2020 January 2020 – V13
PRINT LIBRARY
PMT DIGITAL LIMITED
An approved supply for MGroup Services
1
PMT DIGITAL LIMITED
CONTACT DETAILS
Main contacts
Tim Egan e. [email protected]
t. 01480 493666
m. 07792 586282
Colin Sandford e. [email protected]
t. 01480 493666
m. 07857 449377
Paul Foley e. [email protected]
t. 01480 493666
m. 07816 882123
Estimating e. [email protected]
Martin Smith t. 01480 493666
Production e. [email protected]
Arran Balls t. 01480 493666
2
Contents 2020
Print Library
Section A TBT (Tool Box Talks)
Section B Binders & Workbooks
Section C Pads
Section D Cards
Section E Labels/Stickers
Section F Brochures, Flyers, Newsletters
Section G Boards, Signage
Section H Posters
Section I Banner Stands & Pop-up Stands
Section J Miscellaneous
3
4
3SSTheTeMaomrrisonMENT 4GUIDANCE OccupWioerdkiPnrgeimnises 9 SaoffeWSoyrsktem 10 AGsesneesriscmeRinstk Section A – TBT (Tool Box Talks)
EmplNooyne-es 5
Illustrations copyright CENTURY 21 PROJECTS ‘02
Page 1 SPaufebltiycASSE 8
2RISK AsseRsisskment 09/09/2011
2:08 pm 7 AFsosresmsalmeRinstk Electrical Isolation
7/1/05 2 WROisRkKAsIsNesGsmIeNnt SU3BSETleAcTtricIaOl SNaSfety Rules 4
Storyboard Why! 10:37 Page 1
ThRiewsrhkey aAwrseseecsmasarnrmyyenroteusa!tsons stations storyboard.qxp 13/11/07
1 TiVdeinhiecslse 1 Substation Entry
6
Untitled-19 1
!" # Exposed LV Bars
7
Exposed HV Bars
GIVE YOURSELF ENOUGH ROOM
5 6
0
Access/Egress
BARS PROJECTS ‘02
18/02/2011
CENTURY
-
BEWAREIlluEstrXatiPonsOcoSpyErigDht21
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5
6
Section A – TBT
RISK ASSESSMENT GUIDANCE STREET WORKS SAFETY
1 Why! 2 Public 3 The Morrison 4 Non- 5 Working in 1 Legislation 2 Risk 3 Red 4 Pedestrian 5 Pedestrian Walkway
Safety Team Employees Occupied Premises Assessment Book Safety
N.R.S.W.A. minimum width for
(Section 74) temporary footway
H.A.S.A.W.A. 1 metre
Use 1.5 metres
or more where possible
minimum width for
two-way traffic
(see page 52)
safety zone
sideways clearance (S)
(see page 6)
There are many reasons Works on footway with temporary
why we carry out footway in carriageway
Risk Assessments! 9 Delivery
Vehicles
6 Vehicle 7 Formal Risk 8 Risk 9 Safe System 10 Generic Risk 6 Courtesy 7 Customer 8 Fencing
Tidiness Assessment Boards Access
Assessment Assessment of Work
Illustrations copyright CENTURY 21 PROJECTS ‘02
01 - Risk Assessment 02 - Personal Protective Equipment PPE 03 - Street Works Safety Illustrations copyright CENTURY 21 PROJECTS ‘02
REF: A001 REF: A002
REF: A003
WORKING NEAR OVERHEAD CABLES WORKING IN SUBSTATIONS
2 Risk Assessment 3 Electrical Safety Rules 4 Electrical Isolation
1 Risk 2 Cable Height 3 Exclusion Zone 4 Exclusion Zone 1 Substation Entry
Assessment
Pylon Profiles
Safe Stand Off Distance
Exclusion
Zone
Poles Profiles
? Maintain a minimum Maximum Operating Reach
clearance of 600mm
from Poles, Pylons Spoil and equipment to be
and Stays. lifted, to be inside this area.
For excavation
275 or 400 KV 132 KV 33 KV 11KV LV work a Banksman
Exclusion Zone Exclusion Zone must be used -
Exclusion Zone Exclusion Zone remember to
7m 6m take account
of oversail.
3m 1m
Exclusion Zone is the Minimum Safe Working Stand off distance is the Exclusion Zone
Distance from Overhead Conductors or Equipment. plus the Maximum Operating Reach.
5 Goal Posts 6 7 Stow Jibs 5 Access/Egress 6 Exposed HV Bars 7 Exposed LV Bars
Arcing
SAFE STAND OFF DISTANCE GIVE YOURSELF ENOUGH ROOM
!
BEWARE OF ARCING! BEWARE EXPOSED BARS
Illustrations copyright CENTURY 21 PROJECTS ‘03 Illustrations copyright CENTURY 21 PROJECTS ‘02
04 - Safe Digging 05 - Working Near Overhead Cables 06 - Working in Substations
REF: A005 REF: A006
REF: A004
CABLE HANDLING 1 CABLE LAYING GUIDANCE 2 MANUAL HANDLING GUIDANCE
Risk Cable Drums Cable Drums Cable Drums Mechanical 1 Risk 2 Cable Location 3 Cable Location 4 CAT & Genny 5 Marking Out 1 Manual 2 Types of 3 Before 3.1 Before you 3.2 Before you 4 Safe Lifting
Assessment Methods Assessment Handling Technique-
Injuries you Lift Lift (continued) Lift (continued) Positioning
DEFINITION
Any transporting
or supporting of a Unsuitable clothing,
footwear and confined
load, (including One third of all Reminder: Use suitable equipment spaces will make positioning
the lifting, injuries at work in the T - Task when possible.
I - Individual capabilities difficult.
putting down, UK result from L - Load Putting the 8
pulling, carrying incorrect Manual E - Environment Load Down
or moving) Handling.
by hand
or bodily force.
“Where did you say you did
your CAT training son?”
Cable Cable Cable Cable 6 Damage 7 Cable Pulling Operation 5 Lifting 5.1 Lifting 6 Moving the 7 Reporting
Load
Dispensing Dispensing Dispensing Dispensing (continued)
3 4
1 6
PLAN THE LIFT - USE CORRECT LIFTING TECHNIQUES
2
5
Achieving the correct
posture (i.e. the positioning
07 - Cable Handling ,OOXVWUDWLRQV FRS\ULJKW &(1785< 352-(&76 µ Illustrations copyright CENTURY 21 PROJECTS ‘03 of various parts of the body) Avoid twisting or jerking Plan your route before Avoid crushing fingers or Report any problems DO NOT LIFT AND TWIST
movements. lifting. toes as you put the load immediately to your
REF: A007 08 - Cable Laying Guidance is essential when lifting.
REF: A008 Make sure you are wearing down. supervisor.
the correct P.P.E.
Illustrations copyright CENTURY 21 PROJECTS ‘02
09 - Manual Handling
REF: A009
SLIPS, TRIPS and FALLS LONE WORKING H.A.V.S. GUIDANCE
1 Slips, Trips 2 Public Safety 3 Slips 4 Causes of 5 Vehicle 1 Risk Assessment 2 Communication 3 Identification 4 Aggression 1 H.A.V.S. 2 Causes of 3 Signs and 4 How to Avoid 5 How to Avoid
and Falls Slips Tidiness Symptoms continued
Hand H.A.V.S.
Arm
SLIPS, TRIPS OR Vibration
and FALLS Syndrome
are the most also known as:
Vibration
common cause 5 Aggression 6 White Finger
of accidents and
injury in our
industry Site
Safety
6 How to Avoid 7 If You Don’t . . . 8 Questionnaire
continued
7 Politeness Body
6 Working in 7 Poor 8 Risk 9 8 Language
Assessment
Occupied Premises Housekeeping Exit Route
OR DON’T EXCEED MORRISON ‘SAFE USE’ GUIDELINES
Be aware of Lone Worker Procedure.
Wear gloves to keep Complete and return OR YOUR WORK & SOCIAL LIFE MAY SUFFER
your hands WARM. to Human Resources. Illustrations copyright CENTURY 21 PROJECTS ‘02
Illustrations copyright CENTURY 21 PROJECTS ‘03 Arrange CALL IN times. REF: A012
Illustrations copyright CENTURY 21 PROJECTS ‘03
10 - Slips, Trips & Falls 11 - Lone Working 12 - HAVS Guidance
REF: A010
REF: A011
13 - Environmental Guidance 14 - Excavation Risk Assessment 15 - AWS Contract Rules
REF: A013 REF: A014 REF: A015
7
Section A – TBT
DRIVING GUIDANCE ELECTRICAL JOINTER GUIDANCE 1
1 Driving 2 Towing 3 Housekeeping 4 1 Live 2 Equipment 3 Equipment 4 Sub Station Entry
Licences Jointing Checks
Speed
Image not available !
5 Reversing 6 Grab Lorry 7 Damage Reporting 5 Electrical 6 Gas Bottles 7 Changing
Safety Rules in Vehicles Cut-outs
FOLLOW SAFETY RULES
! GIVE YOURSELF ENOUGH ROOM
Illustrations copyright CENTURY 21 PROJECTS ‘03
Illustrations copyright CENTURY 21 PROJECTS ‘02
REF: A018
16 - Disposal & Quality 17 - Driving Guidance 18 - Electrical Jointer 1
REF: A016 REF: A017
jointer 2 front.qxd 18/5/07 13:21 Page 1
ELECTRICAL JOINTER GUIDANCE 2 EMERGENCY & METERING CONTRACTS HOME SAFETY GUIDANCE
1 Risk 2 Locate Cable 3 Expose 4 Cable Identification 1 Legislation 2 Risk 3 Confined 4 Lone Working 5 Violence and 11 Safety 2 Trips 3 Fire 4 Fire 5 Poisoning
Assessment All Cables Assessment Spaces Aggression at Home (Kitchen) (Electricity)
The work carried More people die
out on this each year through
contract is accidents at home
governed by the than in the
Gas Safety workplace.
Installation & Use Every area of the
Regulations home environment
can be potentially
dangerous!
5 Cable Identification cont. 6 Suspect 7 Testing 8 Record Work 6 Sharps 7 Manual 8 Testing 9 Appliance 7 D.I.Y. 8 Manual 9 Child
HV Cable!! Handling Checks 6 Poisoning Ladders/Steps Handling Supervision
(continued)
ALWAYS TEST
DON’T TAKE RISKS
! !!
Illustrations copyright CENTURY 21 PROJECTS ‘03 ALWAYS CHECK 21 - Home Safety If something does go wrong -
BE PREPARED
19 - Electrical Jointer 2 Illustrations copyright CENTURY 21 PROJECTS ‘03
REF: A019 Illustrations copyright CENTURY 21 PROJECTS ‘03
20 - Emergency & Metering Contracts REF: A021
REF: A020
LADDERS AND STEPS MECHANICAL & ELECTRICAL GUIDANCE OFFICE SAFETY
1 Risk 2 Angle 3 3 Points of 4 Over-Reach 5 Foot Ladder & 1 Permit 2 Electrical 3 Electrical 4 Mechanical 5 Mechanical 6 Auxiliary 12 Display Screen 3 Slips, Trips 4.1 4.2Manual Handling Manual Handling 5 Stairways
Contact Wearing Harness to Work Equipment and Falls Operations Regulations (continued)
Assessment Isolation Isolation Isolation Isolation Supplies OFFICE (D.S.E.) 1992 and Stacking
SAFET Y!
Isolation of live
electrical and The office
mechanical can be a
systems is Refer to D.S.E. Remove all Tripping YOU must make proper use • Never stand on chairs- Hold on to
dangerous place Assessment Hazards of any working practices put use steps or ladders. handrails/banisters
Tie Ladders 7 Face Work 8 Face Work essential for safe if we don’t in place by Morrison Utility when using stairways.
working. 8 First Aid Services to reduce risk of • Never overreach.
stop and think. injury during Manual Handling. • Never overload shelving.
Permit to Work
systems must be
implemented and
adhered to.
6 7 Confined Spaces 8 Slips, Trips 9 Mechanical 10 Hygiene 6 Control of Substances 7 Fire Safety 9 Statutory 10 Housekeeping
Wet/Dry Well and Falls Entrapment Hazardous to Health Notices
Tie to (C.O.S.H.H.)
scaffold
Various substances we work In the event of a FIRE: Notices must be displayed REMEMBER:
with can be bad for us. and made available, e.g: Poor housekeeping
• Know who your Fire can be the cause of
Tie to scaffold “WHO changed the toner last?” Marshal is (and follow •Health and Safety Law
A COSHH Assessment must be instructions). posters. many accidents.
Tie to trench sheet. Tie to trench sheet. completed and made available for Poor housekeeping causes accidents.
Illustrations copyright CENTURY 21 PROJECTS ‘03 • Keep Emergency Exits •Employers Liability • Inspect your KEEP THE OFFICE TIDY.
Always comply with everyone to see. clear. Information.
Permit to Work procedure. It allows us to identify all the dangerous workplace regularly.
• Raise the Alarm. •The Morrison Health
Illustrations copyright CENTURY 21 PROJECTS ‘02 substances that can harm us. • Evacuate using the and Safety Policy. • Remove rubbish and
nearest available and •Accident Book. waste materials.
safest route.
You must be aware of • Keep walkways clear.
• Go to your designated First Aiders names. • Remove tripping
assembly point and It must be displayed
remain there until who your First Aiders are. hazards.
instructed that it is
safe to return. • Report electrical
hazards.
Illustrations copyright CENTURY 21 PROJECTS ‘02
22 - Ladders & Steps 23 - Mechanical & Electrical 24 - Office Safety
REF: A022 REF: A023
REF: A024
OVERHEAD GUIDANCE 1 OVERHEAD GUIDANCE 2 GUIDE TO SPOIL (WASTE REDUCTION)
11 Risk 2 Cable Location 3 Cable Location 4 Drum 5 Drum 1 Landowner 2 Vehicles 3 Inspection 4 Access 1 Law Requirements 2 Waste Management License 3 Re-use of Materials
Assessment Movement Storage Permission
Duty of Care
6 Conductor 7 Drum Siting 8 Equipment 9 Safety Rules 5 Ladders 6 Ladders 7 Pole 8 PPE 4 5 6
Pulling Checks Climbing
Material to Tip Excavation Size
Pole
Climbing
!
Illustrations copyright CENTURY 21 PROJECTS ‘03 Illustrations copyright CENTURY 21 PROJECTS ‘03
25 - Overhead Guidance 1 Illustrations copyright CENTURY 21 PROJECTS ‘03
REF: A025
26 - Overhead Guidance 2 27 - Guide To Spoil (Waste Reduction)
REF: A026 REF: A027
SPOIL DISPOSAL/RECYCLING: GUIDE FOR GRAB DRIVERS
1 Cost 2 Safety at Site 3 Waste Transfer Note 4 Landfill Sites
5 Quality 6 Site Delivery 7 Vehicle Checks
of Imported Fill
REDUCE 3R’s
RE-USE
RE-CYCLE
Illustrations copyright CENTURY 21 PROJECTS ‘02
28 - Traffic Management Act 29 - Excavators 30 - Spoil Disposal/Recycling Guide for Grab Drivers
REF: A028 REF: A030
REF: A029
8
Section A – TBT
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REF: A032
31 - Daily Vehicle Checks 32 - Winter Driving 33 - NG Contract Rules
REF: A031 REF: A033
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! " # !
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- 5
3
4
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35 - Lorry Loaders
3
4 " ! 5 )
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34 - Make Time For Safety - Job REF: A035 36 - Line Managers Responsability
REF: A034 REF: A036
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+
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37 - Road Risk 38 - Working On or Near Railway 39 - PE Pipe Handling
REF: A038 REF: A039
REF: A037
40 - Pipe Laying 41 - Use of PE Pipe Coil Trailers up to 180 mm 42 - Customer Expectations & Service Delivery
REF: A041 REF: A042
REF: A040
43 - Extra Duty of Care at Streetworks 44 - Protecting the Public 1 YW 44A - Protecting the public (Physical Barriers)
REF: A043 REF: A044 REF: A044A
9
Section A – TBT
No. 45 Version 2 - Aug 2010 Illustrations copyright CENTURY 21 PROJECTS 2010
45 - Protecting the Public 2 46 - Overweight - Know Your Plate 47 - Customer Expectations & Service Delivery v2
REF: A045 REF: A046 REF: A047
Printed by PMT Digital
48 - Working on New Development Sites 49 - Working Near High Pressure Pipelines 50 - Working on Highway Bridges
REF: A048 REF: A049 REF: A050
51 - Healthy Lifestyle 52 - Saving Fuel 53 - Towing and Trailer Awareness
REF: A051 REF: A053
REF: A052
54 - Avoiding Fines and Complaints 55 - Waste Metal Disposal 56 - Testing Polarity, Rotation and Phase
REF: A054 REF: A055
Identification REF: A056
Image not available Image not available
57 - Yorkshire Common Permit Scheme 60 - Customer Expectations & Service REF: A058 60 - Customer Expectations & Service REF: A059
REF: A057
10
Section A – TBT
60 - Customer Expectations & Service Delivery 61 - Meter Installation and Exchange 62 - DG3
REF: A061
3 Photographic Images REF: A060 REF: A062
74 - Vehicle Tracking
REF: A063
SPECIFICATION &
OPTIONS AVAILABLE
• A4 size (standard)
• Thick card material
• Thick encapsulate for protection
• Drilled with 4 holes to fit binders
11
12
DeWliveePrirnogmWisheat Section B – Binders & Workbooks
ZEHRAORM ReNpeoarrtMalilsUsetsiliatyndDaHmazaagredss, tInoctidheenIntsc,idAecnctidLeinnets, y ack
Nothing we do is so important Tel: 0845 437 8288
that we cannot take the time
to do it safely
24732 - Gas Team Pack Cover Amended Logo.indd 4561 BIBLE
Team Safety
Pack
BIBLE
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- Affinity Water Binder_Cover.indd 101
13
14
Section B – Binders/Workbooks
Delivering What
We Promise
Gas Team Pack Electrical Team
Binder Pack Binder
210 pages 238 pages
REF: B002
BIBLE
Telecoms Team
REF: B001 Pack Binder
Delivering What We Promise 732 pages
for the REF: B004
Water Industry New Entrant
Starter Packs
Water Team
Pack Binder • Employee
• Managers
370 pages • Benefits
BIBLE REF: B006
REF: B003
SAFETY PASSPORT Safety Passports
Binders
S CS OGO
31 pages + Dividers
Optional Extras
A] Number Pages P1 & P2
B] Verify Page
C] Label for IFC
D] Extra A5 Multi Punch
Pockets
E] Water Section
REF: B005
Cable Jointing Code of Practice
Binder Binders
264 pages Volume 1 - 437 pages
Volume 3 - 441 pages
REF: B007
REF: B008
15
Section B – Binders/Workbooks On Site Risk
Assessment Folders
On Site Risk - Multi Utility
Assessment Folders
- Groundworks • General Control Measures
Multi Utility V1
• General Control Measures Ground
Work V2 • Completion Guide Multi Utility
(ENCAP) V1
• Completion Guide Ground Work
(ENCAP) V2 • Excavation Risk Assessment Pad
(30 leaves) V3
• Excavation Risk Assessment Pad
(30 leaves) V3 • Multi Utility On Site Risk Assessment
Pad (100 leaves) V1
• On Site Risk Assessment Pad
(100 leaves) V6 • 14 kinds D/S Tabs
REF: B010
• 14 kinds D/S Tabs
REF: B009 Trench Support
& Timbering
Sub Station Assessment Booklets
Entry Course &
Assessment Paper REF: B012
REF: B011 Motor Vehicle
Incident Procedure
ISIS Purchase Order Packs
System Guide
• Folders
68 Pages • Inserts
REF: B013 • Business Cards
• Windscreen Stickers
GNO1
REF: B014
311 pages
REF: B015 GNO2
16 649 pages
REF: B016
Section B – Binders/Workbooks
Plant Hire - Using Procedures & Safety
inspHire Booklet Rules Manuals
62 Pages Manuals for:
• Electrical Overhead Linesman
REF: B017 • Electricians
• Electrical Jointer
• Electrically Technical Managers
• Project Managers & Supervisors
• Senior Managers
REF: B018
Health & Safety Occupational
Policy June 2008 Road Risk
32 pages 16 pages
REF: B019 REF: B020
Health & Safety OHSAS 18001-2007
Policy Ireland July 2008
Safety Management System Manual
32 pages 57 pages
REF: B021
REF: B022
PCMS 2008
Workshop Five Basic Electrical
Safety Passport
84 pages Insert
REF: B023
6 pages
REF: B024
17
Section B – Binders/Workbooks
NRSWA NRSWA
Operative Supervisor
Portfolio Portfolio
109 pages 135 pages
REF: B025 REF: B026
UK Power Code of Practice
Networks info Binders volume
inserts 1&3
4 & 14 pages 437 & 441 pages
REF: B027 REF: B028
Team Safety Pack
MUS ELECTRICAL MUS Distribution MGJV Water
SAFETY RULES Safety Rules Team Packs
MUS-MOPs-EMS-PN-0001 • 102 Pages 228 pages
July 2012 REF: B029
Ref: 0071 REF: B030
Thames Water ON SITE RISK
New Service and Developments ASSESSMENT PACK
Contract Gas Contract
11860 - Thames On Site Risk
Water New Assessment Folders
Service Dev - Gas Contract
Team Pack
• General Control Measures
220 pages • Completion Guide (ENCAP)
• On Site Risk Assessment Pad
Ref: 001 REF: B031
(50 leaves) V2
• 14 kinds D/S Tabs
REF: B032
18
Section B – Binders/Workbooks
Personal Protective Important Company
Equipment (PPE) Car Information
Issue Record A5 Insert
Passport Insert
2 pages
2 pages REF: B034
REF: B033
Operational Activity
Training Portfolio
Competencies Passport Insert
Passport Insert
2 pages
1 page REF: B036
REF: B035
Excavation Shoring
BMS Managers Designs
Handbook
12 pages
104 pages REF: B038
REF: B037 BMS
Environmental
A(rLoesirnpwieonerMlttlhtaaoens aetrhegvepeenorMMtratUosinfSUqgtuUhSaiKcekvVdlUeyORerhTihaueKvicesietplceriloolseVb:firpnIethnreciaoanic0dchiulgdtleM8rienuiUcsn7actnltoetbatil0laolLbeiervtiln.tryee8heiIttDesn3hoooaMen0dcmnUio0Iin3Tan8Sdfs7gUoo8eIcn0eera3mtclis8ni.,idpd3a6lIae0tti0neisnto3cs8tyLneni8dLn34idtieSg6nnen5eeeatRrte,an)rsti4d,emlvheAeh3idpuccisdsb7ctoe/riheid8svleroeert2wIrnni8tnosc,n8giNdtheeearnmMtesislsaisngeisne&g Hazards Handbook A4 or A5
service
32 pages
and contact your line manager REF: B040
Once connected you will be asked to provide the following details 19
Your name, your phone number, the address and details of the incident
you are reporting.
