issue? - is there redundant material left lying around ? 8.8 Vegetation - Is there a tree preservation order? - Is there Japanese Knot Weed on site? 8.9 SSSI Sites? -Is the site a SSSI site and are staff aware of this? 8.10 Environmental Plans - Is there an Environmental Emergency Plan on ..Site? - Is there a Site Waste Management Plan?

6.4 Communication Arrangements - Do communication arrangements appear to be working effectively? 6.5 Isolations - Has a Form C been issued? - Are staff aware of the isolation limits? - Have earthling straps been applied Correctly?

Any Other Comments

Signature of Inspector Signature of On Site Supervisor

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Please list the Corrective Actions below identified during your Inspection and agree an action plan with the Contractor Site Supervisor in order to close them out.
Action Levels = H Requiring Immediate Action where there is significant risk to staff or the environment; M To be resolved in 24 hours; L To be resolved in 7 days

No

Issue

Action Level

Action Taken

Signed & Dated

On completion retain the original copy and send copies to the Contractor Site Supervisor, Scheme Project Manager, Scan form and place in the appropriate folder in CCMS as per Safety & Environmental Tours & Planned General Inspections/NAT/PRC/INI/HSEA/SP&C-7882366

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