You may also be asked to provide the following details.
Please have them available when making the call
The date & time of the incident
The contract and client you are working for
The name of your supervisor or line manager
The name of the team leader
The company you work for, MUS or subcontractor
The depot where you are based
The reference number of the job you are working on Incident Reporting
Insert
The type of utility damaged and the name of the person causing
the damage 1 page
Details of the utility and location if reporting a latent damage REF: B039
The exact location of the incident, accident, damage
The nature of any injuries, their type and extent
The name and address of any injured party
Details of any action already taken
Details of any environmental incidents or contamination
Details of any motor vehicle damage and the registration of any
other vehicles involved - For MVI reporting see overleaf:
10/09/2014 09:48
d t Reporting Additional Page.indd 2
Section B – Binders/Workbooks
UK Power BDUK
Networks Telecoms Team
Excavating Pack Binder
inserts
740 pages
2 pages &15 pages
REF: B041 REF: B042
BMS Red Binder
Business Dividers
Management Policy
& Corporate 10 Dividers
Standards Brochure
REF: B044
24 pages
REF: B043 Central
Networks
Rail Divider & Electric Team
Switching Log Pack Binder
2 pages 238 pages
REF: B045
REF: B046
Trench Support
8
? 8C
< Customer Service
Reassessment Handbook
26 pages 32 pages
REF: B047 REF: B048
20
Section B – Binders/Workbooks
Standard Technique NGT BT
CA6a/s Telecoms Team
Pack Binder
62 pages
REF: B049 850 pages
EON Electric REF: B050
Metering Team
Pack Binder British Gas
Electric
264 pages Metering Team
REF: B051 Pack Binder
282 pages
REF: B052
FTTP Team Packs Civils Team
Packs
1998 pages
(3x Binders) 668 pages
REF: B053 REF: B054
Delivering What
We Promise
Flex Team Packs WPD/MUSR
Electric Team
Pack Binder
632 pages Ref: WPD/MUSR BIBLE 236 pages
REF: B055 REF: B056
21
Section B – Binders/Workbooks
IT Services GRAB AND SUPPORT Grab and
Guide A4 DRIVERS PACK Support Drivers
Pack A5
Report ALL utility damages, incidents, near misses and hazards
14 pages Reporting incident line: 0845 437 0362 60 pages
For out of hours reporting, please follow contract specific procedures
REF: B057 REF: B058
and leave brief details on the incident line answer phone service
Gas Emergency Metering Services SGN Gas Health, Safety and Thames Water
Emergency Wellbeing Eight 20 Team
TEAM SAFETY PACK Metering Team Pack Safety Pack A4
Services Team
working with Safety Pack A4 BIBLE 670 pages
Bible 206 pages REF: B060
REF: B059
Meter Installer Report ALL utility damages, incidents, near misses and hazards
SHEQ Manual Alliance incident line: 0845 437 0362
For out of hours reporting, please follow contract specific procedures
MGJV Meter Thames Water
and leave brief details on the incident line answer phone service Agility Alliance
Installer SHEQ Team Safety
Infrastructure Pack A4
Alliance
486 pages
Health, Safety and
Wellbeing REF: B062
Team Pack
Bible
Manual A4
Ref: 01 364 pages
REF: B061
Plumber/Surveyor alcohol
SHEQ Manual & drugs
MGJV Plumber/ Employee Guide Alcohol &
Surveyor SHEQ Drugs Employee
Manual A4 TFHAECTS Guide A5
Ref: 01 280 pages 16 pages
REF: B063 REF: B064
22
Section B – Binders/Workbooks
ZEHRAORM Report all Utility Damages, Incidents, Accidents,
Near Misses and Hazards to the Incident Line
Tel: 0845 437 8288
Nothing we do is so important that we cannot take the time to do it safely
Team Safety Affinity Water ENVIRONMENTAL Environmental
Pack Team Safety HANDBOOK Handbook A5
Pack A4
BIBLE 36 pages
484 pages
N1oRtWhKLinQJg iLsV sVRo ,ImPpSoRUrtWaDnQWt tWhKaDtW wZeH C&aDnQnQoRWt tWaDkNeH tWhKeH WtiLmPHe WtRo GdRo LiWt S6aDfeIHlOy\ REF: B066
REF: B065
Issue 1 MUS-GD-E-001 Revision 2
IOS Graduate Programme
Assessment Centre Manual
2017
Electrical - Distribution Safety Rules Electrical Safety Assessment
MUS-MOPs-EMS-CM-0008 Rules A5 Centre Manual
December 2016 A4
68 pages
BIBLE 32 pages
REF: B067
REF: B068
Graduate Programme Interview Dear Colleague, New Entrants
Interview Questions Questions Starter Packs
2017 A4L RE - NEW ENTRANT STARTER PACK (OPERATIVE) A4
258 pages May we first take the opportunity to welcome you to Morrison Utility Services. Please find 258 pages
enclosed a number of documents for your review.
REF: B069 REF: B070
The documents are divided into 2 packs – one pack contains all the documents that require
completing prior to commencing your employment and the other pack is for your review,
familiarisation and retention.
Please ensure that you bring the completed documentation, together with any additional
supporting documentary evidence required, on your first day of employment. Failure to do
so may mean that you may not be able to commence employment and that your start date
may need to delayed. Please refer to the form entitled ҊDocuments Required on Day 1ҋ which
details, for ease of reference, the information that you are required to bring.
Your details can only be forwarded to our payroll department once all the required
documentation has been received by your line manager
Key starter forms to be completed and brought to your Day 1 induction
¾ Employee Information Form
¾ Job Application Form
¾ Qualification & Training History Form
¾ Pre-placement Medical Questionnaire & HAVS Questionnaire (please place the completed
questionnaires in the envelope marked ҊStrictly Private & Confidentialҋ – please ensure that you
include a contact number as our Occupational Health provider ҊDuradiamondҋ may contact you
directly if they have any questions arising from answers provided on this questionnaire.
¾ Driving Entitlement Consent Form – 3 year mandate
¾ 48 hour Week opt out form
¾ Receipt of Policies, Procedures & Guides Acknowledgment
¾ P46 (if not in receipt of a P45)
Evidence to be brought on Day 1
¾ Right to Work in the UK – documents required as evidence with regards to the
Immigration, Asylum & Nationality Act 2006.
¾ Original certificates of any training & qualifications
¾ Driving Licence (both parts if photo card licence)
For your review, familiarisation and retention
General Information
¾ Company information (Fast Facts, Milestones)
¾ Company Vision & Values
¾ Quick Reference Guide
¾ Right to work in the UK – Employee Guide
¾ Driving licence checking process information & FAQҋs
Company Policies
¾ Alcohol & Drugs Employee Guide
¾ Alcohol & Drugs Policy
¾ Annual & Other Leave Policy
¾ Business Ethics and Anti-bribery Policy
¾ Dignity at Work Policy
09102014
MORRISON UTILITY SERVICES LTD. Dosbarthu Yr hyn yr ydym yn ei
HOLIDAY RECORD FORM addo ar gyfer y Diwydiant Dŵr
Name: _____________________________ Location: _____________________________________________ Delivering What We Promise for
Position: ___________________________ Annual Entitlement (days): __________________________ the Water Industry
Area: ______________________________ Year from: _________________ To: _____________________ Team Pack
This form must be completed for any proposed time-off you require. You should give at least 4
weeks prior notice of your intention to take annual leave (1 week for occasional days) to your
immediate Supervisor/Manager/Director. Any cancellations of holiday dates should also be entered
on this form and forwarded in the usual way for authorisation.
It is the employee’s responsibility to obtain authorisation from his/her line Manager and retain the
original copy of this form.
Inclusive dates No of No of Authorised by: Date Holiday
days Days Authorised Outside
From: To: taken Rem. Mgr/Director Print Name EEC
Signature (please
tick)
Holiday Record Report ALL Utility Damages, Incidents, Accidents, Near Misses & Hazards BIBLE Welsh Alliance
Form A5 Team Pack A4
Morrison Utility Services Incident Line
2 pages Tel: 0330 123 1092 380 pages
REF: B071 Motor Vehicle Incidents (MVI) - 08708 303 836 REF: B072
Nothing we do is so important that we cannot take the time to do it safely 23
Issue 1 MUS-FM-HR-006 Revision 1
Section B – Binders/Workbooks
Quick Action Guide First Aid Field Be Field Metering
for Emergencies Booklet A5 metering consistently Services
on Agility Alliance services. Booklet A5
brilliant.
ϭ NON HOUSEHOLD
12 pages 24 pages
REF: B073 REF: B074
Telecom Division Telecom Telecom Division Telecom
Division Division
Operational Reinstatement Operational Safety Handbook Safety
Quality Plan Reinstatement Handbook
Booklet A5 Booklet A5
44 pages 68 pages
REF: B075 REF: B076
HGV Driver HGV Driver HGV Driver HGV Driver
Information Information Pack Information Information
Pack 7.5t Pack ECON Pack 26/32t
HGV Driver tipper ECON Hotbox Hotbox tipper
Information Pack A5 A5 LGV Driver A5
7.5 Tonne Tipper Information Pack
40 pages 82 pages 68 pages
REF: B077 REF: B077a 26/32 Tonne
Grab Tipper Vehicle REF: B078
Environmental
Handbook
Welsh
A5
36 pages
REF: B079
0RUULVRQ 8WLOLW\ 6HUYLFHV ² 3HRSOH 2SLQLRQ 6XUYH\
ENVIRONMENTAL $UH \RX Peoples Opinion
HANDBOOK A4
6(&7,21 $%287 <28 o 0DOH
24 o )HPDOH 8 pages
o 2WKHU
o 3UHIHU QRW WR VD\ REF: B080
'R \RX ZRUN IRU D
o 0RUULVRQ 8WLOLW\ 6HUYLFHV OLQH 0DQDJHU
o &OLHQW -9 /LQH 0DQDJHU
3OHDVH VHOHFW \RXU DJH UDQJH EHORZ
o ²
o ²
o ²
o ²
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o
Section B – Binders/Workbooks
HS2 Multi-Utility HGV Driver
Diversionary Information Pack
Work 7.5t tipper
A4
HS2 Team Pack
A4 40 pages
HGV Driver
610 pages Information Pack REF: B082
7.5 Tonne Tipper
REF: B081
Report ALL Utility Damages, Incidents, Accidents, Near Misses & Hazards BIBLE
Morrison Utility Services Incident Line
Tel: 0330 123 1092
Motor Vehicle Incidents (MVI) - 0333 207 5567
Nothing we do is so important that we cannot take the time to do it safely
HGV Driver HGV Driver HGV Driver
Information Information Pack Information Pack
Pack 26/32t Grab ECON Hotbox
Tipper A4 ECON Hotbox A4
LGV Driver
68 pages 82 pages
Information Pack
REF: B083 REF: B083
26/32 Tonne Grab Tipper Vehicle
HGV Driver HGV Driver HGV Driver
Information Pack Information Pack Information Pack
LGV Driver Roadmender 7.5 Tonne Tipper with 7.5t tipper with
A4 swinglift
Information Pack SwingLift A5
Roadmender Vehicle 42 pages 48 pages
REF: B084
REF: B086
Position Network Construction Operations (Water) Apprenticeships
Reporting to Contract Management (REV 0 Effective 01.04.11) (Page 1 of 8)
Recruitment Location(s) East Riding of Yorkshire, West Yorkshire, South Yorkshire, Building Essential Skills (REV 0 Effective 01.04.11) (Page 1 of 11)
North Yorkshire Numeracy 1 – Question Booklet Building Essential Skills
Literacy 1 – Question Booklet
Department Site Depots Literacy Initial Assessment
Reference Number Morrison Water Apprenticeships There are 24 questions in this paper.
Starting Salary £7.59 per hour Monthly Paid, Numeracy Initial Assessment Try to answer all of them, but if you get stuck, move on to the
next question.
This is an exciting opportunity to become an apprentice in Morrison Utility Services with There are 24 questions in this paper. Delivering What We Promise Trams to Newhaven
opportunities to progress within a highly respected company. Our business is centred upon the Try to answer all of them, but if you get stuck, move on to Write all your answers on the separate Answer Sheet provided. for the Swept Path Contract
provision, replacement, repair and maintenance of utility network infrastructure, for example: the next question.
electricity substations, water and gas pipes, electricity and telecommunication cables and Write all your answers on the separate Answer Sheet provided. IMPORTANT! Water Industry
installation of water, electricity and gas meters on behalf of blue chip utility companies in the UK. You can use rough paper to work things out if you need to.
DO NOT WRITE
Morrison Utility Services is part of MGroup Services: When you see this symbol next to a question, you ON THIS
can use a calculator to work out the answer. Do not
M Group Services – a circa. £1 billion turnover group of businesses that are industry leading service use a calculator in any other questions. QUESTION BOOKLET
providers across Critical Regulated Infrastructure Assets
IMPORTANT!
The businesses that comprise M Group Services operate long-term service framework agreements,
working in collaboration with our Clients to deliver for their customers – we keep the UK DO NOT WRITE
connected ON THIS
As a group, we have over 70 years’ experience with a proven track record and excellent client QUESTION BOOKLET
relationships
Collectively, our businesses order book is set just under £4 billion
M Group Services businesses have an experienced and sector-leading Management Team and now
employs over 7,000 direct staff across the UK and Ireland
‘Morrison Utility Services values diversity and welcomes applications from all sections of the
community. We are committed to equal opportunities.’
,17(59,(:
Assessor Report Form
Candidate Assessor Date
Use the guidelines below to assess the candidate’s performance in the interview. Take care to ensure that Level II Diploma in Network Construction
you write examples of the behaviours listed in addition to ticking them off the lists. The examples form a Apprentice Assessment Centre Operations - Repair and Maintenance
critical part of the assessment and will be used to provide feedback to candidates. Interview Questions
Assessment Centre Manual
Please comment on the candidate’s performance in this exercise in terms of:
overall comments
strengths
areas of concern (particularly important if you have given ratings of 1 or 2 for a competency)
Report ALL Utility Damages, Incidents, Accidents, Near Misses & Hazards Report ALL Utility Damages, Incidents, Accidents, Near Misses & Hazards BIBLE
Morrison Utility Services Incident Line
Tel: 0330 123 1092 BIBLE Morrison Utility Services Incident Line
Tel: 0330 123 1092
Nothing we do is so important that we cannot take the time to do it safely
Motor Vehicle Incidents (MVI) - 0333 207 5567
Nothing we do is so important that we cannot take the time to do it safely
Training Centre Batley 1 Trams to Newhaven
A4 Team Pack A4
United Utilities
REF: B085 Team Pack A4
370 pages 610 pages
REF: B086 REF: B087
25
SPECIFICATION &
OPTIONS AVAILABLE
Binders
• Various sizes, thickness and colours available
• 2 or 4 ring binders available
• Paper or plastic inserts for durability
• Numbered or bespoke tab dividers
• Pockets in binders to insert free issue sheets
Workbooks
• Various sizes and thickness
• Various colours of wirobind available
• Stapled booklets
• Various finishes available
26
Job Number: S S Section C – Pads
Date: MTWT F
Day:
Site Address:
Site Specific Risk AssessmentBrief Risk Assessment Completed by: Con••••fi•A•VMrSlIamAlfulirinelfdeltfiixlhmCeccsetivaoueravmefmnnaoetpttltiolbeoiownfatnwefr1oornii.risrn2eckmdirgsemseasoate/terotriptoreNraesneiieronnsgpttiiuhnrrpceenagelgsanoePcacbnu1eetsetrr:.t,2mrr(ettuJhonmiotcetbtbeeapetPdnrucaedobwcsmlk,iianc,tplhkIlfdneewraotdeeatmdeaxytcbttpeaohyrvUeecausottnweiinlodintotnreytrarkwpactstasli)askthneesskst/LhmeSerebBtnUartaDsokmnptshien place where required.
reverse must be completed
AffectedPbuyblyico&urMAocttiovriitsitess
Description Of Works: Hazard Present Residual Risk Rating
Staff & Contractors Yes No High
Other CDoenttariol lSMiteeaOsbusreersv/aGtioenne/raSlitCeoSmpmeceifincts Medium
Likely to be As(sTeesGasmemneSenaritfcseRtNyisuPkmacbke)rs Low
Persons Visitors
Hazard
PUrE(oCnExWtCxcdPae(caRTrlebocOaoMeaveErtl&rnsvasegcCiiknonatsatctrvoW,i/intsoLutEnoieintTDoruqpognaeooroficnuiuant(afnaoanesetdcitlmpl)WtiAtemshtso/icm(OodseeL&nG)aoesnravneanSnerreySketnoldp(stairuSstHsntuah(cl/u,mEbBgnPce)e(qbIseaWenadeatu-scdlasndSt/aCiktenhpWttrtfiAaoscumeo(tltoenplmrMrni,esoridpCakH)neanrianiteontnon,risvouatutgSes/n&tracC,ursashlseAos,VteHoslbPe)H,doaohrTelnalssiraicsd,eigtlyieleLvih,ioneesstCn,vg(WoiesR,nenleHghgCcdeArroreeeBVofgtlosSeSaeso,,pittnkNicMoo)g)oinlo,iesdSoetuhfc,lo)maDpruasSstauet,nrrifdaalcsPeesd)estrian FP3 Dust Hard Hat Respirator Safety Other
Mask Harness CoTaaRnanrekrkdysenicodoinouwuinttaliteawladlRcoogtirneskyk,osisnuiRtkreaiallltaismni,cnettegirotmahninaownidnaihgcgeae&rlerwefaoxappyrp,earbrdoiaevpsnirceciedaete
Safety Ear Stop work and inform your line manager
GGSlaoafgsesgteyles/s Face Gloves Protection Low
Visor Medium
Hi Visibility
RCeFotlaavmredreaanllst Safety Vest Probability of Injury: High
Boots
VehicleR&ecTorardileBroIonkspectionP(CerirscolneaStOlhHiMtPpoLeIirsogoecePLtawhdreeanicaniputdcptivomerNeonrpaEfiPrqmriraumientipe:ttmfhNoearanitntmthIdeaeivm:tiadsiMuknLL)aLoclwshPaororngbesaMibtoMeiMefliLdatthryiueeomasfuitItnehj,uoHtHMrMrhyiiegsOOehspdpitteSSoiigigsbnnseeSNNwHteMaTauLvoimogmoeprekhre,bwdeii:iten:isyugscomi.ogfmnInepdjluiaOrnFyBNa:tSutLmaarYlnn,asdblb,lyrcsaopultklrhteason,insgbser,oaudnzeneeessd,peeOetOrwcltepWpaockutPePrinronraidicngnrsuetttteifNhoNtacenama,miminsliieaigcetr:ohi:awmtleiptsthlicetettehsetphteeacsHwikfiMLoitcgoorekrhwbdisseiwkuuiamtnhsdsoeeursttVsaMemekUnreaneydnylnaliikonaktencgelcdleyyarOttsiOtnohioopgeponoSopcacSciurlcigleugyurcnsrrnoaeculNvNcteauiaosmrmnoserer:o:etqhueirrse.d, in order toSeverity of injury GrouPnrdin-twedorbkys On Site Risk ATesls.e0ss1m48e0nt4-9C3i6v6ils6
PMT Digital
Job Number:
Site Address: Date
Site Specific Risk Assessment Hazard PresenNStCaiAVSgAomwAlanlnulillelrftfailihdeferictmclqueoLSiuervmOtaeihnapfLpeetnmEetGGtfyoteRieuenlnDlnoanfetoRocwretidriscciiremnsiiuncsfCgkimagt(eRataTAfeirtnooreiotsnesdrinafktsipipsmcntieAsrrua(oaspsrPStptilspesneaeramoseecicrfnsesemsteges:etwnyim(tnc(iotfePatteroct.r(kanghdeoWct.ias.mskgNGr/o)ce.cpuraeaTaklmsrea,n,ttitsobnMIfesikeocpdoortaIrlnsnaetbbeifttveyoiosoe:rarnmnascstr,ahe,uHtiSeinioanvianrteenud,detaAShsttscoehssoreeaiepsnsntee/dyaAdoonDcrfauedceWcleMteLcDasvoaeUisalarnsSkySnAsyMsTtiaut,(eetrHstoCdhatOeososatrh,uprbba ierslssHweeaetsaoFatDri/vnrsoeGrkakdnnaet a,cwitTnooni Honienndobogr.gSaletc,ssloiWC,,tu CenPoRnoStovodarAmpekwceMesrtrmestcSyPa,r ieofkBeT inecueorattrmnscCorS.rli)ositeisn ,tre tMserMotEeclat.Wc)n. aP) gse,rT/Perl eo LjHeRocawetnsMdidlaeMunrasealgdeRetrcis)H.)kigh
Brief Description of Works
Must Be Completed Before Starting Work & Amended If Site Conditions Change
Persons likely to be affected by the works
Visitors Publc & Motorists
Staff & Contractors
Hazard Yes No
APREcrolcoeoetcemstcrsi,t,ciCoiEtnyog;nroHetfrsVoWsl/LoRaVrnokdoPAmlEaremnaatne&adrgnECedqnoWucmyipopPmrokrueoLnncodte,cdaCutairoebnsle, sin,cFluitdtiningg&SAwpitpcharatus
Hot Works
Plant, Tools & Equipment
Overhead & Underground Apparatus HAVS, Noise, Dust,
OMCcaoctneufrpiniaaeltsdio,nSSapulabHcseetasan/lWtcheo(sMr)kainnguaatl Handling,
Height
LEGAifnirdtovidniurigtoniondOnm,paTeelrnreSateiattiselo:nASsspbeecsifticosH, aWzaatredr(Ce.ogu.rDseese,pSEexwcaagvea,tiCono)ntaminated FR Overalls, Long Sleeve Hi Viz, Safety Boots, Hard Hats, Safety Glasses, Gloves, Goggles, Respirator, Dust Mask, Ear Protection, Harnesses
PPE (Circle as necessary. NOTE: Those in RED are mandatory)
27
28
Section C – Pads
Safe Plan of Action (SPA) v5 Pads Excavation Risk Assessment Pads v3
REF: C001 REF: C002
Site Specific Risk Assessment Pad v7 (double sided) Generic Risk Assessment Pad v2 (double sided)
REF: C003 REF: C004
HAVS Record Sheets Multi Utility On Site Risk Assessment Pad v1
REF: C006
REF: C005
General Permit to Work Permit issued by: Permit Number: GPTW 00001
1. Permit issued to:
Time: Date:
2. This permit is valid from / to: Time: Date:
(Max 7 consecutive days)
3. Location of work:
4. Work to be carried out (Tick relevant box):
Excavation Works Lifting Operations Confined Space Work at Height
Hot Works Other
Trench Support Directional Drilling (HDD)
If ‘Other’ Specify:
5. Risk Assessment available and relevant to task: 6. Relevant Competency Level acquired to carry out task:
Yes No Yes No N/A
Note: (If ‘No’) work must not proceed and permit will not be issued Note: (If ‘No’) work must not proceed and permit will not be issued
7. Describe Task to be undertaken: Permit Holder to document Control Measures to be put in
place:
8. Authorisation for Work to Proceed (Agent / Supervisor)
I am satisfied that the control measures noted above are in place and the permit holder understands
the task to be undertaken.
Print Name: Signature: Date:
9. Competent Person (Nominated permit holder – Team Leader)
I am fully aware of and understand the requirements stated on this permit and will ensure that they are
understood by and observed by all persons under my supervision. If conditions change this permit
shall be cancelled and a new one raised.
Print Name: Signature: Date:
10. Cancellation (Team Leader)
The work specified on this permit is now safely completed and the work location has been restored to
a safe condition / transferred to permit no: ________________ and I confirm appropriate checks have
been carried out.
Print Name: Signature: Date:
11. This work permit is cancelled by the Authorised Person (Agent / Supervisor) MUS_PTW_V1
Print Name: Signature: Date:
Original – To be retained in the site file / job pack Printed by PMT Digital
Yellow – To be held by the Team Leader Tel 01480 493666
Pink – To be held by the Issuer
31244 - Permit to Work NCR Pads updated logo.indd 1 28/11/2019 14:57
LV Live Work or Testing Pads Permit to Work Pad
REF: C007 REF: C008
29
Section C – Pads
If the model for typical daily plant usage is not appropriate the following Weekly Assessment of
Exposure should be completed and submitted to the Supervisor and Safety Manager
Name: Job Title: Week
Commencing
1. Time spent using (and not setting up) each item of Plant in minutes.
2. Points used per minute.
3. Total
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
123 123 123 123 123
Type of Plant Used 123123
Time Points Total Time Points Total Time Points Total Time Points Total Time Points Total Time Points Total Time Points Total
Morrison Utility Services
Hand Arm Vibration
Total Exposure Points Name: Printed by PMT Digital Tel. 01480 493666
Contract No.
DAILY EXPOSURE Team Leader Signature:
First Line Manager Signature:
ACTION LEVEL POINTS 100 Top (White) Copy - Contract Manager Middle (Yellow) Copy - Contract Safety Manager Bottom (Pink) Copy - Retain in book
MAXIMUM EXPOSURE POINTS 400
Excavation Safety Booklet & Pad HAVS Booklet & Pad
REF: C009 REF: C010
Civil Works - Site Inspection Form Cable Laying Team Inspection Form
Site Location: Auditor: Inspector (1): Swims Number:
Joint Audit with Client: Yes / No N.R.S.W.A. Card Number: Site Address:
Date of Inspection: REPORT RATING
REPORT RATING 0 - FAIL
Item Client Auditor: Time of Inspection: 0 - FAIL 1 - POOR
No. 0 = Fail Contractor: 1 - POOR 2 - AVERAGE
Team Leader: 2 - AVERAGE 3 - GOOD
3 - GOOD
Site Manager: Rating 1 = Poor 2 = Average 3 = Good
Item
COMMENTS N.R.S.W.A. Card Number: No.RatingCOMMENTS Item
Other team members: No.
1
1 F10 Notice displayed - Correctly displayed & visible to all site personnel - NRSWA Compliance Inspection FormVehicle registration: 2 Reinstatement Team Inspection Form
Displaying the correct information relevant to the site Safe behaviour being displayed by team members 3 1
4
2 Necessary Health and Safety Notices being displayed - i.e. PPE to be Pro Active Safety 5
used, Site visitor information etc 6
Site Specific Risk Assessment current for works being undertaken 7 2
8
3 Site Attendance Register available & being used Manual Handling (Kinetic) 9 3
10
4 Site inductions being undertaken & up to date (see induction registers) Inspector (1): TSewamimPsaNcukminbOerr:der (COSHH, Risk Assessment etc) 11 Team Leader: 4 Company: Inspected by:
N.R.S.W.A. Card Number: 12 Date: Vehicle Registration:
Inspector (2) If Applicable: SSpiitlel KAidt darveasisla: ble and displays an understanding in the use of 13 N.R.S.W.A. Number: 5 Exp. 0 - Fail COMMENTS
N.R.S.W.A. Card Number: Environmental Assessments Available 14 1 - Poor Calibration Date:
5 Health and Safety Plan available - up to date - evidence of review Date of Inspection: 15 ID Card No. 6 2 - Average
Time of Inspection: 16 3 - Good Exp date:
Relevant Insurance certificates on display & in date - EDF Energy Contractor: Utility plans on site & applicable 17 Team Mate: 7 Location / Site Address: Training
Insurance Certificate to be displayed when Principal Contractor Team Leader: 18 Required
6 N.R.S.W.A. Card Number: CAT available, within calibration, demonstration in use of 19 N.R.S.W.A. Number: 8 Exp. Serial No. Item No.
20 Clearance given:
7 Accident Book available - wherabouts known by all site personnel Local Highway Authority notified of the use of traffic lights Worksite & Traffic Management GENNY available, within calibration, demonstration in use of 21 ID Card No. 9 No. of cones used:
Damaged paving/slabs etc identified prior to commencement of work Rating 22
Approved road closure scheme in operation where necessary All underground services identified & marked accurately 23 Pro Active Safety Good general practice bein1g0 displayed Spares available (Y / N) 1
24 Exp date: 2
8 Emergency information being displayed - Nearest hospital / doctors Road Signs (Position & Numbers) COMMENTS 25 Manual Handling (Kinetic)11 Exp date: 3
with route map - Fire & Environment Emergency Plan 26 4
27 Team Pack in order (COSHH,1R2isk, Environmental Assessments) 5
9 Airline & Flashcall contact telephone numbers displayed & available Walkways/Safety Zones in order & Ramps/Plates 28 6
29 Site specific risk assessment va1li3d for site conditions & operations 7
Traffic Lights in order including additional signage 30 8
31 Spill Kit available and disp1la4ys understanding in use 9
10 First Aid - Details displayed, all site personnel aware, on site at all times, first aid Barriers (Position & Numbers) 32 Cable Locator available an1d5in good working order 10
kit fully stocked and available, eye wash available (minimum of 1ltr) & in date 33 Services identified & marke1d6 accurately (if applicable) 11
34 12
Site Manager / Co-ordinator available & on site - site personnel aware Works separated from Public effectively 35 17 13
- roles & responsibility defined 36 Road Signs (Position & Numbers) 14
11 Housekeeping 37 15
38 18 16
12 Work Equipment - Plant records available, inspected, up to date Noticing Joint site meeting with the Local Highway Authority when necessary Excavations in order (shuttering used when necessary etc) 39 Pedestrian access routes available (walkway 1m minimum) 17
register of inspections, issued & operated by competent personnel 40 18
Has team got a valid notice for these works Excavated materials adequately separated and segregated for re-use 41 19 19
42 Traffic Lights in order (additional signage / Stop & Go board available) 20
13 Site NRSWA Compliance Location accuracy Safe access and egress to works location and excavation 43 Worksite & Traffic Management 21
20 22
14 Working at Height - Scaffolding / platforms erected correctly, inspection Correct number of inspection units Protective Equipment Hi-visability vest/jacket available/worn and in good condition Barriers (Handrails, Tapping Boards & Bases in place) 23
regime in place by competent person, correct use of PPE 24
Size of reinstatement accurate Body protection (feet, eye, ear, hands) 21 25
Courtesy / Information Board displayed on site 26
15 Waste Control - segregated if required, stored correctly etc Correct reinstatement location, Carriageway / Footway / Verge Flame Retardant Overalls/Jacket & Trousers 27
22 28
Waste Skips - waste transfer notes available, copy of waste management companies Has the notice been put into progress Wet Weather Clothing available when required Are Safety Zones being provided (cones) 29
waste carriers licence, final destination information i.e. landfill site licence 30
16 Road Signs (Position & Numbers) Welfare Facilities Available 23 31
Sandbags used when weighting is necessary 32
17 Portable Appliances - 110KV, tested, certificates, labelled, evidence Pedestrian access routes / signs available (walkway 1m minimum) First Aid & Eye Wash (in date) 33
available 24 34
Pedestrian / Pelican crossing closed and made safe where necessary Fire Extinguisher 1 / 2 (in date) Kerb ramps in use when necessary 35
18 Work Method Statements available, correct for work activities Electrical Equipment in good condition, tested and in date 36
Traffic Lights in order (additional signage/Stop&Go board available) 25 37
Vehicle/Plant Parked Safely & Environmentally Works seperated from Pub2li6c effectively 38
19 On Site Risk Assessments available, up to date for site activities Traffic light cable in rubber protector where applicable Would pedestrians & motorist2s7know what was expected of them 39
Vehicle, Plant & Work Equipment Vehicle clean tidy, in good Order General Site Housekeeping28 40
Barriers (Handrails, Tapping Boards & Bases in place) Access to houses, shops etc29maintained during operations 41
20 Work Instructions available for works currently being undertaken, Sign, Lighting & Guarding Correct Warning Sticker Displayed 42
previous work instructions available Are all vehicles on site pos3it0ioned safely (Red Book) 43
Courtesy / Information Board displayed on site 44
Compressor & Attachments in good working order (Check air receiver) Excavations in order (Shutt3e1ring) etc 45
46
21 COSHH Assessments available for substances used & stored on site Are Safety Zones being provided (cones) Powerpack & attachments in good working order Hi-Visibility vest / jacket av3a2ilable and being worn 47
48
22 Authorisation / Competencies available & relevant to personnel on Lead in / Exit taper in place with correct angle & number of cones Hand Tools PPE (Dustmasks, Hard Hats, Goggle3s,3Gloves, Ear Defenders & Safety boots) 49
site & work activities, i.e. Sub-Station Entry 50
Minimum widths of carriageway maintained for mode of traffic Wacker Flame Retardent Overalls a3v4ailable & worn correctly
MUS061(Rev1)
23 Identity Cards available, all site personnel Sandbags used when weighting is necessary Excavator in order & Weekly Inspections Complete Wet Weather Clothing ava3il5able
Kerb ramps / pedestrian walk boards in use when necessary Lifting Accessories/Equipment (Jacks, Bars, Chains, Straps etc) Welfare Facilities Available36
24 Drawings / Plans available and relevant to works being undertaken Works separated from Public effectively Cable trailer/jacks being used by competent personnel Protective Equipment First Aid Kit & 2 x 500ml in3d7ate Eye Wash bottles
25 Work Methods comply to written procedure appropriate to task Would pedestrians & motorists know what was expected of them Winching operations in use, site personnel competent to undertake Fire Extinguisher available3, 8in date & pressurised (green)
General site Housekeeping Operators CPCS Available and in date (i.e. Mini Excavator, Dumper etc) Correct Warning Sticker Di3s9played on the vehicle
26 Working Safely - full use of PPE, insulated tools etc Access to houses, shops etc maintained during operations Excavations at appropriate depths for type of cable, footway/highway etc Liquids stored & labelled correct4ly0(Diesel, Petrol,Water & Bitu Kleen)
27 Specialist Equipment Permits - Operator holds an in date permit Are all vehicles on site positioned safely (Red Book) Connection Joint Hole(s) adequate for jointing operations Dust suppression equipme4n1t being used
applicable to range of specialist tools available
Quality All necessary electric cableshave been exposed within the joint hole(s) Hand Tools in good workin4g2 order & stored correctly
Excavations in order (Shuttering) etc (if applicable)
PPE available, being worn, good condition, stored correctly when not in use, in
28 date, appropriate to operations being undertaken, replacement PPE available Herris Fencing erected where necessary Duct size adequate for size of cable to be inserted Wacker / Vib plate in good w4o3rking order & correctly secured
29 Lifting / Handling - Site Personnel able to demonstrate a good Preparation edges sawn vertical & square (Cutback) Fine fill materials and marker tape used to cover newly laid cables Roller & attachments in go4o4d working order
understanding, correct lifting procedures
Cable route follows work instruction Valid operators licence 45 Correctly displayed above tax disc (Y / N)
Granular fill materials in suitable condition & fit for purpose
Additional Site Observations / Instructions Given / Comments
30 Site Tidy / Slip/ Trip / Hazards - Good housekeeping demonstrated Bitumen burn correctly used & in good working order
Granular fill materials installed in appropriate layers & compacted
Reinstatement Quality Sign Visible defects present (Crowning / Depressions) LPG gas bottles correctly secured
31 Access / Egress safe, unobstructed & clearly defined Surface chippings evenly spread & locked in to surface Are Operatives trained to operate plant & equipment on site Hiab / Roller / Mini Excavator etc
1 Part - White, Copy to Safety Department
MUS064(Rev1) - Front White - Safety, Yellow - Area Manager, Pink - Contracts Manager, Blue - Retained by Auditor Preparation edges saMwUnS0v6e2r(tRiecva1l) & square (Cutback)
Adjacent ironwork adjusted to match levels to eliminate trip hazards Granular fill materials in suitable condition & fit for purpose
Recently constructed concrete adequately protected Granular fill materials installed in appropriate layers & compacted
No visible signs of edge cracking Visible defects present (Crowning & Depressions)
Existing surfaces free from any staining Surface chippings evenly spread & locked in to surface
Un-made excavations backfilled as appropriate (i.e. verge etc) Quality Adjacent ironwork adjusted to match levels to eliminate trip hazards
White / Yellow lines & markings replaced as appropriate Recently constructed concrete adequately protected
New surface modules / kerbs (in suitable condition&match existing) No visible signs of edge cracking
Bituminous materials match existing Existing surfaces free from any staining
150mm / 250mm Rule being adhered to Un-made excavations backfilled as appropriate (i.e. verge etc)
Additional Site Observations / Instructions Given / Comments
White / Yellow lines & markings replaced as appropriate
Newsurface modules / kerbs (in suitable condition&match existing
White - Safety, Yellow - Area Manager, Pink - Contracts Manager, Blue - Retained by Auditor MUS063(Rev1) White - Safety, Yellow - Area Manager, Pink - Contracts Manager, Blue - Retained by Auditor
Site Inspection Pads
• Cable Laying Team • NRSWA Compliance Task Instruction Pads
• Civil Works • Reinstatement Team MUS or UK Power Networks
REF: C011 REF: C012
MPS Depot (please tick) Erith
Arlesey
Castleford
Vehicle (Non HGV) Collection & Delivery Note
Complete All Sections Marked in Grey
Collection Address: Fuel on Collection Delivery Address: Fuel on Delivery
(Mark on Gauge) (Mark on Gauge)
F
E F1/4 1/2 3/4 E 1/4 1/2 3/4
Contract No: Contract No:
Date Model & Type MPS Stickers and Documents Checklist (please tick)
Driver Name Reg No.
Vehicle Type Tax Disc Expiry No Smoking Sticker Speed Sticker
Make
VAN / DROPSIDE Vehicle Incident Pack Co regs Sticker
OR TIPPER
Breakdown Sticker CV Users Guide
Overloading Sticker Tyres Sticker
Vehicle Condition (Please Tick) ROOF
Description OK NOT OK Comments
Windscreen
Bonnet
Grill
Front Bumper
Front Valance
Front Lights
N/S/F Wing
N/S/F Door
N/S/Body
O/S/F Wing
O/S/F Door
O/S/Body
Side Doors OFFSIDE - drivers side
NEARSIDE - kerb side
Rear Doors
Roof
Sills - Both sides
Rear Bodywork
Bumpers F/R
Rear lights
Interior (Cab)
Interior (Load Area)
Seats
Cleanliness Outside
Cleanliness Inside
Cleanliness Load Area
Spare Wheel & Tools
Condition of Tyres
On Delivery - Tyre Depth in MM On Collection - Report Condition
l - Legal W - Worn D - Damaged
Comments:: Comments:: Condition Report - Mark any damage on drawing above
Mark damage on Drawing as follows:-
M - Missing D - Dent S - Scrape C - Chip H - Hole
Collection: I release the vehicle to Morrison Plant Services in the condition described on this form Delivery: I receive the vehicle from Morrison Plant Services in the condition described on this form
Signed Signed
Print Name Print Name
Date Time Date Time
Trailer Service Checklist 31396 - Collection and Delivery Vehicle Inspection pads.indd 1 28/11/2019 12:27 Waste Transfer Note
REF: C013 REF: C015
Van Inspection Forms
REF: C014
Earth Electrodes at Cabinets EarthingNGA
Issue 5, July 2014
Report Number: EEC/
Installation Details
Installation address:
Cabinet Type:
Date Installed:
Associated PCP No.:
Particulars of Installation Details of Installation Earth Electrode
Electrode length (total number of Type (e.g. rod(s), tape, mats, conductive concrete, etc) Location Electrode resistance to earth
rods/length of tape, conductive con- 1
crete, etc)
Show position of
earth electrode(s) or
extent of conductive
concrete on diagram
e.g. 3m ( 2 x 1.5m x 3m )
where the 3m is the total length, 2 is
the number of rods, 1.5m is the rod
length and 3m is the spacing
Main Earth Conductor Material: c.s.a mm2 Connection/continuity verified
Declaration
The extent of liability of the signatory or signatories is limited to the work described above as the subject of this certificate.
Inspected and tested by:
Name: Signature: Date: Position:
Company Name :
Address:
Printed by PMT Digital 01480 493666
Earth Electrodes Pad Low Voltage Check Sheet Pad
REF: C016 REF: C017
30
Section C – Pads
ELECTRICAL PERMIT TO WORK HIGH VOLTAGE ELECTRICAL LIMITATION OF ACCESS
SANCTION FOR TEST
Control Ref No
Control Ref No Control Ref No Control Eng Name
Control Eng Name
Permit No Sanction No No being an Person appointed by Morrison Utility Services to issue this document
In accordance with the Safety Rules mentioned here
Control Eng Name
Give Permission to carry out the work described below.
ELECTRICA1 L I HIGH VOLTA1 GIE 1I
SAFETY PRECAUTIONS APPLICABLE
being an HV Senior Authorised Person appointed by Morrison Utility Services being an HV Senior Authorised Person appointed by Morrison Utility Services LIMITATIONIssue this
I hereby declare that the following High Voltage Apparatus has been made safe in accordance with
Issue this To Issue this To To
Safety Rules for work detailed on this Permit to Work to proceed
Permit to Work Sanction for Test Limitation of Access
PERMIT TO WORK(state Organisations I hereby declare that the following High Voltage Apparatus has been made safe in accordance with ELECTRICAL(state Organisations
rules applicable) rules applicable)
Safety Rules for work detailed on this Permit to Work to proceed OF ACCESS(state Organisations
rules applicable)
For work on SANCTION FOR TESTFortestingon Location
Located at
description and serial number (if available) of apparatus description and serial number (if available) of apparatus
Located at
TREAT ALL OTHER APPARATUS AS LIVE Access to
TREAT ALL OTHER APPARATUS AS LIVE
Points of Points of Plant and
Isolation are Isolation are Apparatus
Circuit Main Earths Circuit Main Earths Environment
are applied at are applied at
Access/General
Other precautions, information or Approvals as required to be entered by the Safety Rules being used. Other precautions, information or Approvals as required to be entered by the Safety Rules being used.
The following work
The following work The following is to be carried out
is to be carried out testing is to be
Diagram
Diagram carried out
Diagram
Signed ............................................................................... Time ............................................. Date ................................................................... In Emergency Contact ..................................................................................................................... Tel No .............................................................
This Limitation of Access is valid until either the time stated here or it is cleared and cancelled
Signed ............................................................................... Time ............................................. Date ...................................................................
2 RECEIPT 2 RECEIPT
I accept responsibility for carrying out the work on the Apparatus detailed on this Permit to Work and no attempt will be made by me or persons I accept responsibility for carrying out the work on the Apparatus detailed on this Permit to Work and no attempt will be made by me or persons
under my charge to work on any other Apparatus or in any other area.
under my charge to work on any other Apparatus or in any other area. Valid until time ............................................................................. Date ................................................................
Signed ............................................................................... Time ............................................. Date ................................................................... Signed ............................................................................... Time ............................................. Date ...................................................................
Signed ............................................................................... Time ............................................. Date ...................................................................
Version 5 June 2012 Approved by Mike Bracey Printed by PMT Digital 01480 493666 Version 4 June 2012 Approved by Mike Bracey Printed by PMT Digital 01480 493666
Version 5 May 2012 Approved by Mike Bracey Printed by PMT Digital 01480 493666
HV & LV Permit To Work Pad HV Sanction for Test Pad Limitation of Access Pad
REF: C018 REF: C019 REF: C020
LV/HV DIAGRAM AMENDMENT SCHEDULED SWITCHING LOG FOR SCHEDULED SWITCHING LOG FOR
HIGH VOLTAGE / LOW VOLTAGE (delete as appropriate) HIGH VOLTAGE / LOW VOLTAGE (delete as appropriate)
Ref No
To Page No
Reference No Page No Reference No
Customer Office Tel No
Customer Site Address Site Tel No Customer Name
Address S/S Fax No
Tel Nos: Location Site Details Mobile No Time
Amendment effective from (date) Operation
Job Description Op. Date Time of Operator’s Location of Operation Operation Equipment
No Agreed Operation Name
Sketch Diagram (circle all alterations and mark new work)
Network Details
Description of Work
Morrison staff involved Contact Tel No’s Customers Staff involved Customers Contact Tel No’s
Morrison Representative Mobile No Work Approved by Morrison Utility Services Operations Agreed by Customer (representative to sign and print name) Printed by PMT Digital 01480 493666 Version 2 June 2012 Approved by Mike Bracey Printed by PMT Digital 01480 493666
Office Use Approved by Mike Bracey
Date Date
Version 2 June 2012 Version 2 June 2012 Approved by Mike Bracey
Printed by PMT Digital 01480 493666
Operational Diagram Amendments Scheduled Switching Log Pad Scheduled Switching Log 2 Pad
REF: C022 REF: C023
Page Pad
REF: C021
SYSTEM INCLUSION CERTIFICATE Site Specific Risk Assessment
Reference No It is important that all the persons working or visiting the site are provided with all necessary information/rules/method statements/risk assessments that
may affect them and/or is required to ensure they can carry out their work safely. The person in charge of the site must carry out a site specific safety
briefing to all persons working on/visiting the site and then it must be signed below to show understanding and agreement.
(To be provided by Senior Authorised Person) Print Name of Person Date of Sketch diagram of work site including location of excavations, sign and guarding.
(
= Sign / ---- = Barrier / V = Cone / = Excavation / z = Traffic Light)
To: Network Control Engineer – Site: Print Name Sign Company Giving Briefing Briefing
It is my intention that the Apparatus detailed below is to be MADE LIVE, or must be regarded as being LIVE by reason of its
proximity or relation to other Apparatus or because testing may be in progress,
From (hrs) on (date)
This included network will come under the Control of The Network Control Engineer and be subject to the appropriate Safety Site Address: Job Number:
Rules.
Site Specific Risk Assessment Risk Assessment Completed by: Date: M T W T F S S
No further work may be done on or near the Apparatus after this time and date unless the person in charge of the work is in
possession of a Permit to Work or Sanction for Test issued in accordance with the appropriate Safety Rules. Brief Description Of Works: Confirm the following are in place:
Must be Completed Before Starting Work & Amended if Site Conditions Change
DESCRIPTION OF APPARATUS AND LOCATION Severity of injury (if this can not be achieved you must stop work and contact your line manager)
Please include a final arrangement diagram amendment for use in the Network Control Centre.
- All relevant information present (eg Utility Plans, Scope of Work etc) to undertake these works safely
- Valid Streetworks or Permit Notice
- Minimum of 1.2m unobstructed walkway present with kerb ramps in place where required
- Sufficient barriers to segregate the public from the works
Persons Likely to be Affected by your Activities - Excavation is less than 1.5m deep
Enter the category score for each Hazard and the total score for each excavation. For Record location and rating of each excavation. You can record up to 5 excavations on one Risk Assessmen-t.All relevant documentation completed (e.g. live working assessment. LV cable check sheet etc) for the relevant task
excavations with a score of 13 or greater, excavation support under a Permit to Work is NotSet:aAff s&inCgolentraecntcohrsis classified as Voinseitoerxscavation. Public & Motorists Other
required. Stop work and inform your line manager who will arrange for competent personnel - All competencies / training current and in date to undertake the task
with appropriate equipment to undertake the work.
1. Excavation 2. Excavation 3. Excavation 4. Excavation 5. Excavation
Location HazaLrodcation Generic Risk
Hazard Present Detail Site Observation / Site Specific Residual Risk Rating
Location Location Assessments NuLomcabtioenrs Control Measures / General Comments Low Medium High
Ground Conditions High Medium Low Yes No (Team Safety Pack)
Ground Type Soft Semi Firm Firm Protection of Works / Pedestrians & Vehicles (Red Book)
521
Potential for Instability High Medium Low Underground / Overhead Apparatus
5 2 1
Signed ............................................................................... Time ............................................. Date ................................................................... Potential for Undermining Yes No Excavation(s) (Ground Conditions, Positioning of Spoil etc)
On behalf of Morrison Utility Services 3 1
Traffic Loading Heavy Medium Light Work Location (Sub-Station, Schools, Level Crossing,
5 2 1 Shops and Pedestrian Crossing etc)
Safe Access / Egress No Yes Plant, Tools and Equipment
3 1
(Test Equipment, Instruments, Abrasive Wheel etc)
CONFIRMATION Continual Dewatering Required Yes No Reinstatement (Backfill, Hot/Cold lay, Concrete, Modular
This Apparatus was connected to the System at: Surrounding Structures (walls / poles / lamp columns etc) 5 1
(hrs) on Less Than 500mm Greater Than 500mm Greater Than 1m Surfaces)
3 2
1 Occupational Health (Manual Handling, HAVS, Noise, Dust,
(date) Record of Excavation Inspection (inspections must be undertaken by a competent person TOTAL Materials & Substances)
and recorded every 7 days) DATE
Environmental
(Water Courses, Trees, segregation of materials & Weather etc)
Signed Signed Electricity (LV / HV Jointing, Overhead Lines, Fitting etc)
(Control Engineer) (Senior Authorised Person) Note: Briefing is also required whenever there has been a significant change to the hazards and control measures since the individual was last briefed.
Print Name Print Name Confined Space / Working at Height Activities
Personal Protective Equipment (Circle as appropriate) Overalls Safety Hi Visibility Safety Goggles Face General LV/HV Ear Dust Hard Respirator Other
Boots Vest Glasses Visor Purpose Gloves Gloves Protection Mask Hat
Version 1 June 2012 Approved by Mike Bracey Printed by PMT Digital 01480 493666 High MM H Severity of Injury: Probability of Injury: Residual Risk Rating
Medium
Low L MM High Fatal, broken bones, electrocution, sight etc High Very likely to occur Low Carry out work in a methodical way, based
Medium on knowledge, skills, training & experience
L LM Medium Burns, sprains, deep wounds etc Medium May occasionally occur
Take initial on site action where appropriate
Low Medium High Low Small cuts, grazes etc Low Unlikely to occur and contact your line manager for advice
Probability of Injury To be signed ONLY by those undertaking the initial site specific risk assessment
I am / we are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others. High Stop work and inform your line manager
System Inclusion Certificate 1.Print Name ................................................................ Sign ........................................................................ 3.Print Name ................................................................ Sign ........................................................................ Electrical On Site Risk Assessment - Version 1
REF: C024 2.Print Name ................................................................ Sign ........................................................................ 4.Print Name ................................................................ Sign ........................................................................ Printed by PMT Digital
Electrical On Site Risk Ass v1 (double sided)
REF: C025
On Site Risk Assessment Pad v8 WPD/MRS (double sided) Zero Harm Groundworks On Site Risk Assessment Pad v9
REF: C026
(Double Sided) - Optional Covers REF: C027
31
Section C – Pads
Site Address: Job Number:
Site Specific Risk Assessment Risk Assessment Completed by: Date: MTWT F S S
Day:
Brief Description Of Works:
Confirm the following are in place:
(if this cannot be achieved you must stop work and contact your line manager)
- All relevant information is present (e.g. Traffic Management Plan, Scope of Work etc) to undertake these works safely.
- Valid Street-Works or Permit Notice.
- Minimum sideways and longitudinal safety zones achievable.
- Sufficient signs and barriers to inform and segregate the public from the works.
- Adverse weather conditions do not restrict visibility to undertake works safely.
- All competencies / training current and in date to undertake the task.
Must be Completed Before Starting Work & Amended if Site Conditions ChangePersons Likely to be Affected by your Activities
Severity of injury
Staff & Contractors Visitors Public & Motorists Other
Must be Completed Before Starting Work & Amended if Site Conditions Change
Severity of injuryHazardHazard PresentGeneric RiskDetail Site Observation / Site SpecificResidual Risk Rating
Yes No Assessments Numbers Control Measures / General Comments Low Medium High
Protection of Works / Pedestrians and Vehicles,
(Restricted Visibility, Narrow Carriageways, Refer to Red Book). (Team Safety Pack)
Site Obstructions / Overhead Apparatus Hi-Visibility Safety Boots Safety Glasses Goggles Hearing Hard Hat Gloves Dust Mask Overalls Other
(Electricity / BT Cables / Street Furniture / Bridges / Parked Vehicles). Clothing Protection
Work Location (Schools, Level Crossing, Shops, Bus Stops, Emergency
Services, Residential Homes, Pedestrian Crossings, etc).
Working Area (Free from Slips, Trips and Falls, adequate Space to
Manoeuvre Equipment and Materials).
Plant, Tools and Equipment (Vehicles, Tail Lift, Trailers, Traffic Light
Heads, Signs, Lighting, Barriers, Cones, Batteries etc).
Occupational Health (Night Working, Lone Working, Fatigue, Manual
Handling, HAVS, Noise, Dust, Materials and Substances).
Environment (Water Courses, Trees, Segregation of Materials, Weather,
Spillages, Refuelling, Battery Storage etc).
Working at Height
(Covering Traffic Light Heads, Access / Egress from Vehicle Bed).
Site maintenance / Dismantlement
(Signs, Cones, Cleaning, Battery Maintenance / Exchange).
Other
Personal Protective Equipment
(Circle those appropriate for the task)
High MM H Severity of Injury: Probability of Injury: Residual Risk Rating
Medium
Low L MM High Fatality, broken bones, crush injuries etc High Very likely to occur Low Carry out work in a methodical way, based
Medium on knowledge, skills, training & experience
L LM Medium Burns, sprains, deep wounds etc Medium May occasionally occur
Take initial on site action where appropriate
Low Medium High Low Small cuts, grazes etc Low Unlikely to occur and contact your line manager for advice
Probability of Injury To be signed ONLY by those undertaking the initial site specific risk assessment
I am / we are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others. High Stop work and inform your line manager
1.Print Name ................................................................ Sign ........................................................................ 3.Print Name ................................................................ Sign ........................................................................ Traffic Management On-Site Risk Assessment – Version 1
2.Print Name ................................................................ Sign ........................................................................ 4.Print Name ................................................................ Sign ........................................................................ Printed by PMT Digital
Zero Harm Electrical On Site Risk Assessment Pad v1 Western Gas Risk Assessment Pads
(Double Sided) - Optional Covers REF: C028 REF: C029
Directors SHEQ Tour Record
On Arrival at Site: Park Vehicle in Designated Area and / or in Safe Area - Put on Relevant PPE - Report to Main office
for fixed depots and sign site register. For transient works report to Senior person on site, sign site risk assessment or
Attendance record.
Site: Names of Employees met on the Day:
Location:
Topics Discussed:
Concerns Raised:
Action Taken / Required:
Other Comments:
Directors shall engage employees in open conversation with regards to the following where applicable:
View of MUS.
View of SHEQ procedures (availability / understanding).
Concerns noted from Design
Concerns noted from commissioning
Workplace Conditions.
Equipment Availability / Condition.
Details / Frequency of Communications (Toolbox Talks / Safety Alerts).
Employees biggest SHEQ Concern.
Availability of Training.
Near Miss Reporting Process.
Line Management Feedback on Issues raised by employee previously.
What would they change, how & why?
Name:………………………… Signature:………………………… Date:……………………….
Completed Record to be forwarded to Director of SHEQ and Line Management for onward distribution to their team
Issue 1 MUS-TMP-S-024 Revision 4
Directors SHEQ NCR Pad Calculation Pad Small Works Site Inspection Form Pad
REF: C030
REF: C031 REF: C032
S19 VEHICLE & TRAILER INSPECTION RECORD Site Specific Risk Assessment
Vehicle Make/Model:
Week Commencing: Signature: It is important that all the persons working or visiting the site are provided with all necessary information/rules/method statements/risk assessments that
Drivers Name: may affect them and/or is required to ensure they can carry out their work safely. The person in charge of the site must carry out a site specific safety
briefing to all persons working on/visiting the site and then it must be signed below to show understanding and agreement.
Vehicle Registration: Print Name Sign Company Print Name of Person Date of Sketch diagram of work site including location of excavations, sign and guarding.
Trailer No: (
= Sign / ---- = Barrier / V = Cone / = Excavation / z = Traffic Light)
Giving Briefing Briefing
TRAILER DAILY SAFETY INSPECTION RECORD VEHICLE DAILY SAFETY INSPECTION RECORD
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
Completed by:
1 Towing Eye/Ball/Hitch 1 Oil, Fuel, Fluids, Coolants levels/
leaks
2 Power Cable & Plug 2 Trailer Coupling/Connections Site Address: Job Number:
3 Lights/Trailer Boards/ 3 Wheels & Wheel Nut Date:
Number Plates Indicators. Day:
4 Side/Front Markers 4 Tyres Inflation, Damage, Wear Site Specific Risk Assessment Risk Assessment Completed by: MTWT F S S
5 Breakaway Cable 5 Mirrors/Windows/Wipers/Was
hers
Brief Description Of Works: Confirm the following are in place:
6 Hand Brake 6 Lights/Indicators/Emergency (if this cannot be achieved you must stop work and contact your line manager)
Beacon
Vehicle & Trailer Inspection7 Horn & Seat Belts
7 Jockey Wheel/Clamp/ - All relevant information present (eg Utility Plans, Scope of Work etc) to undertake these works safely
Drop Leg
- Valid Streetworks or Permit Notice
Instruments/Speedo/Speed
8 Decking/Flooring 8 Limiter - Minimum of 1.2m unobstructed walkway present with kerb ramps in place where required
9 Securing Straps 9 Ancillary Equipment/Loads/ Record Book Enter the category score for each Hazard and the total score for each excavation. For Record location and ratingPoefresoanchs Leixkcealvyattoiobne. YAoffuecctaendrbecyoyrdouurpAtcoti5vietixecsavations on one Risk Assessment. - Sufficient barriers to segregate the public from the works the reverse must be completed
Aids excavations with a score of 13 or greater, excavation support under a Permit to Work is Note:SAtasfifn&glCeotnretnracchtoisrsclassified as onVeiseitxocrasvation. Public & Motorists Other - If excavation is deeper than 1.2m, the excavation assessment on task
required. Excavation support under a Permit to Work is mandatory for excavation of 1.5m or - All competencies / training current and in date to undertake the
10 Wheels, Wheel Nut 10 Brakes/Steering/Exhaust - deeper. Stop work and inform your line manager who will arrange for competent personnel
Indicators & Dust Caps. Condition/Smoke with appropriate equipment to undertake the work.
1. Excavation 2. Excavation 3. Excavation 4. Excavation 5. Excavation
Tyre Condition/Pressure/
11 Valves 11 Number Plates Location Location Location Hazard PresenLtocation Generic LRNociusatkmionbers Detail Site Observation / Site Specific Residual Risk Rating
Hazard Yes No Assessments Control Measures / General Comments Low Medium High
12 Lashing Points/Hooks 12 Body/Guards/Spray Ground Conditions High Medium Low
suppression (Team Safety Pack)
13 Tailgate/Mud Guards 13 Reflectors/Markers Ground Type Soft Semi Firm Firm
5 2 1 Protection of Works / Pedestrians & Vehicles (Red Book)
14 Trailer correct for weight 14 Steps & Handrails Potential for Instability High Medium Low
of load
5 2 1 Underground / Overhead Apparatus
Reverse Bleeper/Camera/
15 Securing Pins & Clips 15 Alarms Audible and Visual Potential for Undermining Yes No Excavation(s) (Ground Conditions, Positioning of Spoil etc)
Traffic Loading 31 (Excavation Assessment on reverse)
Safe Access / Egress
DEFECTS SECTION DEFECTS SECTION Completed by: Continual Dewatering Required Heavy Medium Light Work Location (Sub-Station, Schools, Level Crossing,
Surrounding Structures (walls / poles / lamp columns etc) 5 2 1 Shops and Pedestrian Crossing etc)
No Yes Plant, Tools and Equipment
31 (Excavator, HIAB, Abrasive Wheel, Compaction Equipment etc)
Yes No Reinstatement (Backfill, Hot/Cold lay, Concrete, Modular
51 Surfaces)
Less Than 500mm Greater Than 500mm Greater Than 1m Occupational Health (Manual Handling, HAVS, Noise, Dust,
321 Materials & Substances)
Record of Excavation Inspection (inspections must be undertaken by a competent person TOTAL Environmental
and recorded every 7 days) DATE (Water Courses, Trees, segregation of materials & Weather etc)
Note: Briefing is also required whenever there has been a significant chaCnagblee /tPoipetLhayeinghaacztivaitrieds s and control measures since the individual was last briefed.
Confined Space / Working at Height
Personal Protective Equipment Overalls Safety Boots Hi Visibility Safety Glasses Goggles Ear Protection Hard Hat Gloves Dust Mask Respirator Other
(Circle those appropriate for the task) Vest
High MM H Severity of Injury: Probability of Injury: Residual Risk Rating
Medium
Low L MM High Fatal, broken bones, electrocution, sight etc High Very likely to occur Low Carry out work in a methodical way, based
Medium on knowledge, skills, training & experience
L LM Medium Burns, sprains, deep wounds etc Medium May occasionally occur
Take initial on site action where appropriate
Low Medium High Low Small cuts, grazes etc Low Unlikely to occur and contact your line manager for advice
Probability of Injury To be signed ONLY by those undertaking the initial site specific risk assessment
I am / we are familiar with the task to be undertaken and the precautions required, in order to complete the works without endangering ourselves or others. High Stop work and inform your line manager
1.Print Name ................................................................ Sign ........................................................................ 3.Print Name ................................................................ Sign ........................................................................ Ground-works On Site Risk Assessment - Version 9
2.Print Name ................................................................ Sign ........................................................................ 4.Print Name ................................................................ Sign ........................................................................ Printed by PMT Digital
Vehicle & Trailer A4 Pad with Cover Ground-works On Site Specific Risk Assessment
REF: C033 A4 Pad with Cover v9 (double sided) REF: C034
Pneumatic Pad A4 Training Register NCR Pad A4
REF: C035 REF: C036
32
Section C – Pads
^ƵƉĞƌǀŝƐŽƌ /ŶƐƉĞĐƟŽŶ
Site Specific Risk Assessment ( % *"% # !&# ' "!& % ! && !' # %' " !&(% ! ' "!' !( ' / & ', ! * ! "
"(% # "# 0 % #(%#"& & '" !&(% ' ' ' "!'%" &(% & ) ! # !' "%% ' , ! ' '
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may affect them and/or is required to ensure they can carry out their work safely. The person in charge of the site must carry out a site specific safety #%" &&0
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Traffic Management On Site Risk Assessment Pads Thames Water Supervisor
Inspection Form NCR REF: C036
(Double Sided) REF: C035
UK Power Networks DSR 01 016a Site Specific Risk Assessment
POLARITY RECORD v1.0
It is important that all persons working or visiting the site are provided with all necessary information/rules/method statements/risk assessments that
may affect them and/or is required to ensure they carry out their work safely. The person in charge of the site must carry out a site specific safety
briefing to all persons working on/visiting the site and then it must be signed below to show understanding and agreement.
SPEN’s / Area / Parish Date: Job No: Print Name Sign Company Print Name of Person Date of Brief
Giving Briefing
Transformer: Operative (Print):
Property Details Pre Work Tests
Address: Phase L1 L2 L3 Comments Phase L1 L2 L3 Comments
Socket Yes No Yes No Yes No Volt Stick Yes No Yes No Yes No
Volt Stick Yes No Yes No Yes No Neon Yes No Yes No Yes No
Neon Yes No Yes No Yes No Test Lamp Yes No Yes No Yes No Site Address: Job Number:
Meter No. Test Lamp Yes No Yes No Yes No Rotation With Arrow Against Arrow Serial No.
Single Split Phase 3 Phase Rotation With Arrow Against Arrow Serial No. ELI Serial No. Date
CNE SNE Other: ELI # Voltage Follow Up Work? Yes No Risk Assessment completed by:
Voltage Name
60A 80A 100A Other: Safety Shield fitted Yes No Socket Yes No Yes No Yes No Cut Out/Meter Sealed? Yes No
" ! Witnessed by: Sign: Date: Time: Witnessed by: Sign: Date: Time: Site Specific Risk Assessment Signature Day
! ! ! $
() ()* &
% $ % Must Be Completed Before Starting Work & Amended If Site Conditions Change Brief Description of Works Confirm the following are in place: (if this cannot be achieved then you MUST stop work and contact your Site Manager/Project Manager)
$ %
Property Details Pre Work Tests
All relevant information is present (e.g. Task Information, Scope of Works, Cable Drawings, RAMS etc.)
Valid Safety Documents (Permit to Work, Isolations, Site Asset/Access Authorisation, Hot Works Permits etc.)
Address: Phase L1 L2 L3 Comments Phase L1 L2 L3 Comments Sufficient Guarding to protect work area,to prevent unauthorised access (Heras Fencing, Covers, Barriers etc.)
All equipment is fit for purpose (e.g. Gas Monitors, Harnesses and Lanyards, Hand Tools, Power Tools, MEWPs, Tele Handlers etc.)
Socket Yes No Yes No Yes No Volt Stick Yes No Yes No Yes No with LOLER etc Certificates
Volt Stick Yes No Yes No Yes No Neon Yes No Yes No Yes No Persons likely to be affected by the works All competencies and training cards/certificates are in date and relevant to the task to be undertaken
Neon Yes No Yes No Yes No Test Lamp Yes No Yes No Yes No
Meter No. Test Lamp Yes No Yes No Yes No Rotation With Arrow Against Arrow Serial No. Staff & Contractors Visitors Publc & Motorists
Single Split Phase 3 Phase Rotation With Arrow Against Arrow Serial No. ELI Serial No.
CNE SNE Other: ELI Serial No. Voltage Follow Up Work? Yes No
Voltage Residual Risk
Low Med High
60A 80A 100A Other: Safety Shield fitted Yes No Socket Yes No Yes No Yes No Cut Out/Meter Sealed? Yes No Hazard Hazard Present Generic Risk Assessment Numbers Detail Site Observation.SiteSpecific Control
Access, Egress and Emergency Procedures Yes No (Team Safety Pack) Measures/General Comments
" ! Witnessed by: Sign: Date: Time: Witnessed by: Sign: Date: Time:
! ! ! $
() ()* &
% $ % $ %
Property Details Pre Work Tests
Address: Phase L1 L2 L3 Comments Phase L1 L2 L3 Comments Protection of Work Area and Work Location, including Switch
Room, Control Room and Compound
Socket Yes No Yes No Yes No Volt Stick Yes No Yes No Yes No Electricity; HV/LV Plant & Equipment, Cables, Fitting & Apparatus
Volt Stick Yes No Yes No Yes No Neon Yes No Yes No Yes No
Neon Yes No Yes No Yes No Test Lamp Yes No Yes No Yes No
Meter No. Test Lamp Yes No Yes No Yes No Rotation With Arrow Against Arrow Serial No.
Single Split Phase 3 Phase Rotation With Arrow Against Arrow Serial No. ELI Serial No. Hot Works
CNE SNE Other: ELI Serial No. Voltage Follow Up Work? Yes No
60A 80A 100A Other: Voltage Socket Yes No Yes No Yes No Cut Out/Meter Sealed? Yes No Plant, Tools & Equipment
Safety Shield fitted Yes No
" ! Witnessed by: Sign: Date: Time: Witnessed by: Sign: Date: Time: Overhead & Underground Apparatus
! ! ! $
() ()* &
% $ % $ % NOTE: Briefing is also required whenever there has been a signiOficccaupnattiocnhaal Hnegaeltht(oMatnhuealhHaanzdalirndg,sHaAnVSd, Ncooisnet,rDoulsmt, easures since the individual was last briefed
Materials, Substances)
Confined Spaces/Working at Height
Lifiting Operations
Environmental: Asbestos, Water Courses, Sewage, Contaminated
Ground, Trees
Additional Site Specific Hazard (e.g. Deep Excavation)
PPE (Circle as necessary. NOTE: Those in RED are mandatory) FR Overalls, Long Sleeve Hi Viz, Safety Boots, Hard Hats, Safety Glasses, Gloves, Goggles, Respirator, Dust Mask, Ear Protection, Harnesses
UKPN Polarity Record Pads Sub Station Risk Assessment Pads
REF: C037 (Double Sided)
REF: C038
The Hazardous Waste Regulations 2005: Consignment Note Morrison Utility Services Ltd
Abel Smith House, Gunnels Wood Road
CONSIGNEE’S COPY
Stevenage, SG1 2ST
PART A Notification details The Hazardous Waste Regulations 2005: Consignment Note Morrison Utility Services Ltd
CARRIER’S COPY Abel Smith House, Gunnels Wood Road
The Hazardous Waste ReStgevuelnaatgieo, nSGs1220S0T5: Consignment Note Morrison Utility Services Ltd
1 Consignment note code: / 3 The waste will be taken to: Abel Smith House, Gunnels Wood Road
Name: Stevenage, SG1 2ST
PRODUCER’S/HOLDER’S/CONSIGNOR’S COPY (Delete as appropriate)
Insert ‘D’ in the end box if you are employed by MUS, use anPMAURSTvehAiclNe otifAicdadtrieosns:details
to move the waste and take the waste to an MUS depot for storage. / 3 The wasPteAwRillTbeAtaNkoentiftioc:ation details Site Address: Job Number:
1 Consignment nPotoestccooddee:: Name:
Address1: Consignment note code: Site Specific Risk Assessment Risk Assessment Completed by:
2 The waste described below is to be removed from: Insert ‘D’ i4n tThheeenwdabsotex ipf ryooduuacrerewmapslo:yed by MUS, use an MUS vehicle / 3 The waste will be taken to: Date:
to move theNwamasete: and take the waste to an MUS depot for storage. Name: Brief Description Of Works: Day:
Name: Address: MTWT F S S
Address: Address: Postcode: Insert ‘D’ in the end box if you are employed by MUS, use an MUS vehicle
Postcode: 2 The waste described below is to be removed from: to move the waste and take the waste to an MUS depot for storage.
Telephone: 4 The waste producer was:
Name: Postcode: Postcode: Confirm the following are in place: (to be completed by contract)
E-mail: Address: Telephone: Nam2eT:he waste described below is to be removed from: • All relevant information present, Job Pack, In date Utility plans/LSBUD
Address: Name: 4 The waste producer was: • Valid street works or Notice Permit
PART B Description of the waste E-mail: Name: • Minimum of 1.2 metres unobstructed walkway present with kerb ramps in place where required.
1 The process giving rise to the waste was: Address: • Sufficient barriers to segregate the public from the works
Postcode: If continuation sheet used, tick here Postcode: Address: • If excavation is deeper than 1.2 metres, the excavation assessment on the reverse must be completed
Telephone: • All Competencies/training current and in date to undertake the task
Telephone:Postcode:
E-ma2il: SIC (2007) for the process giving rise to the waste: . E-maiTl:elephone: Postcode:
IEf -cmonatinl:uation sheet used, tick here Telephone:
3 WASTE DETAILS (where more than one waste type is collectePd aAllRofTthBe inDfoermsactrioipn tgioivennobfeltohwemwusat sbetecompleted for each EWC identified) Persons Likely to be Affected by your Activities
E-mail:
Description of waste List of wastes (EWC) Quantity 1 TTcohhmeepcpohneroemncictesasiln/bstiohgleoivgwiicnaasglteraisned tthoeitrhe w(Pgahasysst,eicliaqwlufiaod,rsm: Hazard Container 2 SIC (2007) PfoAr tRheTpBrocDeessscgirvipintgiorniseotfotthhee wwaasstete: . Staff & Contractors Visitors Public & Motorists Other
code (6 digits) (kg) code (s) type, number If continuation sheet used, tick here
concentrations are: solid, powder, and size (no.
3 WCoAmSpoTnEenDt ETAILC(S%on(owcrehmnetgrra/ektgiom)nore tmshluaixdnegdoe)noer waste type is collecteoldofoassalelc)oksf tohre information given1bTelhoew pmruosctebsescgoimvipnlgeteridsefotroeathceh EwWasCteidwenatsif:ied) 2 SIC (2007) for the process giving rise to the waste: . Hazard Present Generic Risk
Yes No Assessments Numbers
Description of waste List of wastes (EWC) Quantity The chemical/biological Physical form Hazard Container Hazard Detail Site Observation / Site Specific Residual Risk Rating
Protection of Works/Pedestrians & Vehicles (Red Book) (Team Safety Pack) Control Measures / General Comments Low Medium High
code (6 digits) (kg) components in the waste and3thWeirAST(EgasD, EliqTuiAd,ILS (wchoedree(sm) ore thatynpeo,nneumwabesrte type is collected all of the information given below must be completed for each EWC identified)
Other
The information given below is to be completed for each EWC identified concentrations are: ConcentratDioenscriptissolounldidog,fepwooawrsdteer, Lcoisdteof(oalo6wnfodsdasaisegsct)iiekztsses)(o(EnrWo. C) Quantity The chemical/biological Physical form Hazard Container Residual Risk Rating
Component (kg) components in the waste and their (gas, liquid, code (s) type, number
concentrations are: solid, powder, and size (no. Carry out work in a methodical way, based
EWC code UN identification Proper shipping name(s) UN Packing Special handling requirements (% or mg/kg) mixed) on knowledge, skills, training & experience
class(es) Take initial on site action where appropriate
number (s) group(s) Component Concentration sludge or of sacks or and contact your line manager for advice
Stop work and inform your line manager
(% or mg/kg) mixed) loose) Underground/Overhead Apparatus
Ground-works On Site Risk Assessment - Civils
The information given below is to be completed for each EWC identified Excavation(s) (Ground Conditions, Positioning of Spoil etc) Printed by PMT Digital Tel. 01480 493666
(Excavation Assessment on reverse)
PART C Carrier’s certificate EWC code PART DnUuNmCidboeenrnt(isfsi)ciagtionnor’sPrcopeerrtsihfiipcpaintgename(s) UN Packing Special handling requirements
Cable / Duct Laying
(If more than one carrier is used, please attach schedule for subsequent carriers. I certify that the information in A, B and C has been class(esT) he ginrofuopr(ms)ation given below is to be completed for each EWC identified
If schedule of carriers is attached tick here.) completed and is correct, that the carrier is registered or Work Location (Sub-Station, Schools, Level Crossing, Shops and Pedestrian
EWC code UN identification Proper shipping name(s) UN Packing Special handling requirements Crossing etc)
class(es) group(s) Plant, Tools and Equipment
number (s) (Test Equipment, Instruments, Abrasive Wheel etc)
I certify that I today collected the consignment and that the dPetAaRilsTinC Carerxieerm’sptcaenrdtifwicaastaedvised of the appropriate precautionary PART D Consignor’s certificate Reinstatement (Backfill, Hot/Cold lay, Concrete, Modular Surfaces)
A2, A3 and B3 are correct and I have been advised of any rsoAh(IIpfIuface2snmencc,drhidoAfteiilrcif3ednyugatthlhenraaedontqfBoIucn3atierorhIhc(meardEciomiaceraeeaneronryrrearsgnrdaecisnclieflrcsoauiitcorrnstrnrmahlilgr.yesldteeytsauratccaae.hcsnttnhesqaAedadeddutlrnld,teiIWrhdtophqehteiflcIeemauatkachivhlrecesaeaheeosnerevd)nrftwreauiseseRbta.l.tifbrygaeislehclntgRe)eehamudenssliasegmcabtnuhpideyolteaavendadctinusisnukoledeat2anydgd0ft1ohtev1oor2aid1fssta.oaeuatpfnbdhnpstyedhoelysefqdlapuateWhbeenteaencyatiillfwlsssecictaapdeinrserticeeirasl.
handling requirements. the cI ocmerptilfeytethdaPatAnthdReiTsincfCoorrmrCeacattir,ortniheainrt’stAh,ceBecraatrnirfdiiecCraisthearesgbiseteenred or PART D Consignor’s certificate Occupational Health (Manual Handling, HAVS, Noise, Dust,
Materials & Substances)
Where this note comprises part of a multiple collection exempt an(dIf mwoarseathdavnisoendeocfarthrieeraispupsreodp,ripaleteaspereacttacuhtioscnhaerdyule for subsequent carriers. I certify that the information in A, B and C has been Environmental (Water Courses, Trees, segregation of materials
measures.IfAscllhoefdtuhlee owf acasrterieirss pisaactktaacgheedd aticnkdhlearbee.lle)d completed and is correct, that the carrier is registered or & Weather etc)
number and collection number are: . exempt and was advised of the appropriate precautionary
measures. All of the waste is packaged and labelled Confined Spaces/Working at Height
1 Carrier Name: correctly aIncdetrhtiefyctahrartieIrtohdaasybceoelnleactdevdistehde ocfoannsyigsnpmeecniatland that the details in correctly and the carrier has been advised of any special
handling requirements.
2 Address: Where this note comprises part of a multiple collection the round handling reAq2u, iAre3maenndtsB. 3 are correct and I have been advised of any specific
number and co1lleCctoionnsignnuomrbnearmaere:: . e I confirm thhaatnIdhlinagverefuqlufiilrleemd emnytsd.uty to apply the waste
Postcode: On behalf of hierarchy aWshreerqeutihreisdnboyteRceogmulpartiosens1p2aortf othfeaWmauslttieple collection the round
Telephone:
1 Carrier NNaammee:: (England annudmWbearleasn)dRceoglluelcattiioonnsnu2m01b1e.r are: . I confirm that I have fulfilled my duty to apply the waste
E-mail: 2 AAddddrreessss:: hierarchy as required by Regulation 12 of the Waste
1 Consigno1r name: e (England and Wales) Regulations 2011.
On behalf o2f Carrier Name: Personal Protective Equipment Flame Safety
3 Carrier registration no.: PPoossttccooddee:: Address: (Circle those appropriate for the task) Retardant Safety Hi Visibility Glasses/ Face Safety Ear FP3 Dust Hard Hat Respirator Safety
4 Vehicle registration no: TTeelleepphhoonnee:: Name: Coveralls Boots Vest Goggles Visor Gloves Protection Mask Harness
Signature: Address: Postcode: 1 Consignor name: e
EE--mmaaiill:: On behalf of
Date: Time: High MM H
Name: Medium L MM
3 Carrier registSraigtinoantunroe.:: Date: Time: Telephone: Address: Severity of injury Low L LM Severity of Injury: Probability of Injury:
E-mail: Low Medium High
4 Vehicle registration no: Postcode: Probability of Injury High Fatal, broken bones, electrocution, sight etc High Very likely to occur Low
TeleEph-monaei43l:: Carrier registration no.: Medium
PART E Consignee’s certificate (where more than one wasteStyigpenaistucorlele:cted all of the information given beloDwamteus:t be completeTd ifmor ee:ach EWC) Vehicle registration no: Postcode:
Telephone: High
EWC code(s) received Quantity of each EWC code received (kg) EWC code (delete as applicable Waste management operation (R or D code) Signature:Signature: Date: TimeD: ate: Medium Burns, sprains, deep wounds etc Medium May occasionally occur
Accepted / rejected E-mail:
Time: Signature:
PART AEccCeptoedn/sriegjencteede ’s certificate (where more than one waste type is collected all of the information given below must be completed for each EWC) Date: Time: Low Small cuts, grazes etc Low Unlikely to occur
1 I received this waste at the address given in A3 on: Date EWC code(s) rece.iveTdime Quantity of e.ach EWC code received (kg) EWC code (delete as applicable Waste management operation (R or D code)
2 Vehicle registration no.: . Name: Acceepted / rejected PART E Consignee’s certificate (where more than one waste type is collected all of the information given below must be completed for each EWC) To be signed ONLY by those undertaking the initial site specific risk assessment
On behalf of Accepted / rejected EWC code(s) received Quantity of each EWC code received (kg) Waste management operation (R or D code)
3 Where waste is rejected please provide details: EWC code (delete as applicable I can confirm that I am in charge of the site, the site is set up, is compliant and all We are familiar with the task to be undertaken and the precautions required, in order to
Accepted / rejected e individuals on site are authorised to be working. complete the works without endangering ourselves or others.
1 I received. this wastNeaamt teh:e address given in A3 on: Date . Time . Accepted / rejected
I certify that waste permit/exempt waste operations number:2 Vehicle re.gistratioAnddnroe.:ss:
. NOanmbee:half1ofI received this waste at the address given ineA3 on: Date Site Leader Print Name: Op Sign Name: Op Print Name: Op Sign Name:
authorises the management of the waste described in B at th3eWahdedrreeswsaste is rejected please provide details: . Time . Op Print Name: Op Sign Name: Op Print Name: Op Sign Name:
Postcode:
given in A3. . Nam2eV: ehicle registration no.: . Name:
. On behalf of
Where the consignment forms part of a omf uclotinpsleigcnomlleecnttisonfo,ramIasiucnietdghreottinhfrytiesifteihesadtthweamstSTaeeingplaenegEapremth-ummoirtnea/ee:nilx::teomf tphtewwaassteteodpeesracDtriaiobtnesd: number: Addre3ssW: here waste is rejected please provide details: . Name:
number in B at tTheimaed:dress
in Part C, I certify that the total PostcodI ec:ertify that waste permit/exempt waste operations number: Address:
collection are: . given in A3. TeleEph-mongaaeiuivl::tehnoriinseAs3t.he management of the waste described in B at the address .
SignatureW: here the consignmDeanttef:orms partToimf ae:multiple collection, as identified
MUS-FM-E-007 Where the consignment forms part of a omf uclotinpsleigcnomlleecnttisonfo,ramsinidgetnhteiIfsiesdue 1 Postcode:
in Part C, I certify that the total number Telephone:
Groundwords Risk Assessment – Civils version
collection are: . E-mail: REF: C040
Signature:
in Part C, I certify that the total number of consignments forming the Date: Time:
MUS-FM-E-007 collection are: . Issue 1
MUS-FM-E-007 Issue 1
Hazardous Waste 3 Part NCR - A4
REF: C039
No: 0001 No:
Driver Name: HGV PRE START CHECK AND DEFECT RECORD Waste Transfer Note / Multi-site waste pick up register
Vehicle Registration: 086 )0 (
Start Mileage: Driver Signature: Waste Containment: Loose Sacks Skip Other (Specify) [ ]
Stop Mileage:
Date: Driver’s Name: Vehicle Registration: Depot Address:
Date of collection
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY List of Waste Code
Site/Project/Depot address Team Leader – Name Weight (tonnes)
17 05 04 17 03 02 17 09 04 Other
HGV PRE START INSPECTION RECORD 24 Mudguards/Spray suppression secure
¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH 25 Wheels/wheel nut indicators/dust caps
No Item Mon Tue Wed Thu Fri Sat Sun 26 7\UHV GDPDJH EXOJHV FXWV ZHDU
1 'ULYHU 3DVVHQJHU VHDW VHDW EHOW IXQFWLRQ VHFXULW\ 27 8QGHUUXQ EDUV VHFXUH GDPDJH
2 1R 6PRNLQJ 6LJQ YLVLEOH 28 :DVKHUV VFUHHQ ZDVK ZLSHUV LQ ZRUNLQJ RUGHU
3 9XOQHUDEOH 5RDG 8VHU &\FOH 6DIHW\ VWLFNHU OHJLEOH 29 Steering - wear, operation
4 7DFKRJUDSK IXQFWLRQDO FRUUHFW WLPH HWF 30 2Q ERDUG :HLJKHU IXQFWLRQ RSHUDWLRQ
5 Tachograph rolls - at least two rolls in vehicle HGV PRE START INSPECTION RECORD
6 )LUH H[WLQJXLVKHU LQ GDWH VHYLFHDEOH LI DSSOLFDEOH ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH
7 1 6 ,QGLFDWRU $XGLEOH ZDUQLQJ DODUP RSHUDWLRQ No Item Mon Tue Wed Thu Fri Sat Sun
8 Interior warning devices go out when started 1 7RZLQJ (\H FRXSOLQJ EDOO KLWFK Total Quantity: tonnes
9 Fuel level 2 3RZHU FDEOH SOXJ PRODUCER / WASTE CARRIER’S DETAILS (TRANSFEROR): WASTE TRANSFER / DISPOSAL SITE DETAILS (TRANSFEREE)
10 )XHO WDQN %DWWHU\ VHFXUH ZLWK ]HUR OHDNV 3 /LJKWV ,QGLFDWRUV RSHUDWLRQDO Producer: Carrier: Registration No SIC code (2007) Site Operator: [ ] Site Name: [ ]
11 2LO IOXLG /HYHOV FKHFN 4 5HIOHFWRUV 0DUNHUV LQWDFW Morrison Utility Services Ltd Morrison Utility Services Ltd CBDU81105 42990
12 :DWHU OHYHO FKHFN 5 %UHDNDZD\ FDEOH Abel Smith House or Site Address: [ ]
13 :LQGVFUHHQ FKLSV FUDFNV YLHZ RI WKH URDG 6 +DQG %UDNH DGMXVWPHQW RSHUDWLRQDO Gunnels Wood Road 6XE &RQWUDFWRU FRPSOHWH EHORZ [ ] Site Licence Number/Exemption Number:
Stevenage SG1 2ST [] [
[] [ ][ ]
14 Horn - operational 7 Tailgate/mudguards ][ ]
15 %UDNH SUHVVXUH QR OHDNV 8 7UDLOHU FRUUHFW IRU ZHLJKW RI ORDG [] [ ]
16 2SHUDWRUV /LFHQFH 'LVF FRUUHFW DQG YLVLEOH 9 -RFNH\ ZKHHO FODPS GURS OHJ []
17 1R H[FHVVLYH VPRNH IURP H[KDXVW 10 'HFNLQJ IORRULQJ On behalf of Carrier: On behalf of Site Operator:
, FRQ¿UP WKDW 086 KDV IXO¿OOHG LWV GXW\ WR DSSO\ WKH ]
18 &ODVV 9 9, PLUURUV VHFXUH DQG YLVLEOH 11 Securing steps ZDVWH KHLUDUFK\ DV UHTXLUHG E\ 5HJXODWLRQ RI WKH Name: [
Waste (England and Wales) Regulations 2011. Date of transfer: [ Signature: [
19 $OO /LJKWV ,QGLFDWRUV RSHUDWLRQ FOHDQ DQG OHJLEOH 12 Wheels/wheel nut indicators/dust caps ] ] Date: [ ]
] Time: [ ]
20 5HYHUVLQJ DLGV FDPHUDV LI DSSOLFDEOH 13 7\UHV GDPDJH EXOJHV FXWV ZHDU Name: [
21 5HIOHFWRUV 0DUNHUV OHJLEOH DQG VHFXUH 14 /DVKLQJ SRLQWV KRRNV Signature: [ ]
22 &RQVSLFXLW\ 0DUNLQJV UHIOHFWLYH WDSH VHFXUH OHJLEOH 15 6HFXULQJ SLQV FOLSV
23 1XPEHU SODWHV OHJLEOH VHFXULW\ OHJDO 16 5HDU QXPEHU SODWH /HJLEOH VHFXULW\ Has waste been treated: Yes No How has waste been treated: Segregation Soil Stabiliser (SMR) Re-Used
Note: Failure to carry out daily checks before leaving site may result in disciplinary action being taken. All damages/defects should be reported in writing before leaving site. Defects/breakdowns during your working day, must also be recorded What materials have been segregated: Tarmac Other (Specify) 3%086)0( -DQ
Time Mileage Defect Action Taken What materials have been recycled: Pipe Cable Excavated material Other (Specify)
%LWXPLQRXV PL[WXUHV FRQWDLQLQJ FRDO WDU &RQFUHWH 3ODVWLF
%LWXPLQRXV PL[WXUHV 0HWDO 6RLO DQG VWRQHV
Bricks 17 01 02 Mixed construction waste 17 09 04 Wood 17 02 01
&RSLHV ± :+,7( ± 0RUULVRQ 8WLOLW\ 6HUYLFHV 2I¿FH 3,1. ± &DUULHU %/8( ± :DVWH 7UDQVIHU 'LVSRVDO 6LWH 3ULQWHG E\ 307 'LJLWDO /WG Y
Vehicle and Trailer – HGV Pads Waste Transfer note / Multi-site paste pick up register
REF: C041 REF: C042
33
Section C – Pads
CALCULATION SHEET No: Rev:
General Permit to Work Permit issued by: Permit Number: Project: By: Date:
1. Permit issued to: Subject:
Time: Date: Checked by: Date:
2. This permit is valid from / to: Time: Date:
(Max 7 consecutive days) Vehicle & Trailer Inspection Reference/Results
Record Book
3. Location of work:
4. Work to be carried out (Tick relevant box):
Excavation Works Lifting Operations Confined Space Work at Height
Hot Works Other
Trench Support Directional Drilling (HDD)
If ‘Other’ Specify:
5. Risk Assessment available and relevant to task: 6. Relevant Competency Level acquired to carry out task:
Yes No Yes No N/A S19
Note: (If ‘No’) work must not proceed and permit will not be issued Note: (If ‘No’) work must not proceed and permit will not be issued Week Commencing: VEHICLE & TRAILER INSPECTION RECORD
Drivers Name: Vehicle Make/Model:
7. Describe Task to be undertaken: Permit Holder to document Control Measures to be put in Signature: Vehicle Registration:
place: Trailer No:
TRAILER DAILY SAFETY INSPECTION RECORD VEHICLE DAILY SAFETY INSPECTION RECORD
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
Completed by: Completed by:
1 Towing Eye/Ball/Hitch 1 Oil, Fuel, Fluids, Coolants levels/
leaks
2 Power Cable & Plug 2 Trailer Coupling/Connections
8. Authorisation for Work to Proceed (Agent / Supervisor) 3 Lights/Trailer Boards/ 3 Wheels & Wheel Nut
Number Plates Indicators.
I am satisfied that the control measures noted above are in place and the permit holder understands
the task to be undertaken. 4 Side/Front Markers 4 Tyres Inflation, Damage, Wear
5 Breakaway Cable 5 Mirrors/Windows/Wipers/Was
hers
6 Hand Brake 6 Lights/Indicators/Emergency
Beacon
Print Name: Signature: Date: 7 Jockey Wheel/Clamp/ 7 Horn & Seat Belts
Drop Leg
9. Competent Person (Nominated permit holder – Team Leader) 8 Decking/Flooring 8 Instruments/Speedo/Speed
Limiter
I am fully aware of and understand the requirements stated on this permit and will ensure that they are
understood by and observed by all persons under my supervision. If conditions change this permit 9 Securing Straps 9 Ancillary Equipment/Loads/
shall be cancelled and a new one raised. Aids
10 Wheels, Wheel Nut 10 Brakes/Steering/Exhaust -
Indicators & Dust Caps. Condition/Smoke
11 Tyre Condition/Pressure/ 11 Number Plates
Valves
12 Lashing Points/Hooks 12 Body/Guards/Spray
suppression
Print Name: Signature: Date:
13 Tailgate/Mud Guards 13 Reflectors/Markers
10. Cancellation (Team Leader) 14 Trailer correct for weight 14 Steps & Handrails
of load
The work specified on this permit is now safely completed and the work location has been restored to
a safe condition / transferred to permit no: ________________ and I confirm appropriate checks have 15 Securing Pins & Clips 15 Reverse Bleeper/Camera/
been carried out. Alarms Audible and Visual
DEFECTS SECTION DEFECTS SECTION Printed by PMT Digital Ltd Tel. 01480 493666
Print Name: Signature: Date:
11. This work permit is cancelled by the Authorised Person (Agent / Supervisor)
Print Name: Signature: Date:
Printed by PMT Digital Ltd 01480 493666
Original – To be retained in the site file / job pack Printed by PMT Digital Rev 0 www.morrisonus.com Calculation Sheet (Excel)
Yellow – To be held by the Team Leader Tel 01480 493666
Pink – To be held by the Issuer
Permit to Work NCR pads Vehicle and Trailer A4 pad Welsh Calculation Pad
REF: C044 REF: C045
Welsh
REF: C043
VALID FOR DAY OF ISSUE ONLY Site Address: Job Number:
PERMIT TO WORK IN THE VICINITY DATE Site Specific Risk Assessment Risk Assessment Completed by: Date:
OF OVERHEAD LINES Day:
Brief Description Of Works: MTWT F S S
TIME
Project Number Doc Number Confirm the following are in place: (to be completed by contract)
Site Supervisor Name • All relevant information present, Job Pack, In date Utility plans/LSBUD
SUPERVISOR TO BE IN ATTENDANCE AT ALL TIME WHILST • Valid street works or Notice Permit
WORKING IN THE VICINITY OF THE OVERHEAD LINES • Minimum of 1.2 metres unobstructed walkway present with kerb ramps in place where required.
• Sufficient barriers to segregate the public from the works
Pylon/Pole Number(s) Operating Voltage Persons Likely to be Affected by your Activities • If excavation is deeper than 1.2 metres, the excavation assessment on the reverse must be completed
• All Competencies/training current and in date to undertake the task
Location Staff & Contractors Visitors Public & Motorists Other
Conductor Height Safety Clearance*
Safe Zone working height Issued by Hazard Present Generic Risk Residual Risk Rating
Yes No Assessments Numbers Low Medium High
*Safety Clearance from the conductors shall be in accordance with the Network Owners Distribution Safety Rules Hazard Detail Site Observation / Site Specific
(Team Safety Pack) Control Measures / General Comments Other
Residual Risk Rating
Activity:
Carry out work in a methodical way, based
Protection of Works/Pedestrians & Vehicles (Red Book) on knowledge, skills, training & experience
Take initial on site action where appropriate
Underground/Overhead Apparatus and contact your line manager for advice
Stop work and inform your line manager
Site Address: Excavation(s) (Ground Conditions, Positioning of Spoil etc)
(Excavation Assessment on reveJroseb) Number: Printed by PMT Digital Tel. 01480 493666
Cable / Duct Laying Date:
VERIFICATION CHECKLIST YES NO (Sub-Station, Shops
Tool Box Talk about Working Near Overhead Cables briefed to the team M T W T F SWork Location Level
Emergency Response Procedure briefed and understood Crossing etc)
Daily Pre-Start Brief completed and recorded Site Specific Risk Assessment Risk Assessment Completed by: ScDhoaoyls:, Crossing, and Pedestrian S
Is the proposed excavator the correct machine for the task
Has the Machine Operator(s) Ticket(s) and competence to operate the machine be verified Brief Description Of Works: Plant, Tools and Equipment
Is the machine fitted with a Height Restrictor Device to prevent contact with the line
Is the Height Restrictor Set to prevent infringement of the “Safety Clearance” Confirm the followin(Tgesat rEequinipmpelanct,eIn: s(ttroumbeenctosm, ApbleratseivdebWyhceoenltertacc)t)
Has the Network Owner been advised of the work as documented
Is all the Goalposts/Bunting/Signage in place and in accordance MUS-MOP’s-S-022 • All relevant informReaintsiotantepmreenste(nBat,ckJfiolbl, HPoatc/Cko, lIdnlady,aCteonUcrteiltiety, Mpoladnusla/rLSSuBrUfaDces)
Risk Assessment/Method Statement and task instruction completed and understood
Persons Likely to be Affected by your Activities • Valid street workOs cocrupNaotitoincael PHearmlthit(Manual Handling, HAVS, Noise, Dust,
• Minimum of 1.2 EMmnavetitreorreinasmlsue&nntSoaulbb(sWsttaraunteccretsCe)douwrseasl,kTwreaeys, psergerseegnattiowniothf mkaetrebriarlasmps in place where required.
• Sufficient barriers&tWoesaetgherer getact) e the public from the works
Staff & Contractors Visitors Public & Motorists Other • All CompetenciesC/otrnafiinneindgSpcaucerrse/Wntoraknindg aint Hdeaigtehtto undertake the task
Generic Risk Personal Protective Equipment Flame Safety Hi Visibility Safety Face Safety Ear FP3 Dust Hard Hat Respirator Safety
Assessments Numbers RRCeeotvaseridrdaalnlust al Vest Glasses/ Visor Gloves Protection Mask Harness
Hazard Present (CircleDtehtoaseil aSpipteropOribatseefrovratthieotnas/k)Site Specific RisBkooRtsating Goggles
Hazard Yes No (Team Safety Pack) Low
Control Measures / General Comments Medium
High SeveriLtyowof InjuMrye:dium High
Severity of injury MM H Probability of Injury: High
Severity of injury
Dedicated Banksman nominated Name …………………………………………………………………… Severity of injuryProtection of Works/Pedestrians & Vehicles (Red Book)MediumLMM High Fatal, broken bones, electrocution, sight etc High Very likely to occur
If the answer to any of the above is NO then work shall not proceed Low L L M Medium Burns, sprains, deep wounds etc
Working at Height Low Medium High
Additional Information Site Address: Work Location (near to Sub-Station, Schools, Emergency Services, Level Medium May occasionally occur
Crossing, Shops, PedesJtroiabn NCruomssibngere:tc.)
Working in the vicinity DofaLtVe/o: n Joint User pole Maintain a minimum safe distance of 1m from nPeroarbeasbt illiivtey coofnIdnujucrtyor Low Small cuts, grazes etc Low Unlikely to occur
Site Specific Risk Assessment Risk Assessment Completed by: M T W T F SWorking in the vicinity Dofa1y1:kV S Maintain a minimum safe distance of 3m from nearest live conductor To be signed ONLY by those undertaking the initial site specific risk assessment
Working in the vicinity of 33kV
Brief Description Of Works: Maintain a minimuImcasnafceodnifistramnctehaotfI3ammfirnomchanregaereostf ltihvee csoitned, uthcetosrite is set up, is compliant and all We are familiar with the task to be undertaken and the precautions required, in order to
Confirm the following are Winoprkliancgei:n(tthoebveicicnoitmy pofleatbeodveby33ckoVntract) individuals on site are authorised to be working. complete the works without endangering ourselves or others.
• All relevant information present, Job Pack.
Permit Issued by: • Valid street works or NoEtxiccaevaPteiornm/Rietinstatement Maintain a minSimiteumLesaadfeerdPisrtianntcNeaomf e6:m from nearest live conducOtopr Sign Name: Op Print Name: Op Sign Name:
I confirm that all the team have been briefed and all safety precautions are in place and verified Occupational Health (Manual Handling, HAVS, Noise, Dust, Materials &
• Minimum of 1.2 metresSuubnsotabnsctersu) cted walkway present with kerb ramps in place where required. Op Print Name: Op Sign Name: Op Print Name: Op Sign Name:
Print Name Position
Signature Date/Time Persons Likely to be Affected by your Activities • Sufficient barriers to segCraebgleatPeulltinhge/Lpauyibnglic from the works
Staff & Contractors Visitors Public & Motorists Other • All Competencies/traininPlganct,uTroreolnstanadndEqiunipdmaetnet t(Toesut nEqdueiprtmaeknet,tIhnestrtuamskents,
Abrasive Wheel etc)
Permit Received by: Environmental (Water Courses, Trees, segregation of materials
Generic Risk & Weather etc)
Assessments Numbers
I can confirm the team have been briefed and understand their duties in respect of the tasks and shall maintain “Safety Hazard Hazard Present DeCtiarcilleSrietqeuiOrebdsPePrEvraeqtiuoirned/ Site Specific RReFtlaearmdsaeidntual RiSsafketyRatinHgi Visibility Safety Face Safety Ear Dust Hard Hat Respirator Safety Lanyard Other
from the System” at all times Yes No (Team Safety Pack) Control Measures / General Comments Coveralls Boots Vest Glasses/ Visor Gloves Protection Mask Harness
Goggles
Print Name Position Low Medium High
Protection of Works/Pedestrians & Vehicles (Red Book) High M M H Severity of Injury: Probability of Injury: Residual Risk Rating
Underground/Overhead Apparatus Medium L M M
Signature Date/Time Confined Spaces/Working at Height Low L L M High High Low Carry out work in a methodical way, based
Low Medium High Medium on knowledge, skills, training & experience
Fatal, broken bones, electrocution, sight etc Very likely to occur
Take initial on site action where appropriate
Permit Cancelled by: Medium Burns, sprains, deep wounds etc Medium May occasionally occur and contact your line manager for advice
I can confirm all work has been completed. All machinery/tools have been removed from the area and personnel Work Location (Sub-Station, Schools, Level Crossing, Shops and Pedestrian Probability of Injury Low Small cuts, grazes etc Low Unlikely to occur High
instructed that no further work shall be carried out I the area. Crossing etc)
Stop work and inform your line manager
Print Name Position Plant, Tools and Equipment (Test Equipment, Instruments, Abrasive Wheel etc) To be signed ONLY by those undertaking the initial site specific risk assessment
Signature Date/Time Occupational Health (Manual Handling, HAVS, Noise, Dust, Materials & I can confirm that I am in charge of the site, the site is set up, is compliant and all We are familiar with the task to be undertaken and the precautions required, in order to
Substances) individuals on site are authorised to be working. complete the works without endangering ourselves or others.
Environmental (Water Courses Contaminated Water, Trees, segregation of
Printed by PMT Digital Tel. 01480 493666 materials & Weather etc) Site Leader Print Name: Op Sign Name: Op Print Name: Op Sign Name:
MUS-MOP’S-S-022(a) Cable Installation Op Print Name: Op Sign Name: Op Print Name: Op Sign Name: Printed by PMT Digital Tel. 01480 493666
Permit to Work in the Vicinity PPE Flame Safety Hi Visibility Safety Face Safety Ear FP3 Dust Hard Hat Respirator Safety Other Site Specific Risk Assessment Revision 8 Civils-2
(Circle those appropriate for the task) Retardant Boots Vest Glasses/ Visor Gloves Protection Mask Harness Site Specific Risk Assessment Poling_OH ver3
of Overhead Lines Coveralls Goggles Site Specific Risk Assessment Flex v4
REF: C046 REF: C047
High MM H Severity of Injury: Probability of Injury: Residual Risk Rating
Medium L MM
Low L LM High Fatal, broken bones, electrocution, sight etc High Very likely to occur Low Carry out work in a methodical way, based
Low Medium High on knowledge, skills, training & experience
Probability of Injury
Medium Burns, sprains, deep wounds etc Medium May occasionally occur Medium Take initial on site action where appropriate
and contact your line manager for advice
Low Small cuts, grazes etc Low Unlikely to occur
To be signed ONLY by those undertaking the initial site specific risk assessment High Stop work and inform your line manager
I can confirm that I am in charge of the site, the site is set up, is compliant and all We are familiar with the task to be undertaken and the precautions required, in order to
individuals on site are authorised to be working. complete the works without endangering ourselves or others.
Site Leader Print Name: Op Sign Name: Op Print Name: Op Sign Name:
Op Print Name: Op Sign Name: Op Print Name: Op Sign Name: Printed by PMT Digital Tel. 01480 493666
Warning Notice
Serial No:
Customer Name: Address:
IMPORTANT INFORMATION Date: Ref: Removed Meter Record
METER TECHNICIANS WHILE WE WERE INSPECTING YOUR ELECTRICAL EQUIPMENT TODAY Month Bag.................................. ............................................
Our Meter Technicians will always take action to make your gas equipment safe but they do not carry We found the following safety issue(s) with equipment on your electrical installation that we need Serial Number Final Meter Date Job Number Meter Size Testing
out appliance repairs, or repairs to your pipework. to bring to you or your landlord’s attention and suggest advice of a NICEIC Qualified/Registered Reading Removed Required Y/N
Electrician is sought to rectify the findings set out below:
DEFINITION OF SAFETY CATEGORIES
Your consumer unit (fuse box) or other equipment is showing signs of overheating. DANGER !DO NOT USE
IMMEDIATELY DANGEROUS (ID): A defect has been found which makes the Appliance / Overheating can be caused by overloaded circuits or loose connections, and may cause a fire.
Installation an immediate danger to life or property. Serial No: WARNING NOTICE
Your electrical equipment is damaged, exposing live parts to touch. The equipment needs to
AT RISK (AR): A defect has been found which could in the future make the Appliance / Installation be urgently repaired or replaced to prevent the risk of electric shock. 6th Floor, St Hughes House, Trinity Road, Bootle, Liverpool, L20 3QQ. Gas Safe Registration Number: 578414
a danger to life or property.
Your electrical installation appears not to be adequately earthed. The purpose of electrical THIS NOTICE CONCERNS YOUR SAFETY
WHAT DO I DO NOW? Earthing is to minimise the risk of electric shock and/or fire in your home if a fault occurs in your Issued in accordance with the Gas Safety (Installation and Use) Regulations 1998
electrical installation or an electrical appliance.
This notice explains a situation which is or could become a danger to life or property. This form should be in accordance with the requirement of the Gas Industry Unsafe Procedures
The gas installation/appliance MUST NOT be used until it has been repaired. It is an One or more of your electrical sockets has an issue with Earthing or its wiring
offence to continue to use an unsafe appliance or installation until it has been repaired arrangement. We recommend you avoid using this/these sockets until they have been rectified. Customer Name: Rented Property? Y/N
and tested by a Gas Safe registered Installer.
The cables going into your consumer unit are of poor condition and need replacing as soon
% If the equipmentor Installation is owned by somebody else (e.g. your landlord) as possible. The condition of these may pose a risk if not replaced as soon as practically possible.
you should make them aware of the situation as soon as possible and give them
this notice. For Safety reasons we have fitted an isolator adjacent to the meter and left your supply
switched off because:
% If your localcouncil or housing association normally repair or maintain the
equipment or installation contact them immediately and show this notice to their Address: Landlord Agent Name:
representative upon their arrival.
Address:
% If the faulty gas equipment is covered by a service contract you should get in
touch with the company with which you have the contract as soon as Postcode: Postcode:
possible.
Telephone Number: Telephone Number:
If you do not already know a suitable Gas Safe registered Installer, you can contact Gas Safe
Register on 0800 408 5500 who will give the names of Gas Safe registered Installers in your Other issues: DEFECTS ON APPLIANCE / INSTALLATION (please tick the appropriate boxes)
locality who carry out this type of work.
Appliance Type Tick Location Tick Nature of Problem Tick Category Tick
Alternatively you can log onto www.gassaferegister.co.uk and enter your postcode into
the box titled “FIND A GAS SAFE REGISTERED BUSINESS”. Cooker Kitchen Escape Immediately Dangerous
Fire Lounge Flue
If you smell gas or suspect fumes call the National Grid Emergency Service Telephone Back Boiler Unit Dining Room
Number: 0800 111 999
C/Htg Boiler Bedroom Ventilation At Risk
Warm Air Unit Hall Other
Wall Heater Landing
Non Domestic Utility
Pipework Garage
SAFETY ACTION TAKEN
I acknowledge I have received this safety warning notice with regards to the above issues that Give details: The appliance has been classified as Immediately Dangerous and has been disconnected ID
were found on the electrical installation in the above property during the metering work.
The installation pipework has been classified Immediately Dangerous and disconnected ID
The appliance has been classified as At Risk and has been turned off AR
The installation pipework has been classified as At Risk and turned off AR
Customer Name: Meter Technician Name: The installation pipework has been classified as At Risk and not turned off AR
The customer refused permission to turn off AR
REPORTABLE UNDER RIDDOR: YES / NO The customer refused permission to disconnect ID
Customer Signature: Meter Technician Signature: Printed by PMT Digital Ltd. 01480 493666
Issued by (print name): Date: Time:
Worker ID: Gas Safe Number: MPRN
Signature: Reference Number:
The gas user was not present and this notice has been left on the premises: Gang Name Stores Signature
MUS.MOPs-SM-FM-0001 (29-11-2017) TO USER OF GAS - As this notice explains, a situation has been identified which is, or could become a danger to
life or property. This situation is in relation to that part of the gas installation and appliance/s that we have tested
Customer Warning notices – or visually inspected. The gas equipment MUST NOT be used until it has been repaired. It is an offence to
Gas and Electric continue to use a dangerous appliance or installation.
REF: C048
Please ensure that a Gas Safe registered installer carries out any work on your appliances or installation pipework.
Gas Safe Register is the official gas registration body for the United Kingdom appointed by the HSE.
I acknowledge receipt of this notification concerning the safety of the gas installation. I understand that the use of the
appliance / installation in the case of an IMMEDIATELY DANGEROUS or AT RISK installation could present a hazard
and could place me in breach of the Gas Safety (Installation & Use) Regulations 1998.
Customer’s Signature: Date: Removed Meter Record Book
Position held if non -domestic consumer: A4
REF: C049
MUS.MOPs-SM-FM-0001 (29-11-2017)
34
Section C – Pads
No:
No
Meter Accuracy Test Result Sheet
LOTO Safety Certificate 1001
Customer Name : Date: LOTO Serial number Section 1 Request for LOTO Date Raised
Address: Post Code: Equipment/System Work number Reason
MUS Job No:
% &# ) REQUEST Name Section 1A Originator/LOTO Authorised Person (Person requiring LOTO)
MPAN: Signature
Meter Details Title Originators Contact Number
Meter Number:
Manufacturer: Single or 3phase: Rating (Amps): Requirement for De-Energised testing on completion of work :( Are line checks or further tests YES NO
Version: Seals Intact: Multi Rate: required prior to de-isolation or LOTO removal?) Originator to Complete
Cert Date: Interference: YES NO
KWh Meter Reading - Normal: Section 1B LOTO AUTHORISED PERSON (LOTO Competent SME) YES NO
KWh Meter Reading – Off Peak:
KWh Meter Reading – Other: % $ $%#& % , # %) Name Signature
Time Switch Set Correctly:
Solar Panels Fitted: Person conducting LOTO (LOTO Competent Person) briefed on isolations required as stated on
revers of this certificate
Is there a requirement to prove safe to work? (Mechanically/Electrically isolated Pressure systems
drained
Is Risk Assessment required? YES NO Risk Assessment No
Associated Permit to work raised YES NO PTW Number
Yes: No: N/A: Other: AUTHORISATION FOR WORK Does the LOTO affect other LOTO’s YES NO Associated LOTO No’s
Yes:
No: Other: Section 1C PERSON CONDUCTING LOTO (LOTO COMPETENT PERSON) Isolation of supplies/system or equipment
Name Job Title
Single and Three Phase Test Information Briefed by LOTO Authorised Person YES NO
Last Calibration Date:
Check Meter s/number: I DECLARE THAT THE REQUESTED ISOLATIONS LISTED HAVE BEEN CORRECTLY COMPLETED
Dycon Signal Strength: -(for a Smart consideration) signal strength borderline for Smart Meter
Measured Supply Voltage Line 1: Meter Constant:
Measured Supply Voltage Line 2: Test Method:
Measured Supply Voltage Line 3: ! $%#& % $ . * * # "& $% # ' ! % / Section 1D LOTO COMPETENT PERSON Declaration
Result 1
Standard Load Test ± Test Results (a) I confirm that the system above HAS/HAS NOT been proven safe for work.
(mechanically/electrically isolated and safe, pressure systems drained) and status briefed to Originator
LOTO Competent Person Declaration (b) This system will not be tagged back in until Section 2 has been completed
(c) Originator/LOTO Authorised Person has been briefed.
Result 2 Signature Date
Result 3 Indicate if meter is running fast (+) or slow (-) # % % % % $ ' &# % ( # % $ % $%#& % , # %$* Section 2 REMOVAL OF LOTO (LOTO Competent Person and test engineer if required on completion of work
I confirm that all work for which this LOTO was raised is now complete and it has
Result 4 been left in a safe condition for test, trial or normal operation
. / ++++++++++++++++++++++++** % )-++++++++++++ Declaration by LOTO Competent Person Name
Signature
Result 5
Standard Load Test ± Test Outcome Range . # %/ ++++++++++++++++++++++++++++++++++++++++++ Date
Lowest Test Result Deviation
Highest Test Result Deviation Printed by PMT Digital Ltd 01480 493666 All de-energised testing complete (Test Name
Engineer) Signature
REMOVAL Printed by PMT Digital Ltd 01480 493666
NB: Any Meter operating outside the parameters of +2.5% and -3.5% deviation does not conform to Statutory Limits . / ++++++++++++++++++++++++** % )-++++++++++++ Section 2A LOTO REMOVAL
Comments
I confirm that all approvals have been gained to remove this LOTO. Required
. # %/ ++++++++++++++++++++++++++++++++++++++++++ LOTO Authorised Person Declaration testing is complete. It is safe to restore supplies to this system/equipment. Removal
of this LOTO does not affect any other LOTO Safety Certificate in force
Meter Status Signature
Passed Failed Ave Error % ' $ # # $ % $%#& % , $ &$$ (* Date
Person Removing LOTO (LOTO Name Date
Competent Person) Signature
Test Conducted by: Date:
Signature:
% )- # # ) &! #' $ # & ) %( # LOTO Closed (LOTO labels A, B and C LOTO Authorised Person Name Date
have been destroyed Signature
Issue 1 MUS-MOPs-SM-FM-0003 Issue 1 MUS-MOPS-EMS-FM-0015 Page 1 of 1
Standard Load Results form A4 Variation Contract Pad A5 Loto Safety Certificate A4
REF: C050 REF: C051 REF: C052
H: HGV PRE START CHECK RECORD
Driver Name: Driver Signature: FLM:
Vehicle Registration: W/C Date:
MONDAY TUESDAY WEDNESDAY FRIDAY SATURDAY SUNDAY
Start Mileage: THURSDAY
Stop Mileage:
HGV PRE START INSPECTION RECORD (INTERNAL AND EXTERNAL) HOTBOX PRE START INSPECTION RECORD
¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
IN CAB DAILY CHECKS – MACHINERY SWITCHED OFF
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Contract........................................................................... Date...........................................................................
9 2LO IOXLG /HYHOV FKHFN 9 &RQGLWLRQ RI +RWER[ OLGV VHDOV Depot............................................................................... Driver.........................................................................
DEFECT REPORT - Detail of any faults noted should be entered below, include pre start check reference number (top left of sheet)
10 :DWHU OHYHO FKHFN 10 &RQGLWLRQ RI VSULQJV DVVLVWHUV DQG ORFNLQJ PHFKDQLVP
Defects reported to ......................................................... Signature of driver.....................................................
11 +RUQ RSHUDWLRQDO 11 &KHFN LQVLGH +RWER[ IRU H[FHVVLYH EXLOG XS RI PDWHULDO ACTION TAKEN
Defects rectified by (name).............................................. Dealer name ..............................................................
12 %UDNH SUHVVXUH QR OHDNV 12 &KHFN UHDU GLVFKDUJH FKXWH DVVHPEO\ ² RSHUDWLRQDO Signature ................................................... Position....................................... Date ...........................................
13 2SHUDWRUV /LFHQFH 'LVF FRUUHFW DQG YLVLEOH 13 &KHFN JDV ERWWOHV F\OLQGHUV IRU GDPDJH DQG VHFXUH Grab tipper defect report form A5
REF: C054
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19 372 &DE 6ZLWFK 2SHUDWLRQ 19 &KHFN FRQWURO ER[ LQ WKH FDE ² IXQFWLRQDO VHFXUH Operator Licence Compliance
20 +DQGEUDNH ,QWHUORFN LI ILWWHG 20 &KHFN WHPSHUDWXUH VHWWLQJV
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DAILY CHECKS – MACHINERY RUNNING
EXTERIOR OF VEHICLE 1 &KHFN RSHUDWLRQ RI 372 Pre-use Vehicle Checks and Defect Record Book
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12 7\UHV GDPDJH EXOJHV FXWV ZHDU
13 8QGHUUXQ EDUV VHFXUH GDPDJH Driver Date
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Note: Failure to carry out daily checks before leaving site may result in disciplinary action being taken. All damages/defects should be reported in writing before leaving site. Defects/breakdowns during your working day, must also be recorded
HGV Hotbox pre-start check and
defect record pad A4
REF: C053
Site Address: Job Number:
Site Specific Risk Assessment Risk Assessment Completed by: Date: MTWT F S S
Day:
Brief Description Of Works:
HGV PRE START CHECK RECORD Confirm the following are in place: (to be completed by contract)
• All relevant information present, Job Pack.
Driver Name: Driver Signature: FLM: • Valid street works or Notice Permit
Vehicle Registration: W/C Date: • Minimum of 1.2 metres unobstructed walkway present with kerb ramps in place where required.
MONDAY TUESDAY WEDNESDAY FRIDAY SATURDAY SUNDAY • Sufficient barriers to segregate the public from the works
Start Mileage: THURSDAY • All Competencies/training current and in date to undertake the task
Stop Mileage:
Persons Likely to be Affected by your Activities
Staff & Contractors Visitors Public & Motorists Other
HGV PRE START INSPECTION RECORD (INTERNAL AND EXTERNAL) TRAILER DAILY SAFETY INSPECTION RECORD (IF APPLICABLE) Generic Risk
Assessments Numbers
¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH Hazard Hazard Present Detail Site Observation / Site Specific Residual Risk Rating
Yes No (Team Safety Pack) Control Measures / General Comments Low Medium High
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
IN CAB 1 Towing Eye/Ball/Hitch
1 'ULYHU 3DVVHQJHU VHDW VHDW EHOW IXQFWLRQ VHFXULW\ 2 3RZHU &DEOH DQG 3OXJ Protection of Works/Pedestrians & Vehicles (Red Book)
2 1R 6PRNLQJ 6LJQ YLVLEOH 3 /LJKWV 7UDLOHU %RDUGV 1XPEHU 3ODWHV Underground/Overhead Apparatus
3 7DFKRJUDSK IXQFWLRQDO FRUUHFW WLPH HWF 4 6LGH )URQW 0DUNHUV
4 7DFKRJUDSK UROOV DW OHDVW WZR UROOV LQ YHKLFOH 5 %UHDNDZD\ &DEOH Confined Spaces/Working at Height
5 )LUH H[WLQJXLVKHU LQ GDWH VHYLFHDEOH LI DSSOLFDEOH 6 +DQG %UDNH Work Location (Sub-Station, Schools, Level Crossing, Shops and Pedestrian
Crossing etc)
6 1 6 ,QGLFDWRU $XGLEOH ZDUQLQJ DODUP RSHUDWLRQ 7 -RFNH\ :KHHO &ODPS 'URS /HJ
Plant, Tools and Equipment (Test Equipment, Instruments, Abrasive Wheel etc)
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Occupational Health (Manual Handling, HAVS, Noise, Dust, Materials &
8 Fuel level 9 Securing Straps Substances)
Environmental (Water Courses Contaminated Water, Trees, segregation of
9 2LO IOXLG /HYHOV FKHFN 10 :KHHOV :KHHO 1XW ,QGLFDWRUV 'XVW &DSV materials & Weather etc)
10 :DWHU OHYHO FKHFN 11 7\UH &RQGLWLRQ 3UHVVXUH 9DOYHV Cable Installation
11 +RUQ RSHUDWLRQDO 12 /DVKLQJ 3RLQWV +RRNV
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13 2SHUDWRUV /LFHQFH 'LVF FRUUHFW DQG YLVLEOH 14 7UDLOHU FRUUHFW IRU ZHLJKW RI ORDG
14 5HYHUVLQJ DLGV FDPHUDV LI DSSOLFDEOH 15 6HFXULQJ 3LQV &OLSV
15 :DVKHUV VFUHHQ ZDVK ZLSHUV LQ ZRUNLQJ RUGHU Site Specific Risk Assessment
16 6WHHULQJ ZHDU RSHUDWLRQ
17 2Q ERDUG :HLJKHU IXQFWLRQ RSHUDWLRQ Flame Safety Hi Visibility Safety Face Safety Ear FP3 Dust Safety
Retardant Boots Vest Glasses/ Visor Gloves Protection Mask Harness
18 2YHU KHDG ZDUQLQJ GHYLFHV ² RSHUDWLRQDO LQWHJULW\ (Circle those appCroopriantefifonr theedtaskS) paces Guidance Coveralls Goggles Hard Hat Respirator Other
19 372 &DE 6ZLWFK 2SHUDWLRQ Operator Licence Compliance NC1 Classification High MM H Severity of Injury: Probability of Injury: Residual Risk Rating
20 +DQGEUDNH ,QWHUORFN LI ILWWHG
21 Height Warning Signs Low risk shallow entry wMietdhiumadequateSeverity of injury nL aturaMl onromliMMekcehlyanriisHckaiglhovfeflnotiolFadattiainl,obgrno.k,eenw.bgohn:eesb,reoelecxtreocsu/tion, Carry out work in a methodical way, based
access is simple and unoLbowstructed and Lthere iLs on knowledge, skills, training & experience
EXTERIOR OF VEHICLE Pre-use Vehicle Checks and Defect Record Book sight etc High Very likely to occur Low
1 9XOQHUDEOH 5RDG 8VHU &\FOH 6DIHW\ VWLFNHU OHJLEOH Medium Take initial on site action where appropriate
2 )XHO WDQN %DWWHU\ VHFXUH ZLWK ]HUR OHDNV chambers. Low Medium High Medium Burns, sprains, deep wounds etc Medium May occasionally occur and contact your line manager for advice
3 :LQGVFUHHQ FKLSV FUDFNV YLHZ RI WKH URDG Medium Risk Low Small cuts, grazes etc Low Unlikely to occur
4 1R H[FHVVLYH VPRNH IURP H[KDXVW Probability of Injury
5 &ODVV 9 9, PLUURUV VHFXUH DQG YLVLEOH Printed by PMT Digital Ltd, 01480 493666 A medium risk confined space exists where there are acceTosbseissigsnuedeOsN; LaY bryethaolsiesutnidcertaking the initial site specific risk assessment High Stop work and inform your line manager
6 $OO /LJKWV ,QGLFDWRUV RSHUDWLRQ FOHDQ DQG OHJLEOH expectation of encounItceanriconngfirmathsapt Ieacmifiin ccharrigseko;f tpheosistes,itbhelesiteinistsretoudp,uisccotmioplnianot afndsapllecifiedWreisarke sfamiliar with the task to be undertaken and the precautions required, in order to
7 5HIOHFWRUV 0DUNHUV OHJLEOH DQG VHFXUH
8 &RQVSLFXLW\ 0DUNLQJV UHIOHFWLYH WDSH VHFXUH OHJLEOH during the work activity. individuals on site are authorised to be working. complete the works without endangering ourselves or others.
9 1XPEHU SODWHV OHJLEOH VHFXULW\ OHJDO NC2 Classification Site Leader Print Name: Op Sign Name: Op Print Name: Op Sign Name:
Op Print Name: Op Sign Name: Op Print Name: Op Sign Name:
10 0XGJXDUGV 6SUD\ VXSSUHVVLRQ VHFXUH Printed by PMT Digital Tel. 01480 493666
11 :KHHOV ZKHHO QXW LQGLFDWRUV GXVW FDSV :HHNO\ VLJQ RII 0 DQDJHU Date Vertical direct unobstructed access with continuous attachment to a person riding
12 7\UHV GDPDJH EXOJHV FXWV ZHDU
hoist or similar mechanical rescue device.
13 8QGHUUXQ EDUV VHFXUH GDPDJH
14 5RDG VSULQJV VHFXULW\ FOHDQ RI GHEULV Driver Date Escape Set
Note: Failure to carry out daily checks before leaving site may result in disciplinary action being taken. All damages/defects should be reported in writing before leaving site. Defects/breakdowns during your working day, must also be recorded NC3 Classification
When it is not possible to have persons permanently attached to a safety line. Usually Record all Positive and Negative Gas Tests Below
it will be a team entry which moves away from the entry point. Working without an
attached rescue line and includes working away from the point of entry. Escape Set Gas Test Record GDU Yes/No Calibrated
(Self Rescue) breathing apparatus required to be taken into medium risk. Calibrated Date
HGV Any vehicle pre-start check
High Risk Confined Space and
and defect record pad A4 Working
REF: C055
A high risk confined space exists when there is a specified hazard that cannot be Chamber Time Positive Negative Signature
controlled or eliminated. Number
NC4 Classification
Non standard entries involving complex operations which introduce additional risks
and require specific controls and rescue arrangements, e.g: mechanical hazards,
physical complexity of system introduced hazards, enhanced specific intrinsic hazards.
Fill breathing apparatus (working) required to be worn at all times in high risk.
Note: Print Name: Sign Name: Print Name: Sign Name:
Print Name: Sign Name: Print Name: Sign Name:
Briefing is also required whenever there has been a significant change to the hazards and control measures since the individual was last briefed.
MUS-FM-S-013 Flex Revision 4
Ground Words On-Site Risk Ground Works - On-Site
Risk Assessment Pad
Assessment pad (Flex) A4 (Flex)
REF: C056
35
Section C – Pads
No: No:
L ow Voltage Permit Register No:
Section 1 Request for LOTO Low Voltage Permit to Work GRAB LORRY PRE-TASK CHECK SHEET AND RISK ASSESSMENT
Date Raised
Work Number SITE: Permit to Work No Have you received a comprehensive vehicle/crane familiarisation instruction and you have 100%
Equipment/System Reason XQGHUVWDQGLQJ RI DOO VDIHW\ IHDWXUHV ¿WWHG RQ \RXU YHKLFOH" <HV 1R GHOHWH DV DSSOLFDEOH
REQUEST Name Section 1A Originator/LOTO Authorised Person (Person requiring LOTO) LOW VOLTAGE PERMIT REGISTER FOR BS7671 WORK SITE :- LOW VOLTAGE PERMIT TO WORK for BS7671 WORK Name of Grab Driver / Operator: Date:
Signature LOTO Safety Certificate No:- Signature
First to be signed daily by the Permit Recipient after checking workplace and isolations Part 1: ISSUE - to be completed by Appointed Electrician Name of Mate/Co-Driver/banksman: Vehicle Registration Number:
I hereby give permission to carry out the work described below in accordance with MUS-MOP’s-EMS-CM-0009 LV Safety Rules Signature
Title I hereby declare that the following plant as specified below is dead and isolated from all live conductors.
Contact Number Treat all other plant and areas as dangerous.
Requirement for De-Energised testing on completion of work :( Are line checks or further tests YES NO Then to be signed daily by all those working under this Low Voltage Permit Issued to______________________________________________________ Project Address:
required prior to de-isolation or LOTO removal?) Originator to Complete In the employ of ____________________(Company)_Position__________________________
Date Name Signature Permit Recipient Signature Being an authorised Permit issuer i hereby give permission to carry out the work described below.
Section 1B LOTO AUTHORISED PERSON (LOTO Competent SME) LOCATION OF WORK Streets working on: Team Leader:
Name Signature DESCRIPTION OF WORK - No other work shall be carried out
Person conducting LOTO (LOTO Competent Person) briefed on isolations required as stated on YES NO
YES NO
this certificate Mandatory Checks YES / Control Measures
To be carried out NO / NOT (You MUST UHFRUG WKH UHOHYDQW FRQWURO PHDVXUHV UHTXLUHG WR UHGXFH WKH ULVN WR DQ DFFHSWDEOH OHYHO
Is there a requirement to prove safe to work? (Mechanically/Electrically isolated Pressure systems APPLICABLE
1. Have you signed the site visitors register and been This is to be reviewed if circumstances change on the project which introduces new hazards.)
drained) fully briefed by the Team Leader on all hazards?
Is Risk Assessment required? YES NO Risk Assessment No
Associated Permit to work raised YES NO PTW Number
Does the LOTO affect other LOTO’s YES NO Associated LOTO No’s LV POINTS OF ISOLATION – list isolation and means of isolation (e.g. fuse, lock etc) 2. Have you agreed a safe system of work with your
LOTO Procedure to be followed is MUS-MOPS-EMS-WA-0002 Procedure for the Management of Machinery Isolation mate / banksman for the activity?
AUTHORISATION FOR WORK Permitted to Self-Issue iaw LV Safety Rule MUS-MOP’s-EMS-CM-0009 Page 23, 11.5 YES NO 1
2 3. Have you assessed the road/roads having regard to other road
Section 1C PERSON CONDUCTING LOTO (LOTO COMPETENT PERSON) Isolation of supplies/system or equipment 3 users and the activity to be undertaken? Can vehicles pass the
4 vehicle safely?
Name Job Title 5
State how access to work area is to be controlled 4. Is your vehicle positioned in a safe location within the
Briefed by LOTO Authorised Person YES NO site footprint / barrier system?
Remarks (i.e. Plant and equipment, drawing references, environment and access and egress general)
I DECLARE THAT THE REQUESTED ISOLATIONS LISTED HAVE BEEN CORRECTLY COMPLETED 5. Have you got the correct PPE for the task? Are Occupational
Appointed Electrician Name: ______________________ Health risks being managed? Are harmful substances being
Section 1D LOTO COMPETENT PERSON Declaration considered? Ie HAVS, Dust, Noise, Hydraulic oil
Signed______________________Time_____________Date_________ 6. Have you assessed the safety of members of the public?
(a) I confirm that the system above HAS/HAS NOT been proven safe for Will pedestrians be affected by the operation of the crane or
Part 2: RECEIPT – to be signed by Permit Recipient EDFN¿OOLQJ RSHUDWLRQ" ,H PHPEHUV RI WKH SXEOLF PXVW EH
work. I hereby declare that I have read, understood and accept responsibility for carrying out work in accordance with this Low isolated from the work area with any direction(s) clearly given.
Voltage Permit to Work and no attempt shall be made to undertake any other work by me or the persons under my charge on
(mechanically/electrically isolated and safe, pressure systems drained) and status briefed to Originator any other plant. 7. Are there overhead cables and have you assessed the risk?
LOTO Competent Person Declaration (b) This system will not be tagged back in until Section 2 has been Name _______________________Signature________________________ Time ________ 8. Has spoil / materials been stored away from overhead cables?
Company_____________________Position_________________________ Date_________ Ie Exclusion zones must be adhered to. Works must STOP if you
completed cannot comply. Inform Team and FLM. Do not move until a safe
This Permit and the means of securing the isolations are to be held by the Permit Recipient on site. All people working under system of work for removing or importing materials have been agreed.
(c) Originator/LOTO Authorised Person has been briefed. the authorisation of this Low Voltage Permit are to be briefed by the Permit Recipient and are to sign the attached register. 9. If working near O/H cables can you maintain a safe
A copy of this form is to be retained in the Electrical Safety File by the Appointed Electrician; the original is to be handed to the Permit ZRUNLQJ GLVWDQFH IURP WKH H[FOXVLRQ ]RQH" 6SHFL¿F JXLGDQFH
Signature Date Recipient, together with the means securing the isolations (lock out box key or alternatively the individual isolating links, fuses, and given in the Grab and Support Drivers pack pg 22/23.)
keys).
10. Has reversing of the vehicle been minimised
Part 3: CLEARANCE – to be signed by Permit Recipient and controlled? Ie use of a banksman
I hereby declare and confirm that the work for which this Low Voltage Permit to Work was issued is now suspended/completed*
Section 2 REMOVAL OF LOTO (LOTO Competent Person and test engineer if required on completion of work and that all persons under my charge have been withdrawn, all tools and demarcation have been removed and no further work 11. Are any additional hazards posed by structures / water courses /
shall be carried out. The plant detailed in Part 1 is fit/unfit* for return to service (see below). All previously listed points of railways / temporary works eg scaffolding present on site?
I confirm that all work for which this LOTO was raised is now complete and it isolation remain in force.
has been left in a safe condition for test, trial or normal operation
Service Condition ………………………………………………………………………………………………….
Declaration by LOTO Competent Person Name …………………………………………………………………………………………………………………….. +DYH DEQRUPDO YHKLFXODU DQG SHGHVWULDQ WUDI¿F FRQGLWLRQV EHHQ
Signature Name _______________________Signature____________________Time ________Date_________ FRQVLGHUHG" ,H UXVK KRXU WUDI¿F VFKRRO VWDUWLQJ DQG HQGLQJ WLPHV
Date Part 4: CANCELLATION - to be completed by Appointed Electrician 13. Are Underground Utilities exposed in the excavation?
Prior to removing points of isolation and restoring supplies, all other extant Low Voltage Permits to Work are to be reviewed. Has protective ducting or marker tape been replaced correctly?
Name Name _______________________Signature____________________Time ________Date_________ Once Part 4 is signed, $UH ULVNV DVVRFLDWHG ZLWK H[FDYDWLRQV EHLQJ EDFN¿OOHG
this permit is cancelled and a copy is to be placed in the Health and Safety Folder and the master copy held for a minimum of 3 years considered? Eg depth of excavation / water / access & egress / litter
All de-energised testing complete (Test Signature Proving Unit Serial No Printed by PMT Digital Ltd 01480 493666
Engineer) Printed by PMT Digital Ltd 01480 493666
REMOVAL Date Test Eqip Serial No +DV WKH ULVN RI XVLQJ RI EDFN¿OOLQJ HTXLSPHQW EHHQ FRQVLGHUHG"
LOTO Authorised Person Declaration Eg manual handling / refuelling / visual maintenance checks
Section 2A LOTO REMOVAL
Printed by PMT Digital Ltd 01480 493666 16. When lifting spoil from sites, has Waste Transfer been accurately
I confirm that all approvals have been gained to remove this LOTO. Required recorded? ie waste assessed correctly, segregation, checking for coal tar
testing is complete. It is safe to restore supplies to this system/equipment.
Removal of this LOTO does not affect any other LOTO Safety Certificate in 17. Has Site Housekeeping been considered to remove Slips, Trips
force DQG )DOOV" ,H UHPRYH PXG ORRVH VWRQHV FRUUHFW SODFLQJ RI EDFN¿OOLQJ
Name HTXLSPHQW DQG URDGZRUNV JXDUGLQJ HTXLSPHQW
Signature Date 18. Are there enough operatives available to conduct any manual handling
tasks in a safe and controlled manner? Have you assessed the task?
Person Removing LOTO (LOTO Name Date
Competent Person) Signature Additional Comments:
(Include any additional information
LOTO Authorised Person that is important/relevant to the task)
Name
LOTO Closed (LOTO labels A, B and C Signature HAVS Have you checked the estimated tool usage for today’s works using the HAVS wheel or chart? Yes / No / N/A
have been destroyed) Issue 1
Date MUS-MOPS-EMS-FM-0016 monitoring: 'R \RX H[SHFW WKH WRRO XVDJH WLPH ZLOO WDNH DQ\ RI \RXU WHDP LQWR WKH $FWLRQ ]RQH" ,I \HV FRQ¿UP WKH FRQWURO RSWLRQ VHOHFWHG WR VWD\ LQ WKH 6DIH ]RQH <HV 1R 1 $
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28908 - Grab unit site specific risk ass grab lorry pre-task checklist v3.indd 1 12/12/2019 14:40
Loto Certificate A4 pads Low Voltage Permit Register Low Voltage Permit to Work Grab unit site specific risk
REF: C057
A4 pads A4 pads assessment grab lorry pre-task
REF: C058 REF: C059
checklist A4
REF: C060
No:
Waste Transfer Note / Multi-site waste pick up register
086 )0 (
Waste Containment: Loose Sacks Skip Other (Specify) [ ] Vehicle & Trailer Inspection
Vehicle Registration: Depot Address: Record Book
Driver’s Name:
Date of collection List of Waste Code No.
Site/Project/Depot address Team Leader – Name Weight (tonnes) Week Commencing:
Drivers Name:
17 05 04 17 03 02 17 09 04 Other VEHICLE / TRAILER / PLANT INSPECTION RECORD
Vehicle Make/Model:
Signature: Vehicle Registration:
Trailer No:
TRAILER DAILY SAFETY INSPECTION RECORD VEHICLE DAILY SAFETY INSPECTION RECORD
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
Completed by: Completed by:
1 Towing Eye/Ball/Hitch 1 Oil, Fuel, Fluids, Coolants levels/
leaks
2 Power Cable & Plug 2 Trailer Coupling/Connections
3 Lights/Trailer Boards/ 3 Wheels & Wheel Nut
Number Plates Indicators.
4 Side/Front Markers 4 Tyres Inflation, Damage, Wear
Total Quantity: tonnes 5 Breakaway Cable 5 Mirrors/Windows/Wipers/Was
hers
PRODUCER / WASTE CARRIER’S DETAILS (TRANSFEROR): WASTE TRANSFER / DISPOSAL SITE DETAILS (TRANSFEREE)
Lights/Indicators/Emergency
Producer: Carrier: Registration No SIC code (2007) Site Operator: [ ] Site Name: [ ] 6 Hand Brake 6 Beacon
Morrison Utility Services Ltd Morrison Utility Services Ltd CBDU81105 42990 7 Jockey Wheel/Clamp/ 7 Horn & Seat Belts
Drop Leg
Abel Smith House or Site Address: [ ]
Gunnels Wood Road 6XE &RQWUDFWRU FRPSOHWH EHORZ [ ] Site Licence Number/Exemption Number: 8 Decking/Flooring 8 Instruments/Speedo/Speed
Stevenage SG1 2ST [ ][ Limiter
][ ]
9 Securing Straps 9 Ancillary Equipment/Loads/
[] [ ][ ] Aids
[] [ ] 10 Wheels, Wheel Nut 10 Brakes/Steering/Exhaust -
Indicators & Dust Caps. Condition/Smoke
[]
11 Tyre Condition/Pressure/ 11 Number Plates
On behalf of Carrier: Valves
, FRQ¿UP WKDW 086 KDV IXO¿OOHG LWV GXW\ WR DSSO\ WKH On behalf of Site Operator:
ZDVWH KHLUDUFK\ DV UHTXLUHG E\ 5HJXODWLRQ RI WKH Name: [ ] 12 Lashing Points/Hooks 12 Body/Guards/Spray
Waste (England and Wales) Regulations 2011. Date of transfer: [ suppression
Signature: [ ] Date: [ ]
] ] Time: [ ] 13 Tailgate/Mud Guards 13 Reflectors/Markers
Name: [ 14 Trailer correct for weight 14 Steps & Handrails
of load
Signature: [ ]
15 Securing Pins & Clips 15 Reverse Bleeper/Camera/
Alarms Audible and Visual
Has waste been treated: Yes No How has waste been treated: Segregation Soil Stabiliser (SMR) Re-Used
DEFECTS SECTION DEFECTS SECTION
What materials have been segregated: Tarmac Other (Specify) 3%086)0( -DQ
Printed by PMT Digital Ltd 01480 493666
What materials have been recycled: Pipe Cable Excavated material Other (Specify) Plant Item Plant ID No. Result of Inspection Plant Item Plant ID No. Result of Inspection
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Bricks 17 01 02 Mixed construction waste 17 09 04 Wood 17 02 01
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Waste Transfer Note / Yorkshire Water Vehicle and Trailer Inspection Record pad A4
REF: C062
Multi-site waste pick-up register pad A4
REF: C061
Vehicle & Trailer Inspection Operator Licence Compliance
Record Book Pre-use Vehicle Checks and Defect Record Book
Grab/Tipper Vehicle
GT: HGV PRE START CHECK RECORD
Driver Name: Driver Signature: FLM:
Vehicle Registration: W/C Date:
MONDAY TUESDAY WEDNESDAY FRIDAY SATURDAY SUNDAY
Start Mileage: THURSDAY
Stop Mileage:
S19 VEHICLE & TRAILER INSPECTION RECORD HGV PRE START INSPECTION RECORD (INTERNAL AND EXTERNAL) CRANE/TIPPER AND WACKER CARRIER PRE START INSPECTION RECORD
Vehicle Make/Model:
Week Commencing: Signature: ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH
Drivers Name:
Vehicle Registration: No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
Trailer No:
IN CAB 1 +\GUDXOLF )OXLG 2LO /HYHO
1 'ULYHU 3DVVHQJHU VHDW VHDW EHOW IXQFWLRQ VHFXULW\ 2 &RQGLWLRQ RI 2LO YLVXDO FRORXU
2 1R 6PRNLQJ 6LJQ YLVLEOH 3 +\GUDXOLF 2LO /HDNV
TRAILER DAILY SAFETY INSPECTION RECORD VEHICLE DAILY SAFETY INSPECTION RECORD 3 7DFKRJUDSK IXQFWLRQDO FRUUHFW WLPH HWF 4 &RQGLWLRQ RI $WWDFKPHQW H J %ULFN *UDE 5XEEHUV
No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun 4 7DFKRJUDSK UROOV DW OHDVW WZR UROOV LQ YHKLFOH 5 6WRZLQJ RI $WWDFKPHQW WR 9HKLFOH
Completed by: Completed by:
Oil, Fuel, Fluids, Coolants levels/ 5 )LUH H[WLQJXLVKHU LQ GDWH VHYLFHDEOH LI DSSOLFDEOH 6 +\GUDXOLF 2LO /HDNV
leaks
1 Towing Eye/Ball/Hitch 1 6 1 6 ,QGLFDWRU $XGLEOH ZDUQLQJ DODUP RSHUDWLRQ 7 6WDELOLVHU %HDP 6HFRQGDU\ /RFNV
2 Power Cable & Plug 2 Trailer Coupling/Connections 7 ,QWHULRU ZDUQLQJ GHYLFHV JR RXW ZKHQ VWDUWHG 8 6ZLQJ 8S 6WDELOLVHU /RFNV
Lights/Trailer Boards/ Wheels & Wheel Nut 8 Fuel level 9 6WDELOLVHU +RVHV 3LSHZRUN
Number Plates Indicators.
3 3 9 2LO IOXLG /HYHOV FKHFN 10 2SHUDWLRQ RI &RQWURO /HYHUV 5HPRWHV
4 Side/Front Markers 4 Tyres Inflation, Damage, Wear 10 :DWHU OHYHO FKHFN 11 2SHUDWLRQ RI 5DWHG &DSDFLW\ ,QGLFDWRU
Mirrors/Windows/Wipers/Was 11 +RUQ RSHUDWLRQDO 12 2SHUDWLRQ RI (PHUJHQF\ 6WRS 6ZLWFKHV
hers
5 Breakaway Cable 5 12 %UDNH SUHVVXUH QR OHDNV 13 2SHUDWLRQ RI +HLJKW :DUQLQJ 'HYLFH
6 Hand Brake 6 Lights/Indicators/Emergency 13 2SHUDWRUV /LFHQFH 'LVF FRUUHFW DQG YLVLEOH 14 &RQGLWLRQ RI +RVHV 3LSHZRUN
Beacon
14 5HYHUVLQJ DLGV FDPHUDV LI DSSOLFDEOH 15 &RQGLWLRQ RI +RRN 6DIHW\ &DWFK
7 Jockey Wheel/Clamp/ 7 Horn & Seat Belts 15 :DVKHUV VFUHHQ ZDVK ZLSHUV LQ ZRUNLQJ RUGHU 16 /RDGHU 6WRZLQJ 'HYLFH 7UDQVSRUW 3RVLWLRQ
Drop Leg
16 6WHHULQJ ZHDU RSHUDWLRQ 17 $WWDFKPHQW RI /RDGHU WR 9HKLFOH
Instruments/Speedo/Speed
8 Decking/Flooring 8 Limiter 17 2Q ERDUG :HLJKHU IXQFWLRQ RSHUDWLRQ 18 &RQGLWLRQ RI /LIWLQJ $FFHVVRULHV
9 Securing Straps 9 Ancillary Equipment/Loads/ 18 2YHU KHDG ZDUQLQJ GHYLFHV ² RSHUDWLRQDO LQWHJULW\ 19 /LIWLQJ $FFHVVRULHV 5HSRUW RI 7KRURXJK ([DPLQDWLRQ
Aids
19 372 &DE 6ZLWFK 2SHUDWLRQ 20 /LIWLQJ $FFHVVRULHV 7HVW &HUWLILFDWH
Wheels, Wheel Nut Brakes/Steering/Exhaust -
10 Indicators & Dust Caps. 10 Condition/Smoke 20 +DQGEUDNH ,QWHUORFN LI ILWWHG 21 :DFNHU &DUULHU ² ,QWHJULW\ 6HFXULW\ DQG 2SHUDWLRQ
21 Height Warning Signs
11 Tyre Condition/Pressure/ 11 Number Plates
Valves EXTERIOR OF VEHICLE
12 Lashing Points/Hooks 12 Body/Guards/Spray 1 9XOQHUDEOH 5RDG 8VHU &\FOH 6DIHW\ VWLFNHU OHJLEOH
suppression
2 )XHO WDQN %DWWHU\ VHFXUH ZLWK ]HUR OHDNV
13 Tailgate/Mud Guards 13 Reflectors/Markers 3 :LQGVFUHHQ FKLSV FUDFNV YLHZ RI WKH URDG
14 Trailer correct for weight 14 Steps & Handrails 4 1R H[FHVVLYH VPRNH IURP H[KDXVW Printed by PMT Digital Ltd, 01480 493666
of load
5 &ODVV 9 9, PLUURUV VHFXUH DQG YLVLEOH
Reverse Bleeper/Camera/
15 Securing Pins & Clips 15 Alarms Audible and Visual 6 $OO /LJKWV ,QGLFDWRUV RSHUDWLRQ FOHDQ DQG OHJLEOH
DEFECTS SECTION DEFECTS SECTION 7 5HIOHFWRUV 0DUNHUV OHJLEOH DQG VHFXUH
8 &RQVSLFXLW\ 0DUNLQJV UHIOHFWLYH WDSH VHFXUH OHJLEOH
9 1XPEHU SODWHV OHJLEOH VHFXULW\ OHJDO
10 0XGJXDUGV 6SUD\ VXSSUHVVLRQ VHFXUH
11 :KHHOV ZKHHO QXW LQGLFDWRUV GXVW FDSV :HHNO\ VLJQ RII 0 DQDJHU Date
12 7\UHV GDPDJH EXOJHV FXWV ZHDU
13 8QGHUUXQ EDUV VHFXUH GDPDJH Driver Date
14 5RDG VSULQJV VHFXULW\ FOHDQ RI GHEULV
Note: Failure to carry out daily checks before leaving site may result in disciplinary action being taken. All damages/defects should be reported in writing before leaving site. Defects/breakdowns during your working day, must also be recorded
Printed by PMT Digital Ltd 01480 493666 Grab Tipper HGV vehicle pre-start check and defect record pad A4
REF: C064
Morrison Telecom Services Vehicle and Trailer
Inspection Record pad A4 REF: C063
36
Section C – Pads
6
( - #%,
. ,-(& +
+ ,, SITE AGENTS
INSPECTION REPORT
,$
( (5 EXCAVATION PERMIT
-- ' Team Leader:_____________________________________________ Date: ____________________________ Time: _________________
(& )% - Operative: _______________________________________________ Contract: __________________________ / No. _________________
'7 #- +,('' % Operative: _______________________________________________ Location: ________________________________________________ Auto-code: Date:
2(. ',0 + -( '2 ( -" (%%(0#'! * . ,-#(', #' , -#(' < (+ =3 Plant Operator: ___________________________________________ Work in Progress: _________________________________________
5 , % - -( 2(. + & ' ! + 6 ,. ) +/ #,(+ ,( -" 2 ' Vehicle Registration: _______________________________________ Site Agent: _______________________________________________ DESCRIPTION OF WORK & LOCATION (have copies of legible/colour/appropriate scale service drawings and
clearly mark position of services on the ground).
# '-# 2 #-#(' % ('-+(% & ,. + ,5
This Safety Inspection is to be conducted diligently by completing the checklist.
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"#, ) +& #- #, -( (& )% - 2 -" ) +,(' (' ,#- #' " +! ( -" 1 / -#(' 9 '! +:5 1.0 Site Observations Yes No N/A 5.0 Welfare Yes No N/A
1.1 Safe Access / Egress to the work site?
& & +4 +(
' # '-, 8 +( +& 8 +( (& )+(& #, 1.2 Appropriate warning signs posted? 5.1 Provision for obtaining Hot Water?
1.3 Vehicles clean and tidy? 5.2 Suitable arrangements for Toilets?
<5 ( . & '- -#(' ; * . #)& '- 1.4 Is Vehicle Secure / ignition keys removed / 5.3 Suitable facilities for washing available? ASSUME LIVE SERVICES ARE PRESENT UNLESS CONFIRMED OTHERWISE
5.4 Soap and towels / Wipes available?
#-
' . -#(' 8 %% '7 #- +,('' %6 #,#-(+, , ( parked safely? 5.5 First Aid Kit & Eye wash available and in date?
1.5 Signing / Guarding / Perimeter Fencing correct?
#,$ ,, ,,& '-, ; -"( - - & '-, -( & - . % , #' )% 9 ; (% +: , ( SITE SURVEY ( ✓ AS APPROPRIATE)
Managers Inspection Report1.6 Pedestrian / Public safety satisfactory?
(#'- ( (+$ #,$ ,, ,,& '- (& )% - , ( 1.7 Housekeeping - Safe and tidy site? 5.6 Plant, equipment, materials and vehicles arranged TYPE OF SERVICE INFORMATION INFORMATION SERVICE UTILITY DEPTH
1.8 Operatives working safely - wearing PPE? safely to protect staff & public? REQUESTED RECEIVED IDENTIFIED INDICATED
-#%#-2 % ', / #% % ;
!# % , ( Excavation Permit BookUTILITY
5.7 Are all welfare facilities including toilets cleaned ELECTRIC
; ''2 +-# # , ( regularly? GAS
WATER/SEWERS/DRAINS
; ''2 ,- ' +/ # % , ( $UH WKHUH VXI¿FLHQW DQG VXLWDEOH IDFLOLWLHV IRU TELECOM/FIBRE OPTIC
changing and drying clothes? STREET-LIGHTING
%-" ; -2 + #' ; . -"(+#, 9 (& ) - ' # , 9 3 3 - + 2.0 Documentation Yes No N/A OTHER (specify)
2!# ' 3 ; ''2
/ % =: #' - 3
' . - : 5.9 Is there an adequate supply of wholesome drinking
, ( 2.1 Individual ID Cards on site and Available? water available?
=5 ' + % 2.2 Team Leader Pack Complete? 6.0 Personal Protective Equipment Yes No N/A
#,. % ' ( #- 8 -+ - . +'#-. + ; +, (- , ( $OO GDLO\ 6LWH 6SHFL¿F 5LVN $VVHVVPHQWV DUH VXLWDEOH 6.1 Flame Retardant Overalls in good order & worn?
DQG VXI¿FLHQW VLQFH SUHYLRXV LQVSHFWLRQ"
; ''2 ' (& )% - 8 #'#& . & ( = #'. - , (- % #' %% ( , , ( 6.2 Safety Footwear in good order and worn?
2.4 Service Plans available and legible?
6.3 Hearing protection available and worn where
%% - - +/ # , +$ , ( $UH DOO 7UDLQLQJ &HUWL¿FDWHV 3RFNHW required? FORMAL ISSUE (to be completed by Site Manager/Agent)
ID Cards on site and in date?
+ ((%, . #- % ;
',. % - , ( 6.4 Head protection available and worn where FROM: UNTIL
2.6 Are safety docs / work instructions required? NAME: 7 days max
. #- % ; (+' , ( Adequate & Understood?
6.5 Eye protection available and worn where Position
$ UH 'DLO\ 6LWH 6SHFL¿F 5LVN $VVHVVPHQW RQ VLWH DQG required?
+ 7. , " $, ( % '- ++# . - ' % '- +/ # % , ( signed? SIGNATURE:
'XVW 0DVNV DYDLODEOH DQG ZRUQ ZKHUH UHTXLUHG"
% ," ; + +(( %(-"#'! (+' , ( $ UH 6LWH 6SHFL¿F 5$06 FRUUHVSRQGLQJ WR WKH ZRUN
undertaken on site and signed? 6.7 Is all PPE being correctly stored?
>5 - - -#%#-# , 2.9 Are copies of all active Permits to Work on site and Daily Sign on
correctly completed?
7.0 Environment Yes No N/A
#!" (%- ! % -+# #' %. #'! (/ +" , ( 3.0 Plant & Equipment Yes No N/A 7.1 Are appropriate sized spill kits readily available? STANDARD PRECAUTIONS (REF: HSE PUBLICATION - HS(G)47)
7.2 Is waste correctly separated for disposal? • Ensure area to be dug is scanned using a “Genny” & “Cat” with depth reading capability and/or ground radar. Persons conducting the scan must be
(0 (%- ! % -+# , ( 3.1 CAT No: 7.3 All containers correctly labelled? trained in the equipment by approved trainers. CAT & Genny must be within calibration date
Calibration due date: 7.4 Hazardous materials stored correctly?
(' (' ' +!+(. ' #!" (%- ! % -+# , ( $UH DOO FRQWDLQHUV ¿W IRU SXUSRVH" &RQWLQXH WR VFDQ LQ OD\HUV WKURXJKRXW WKH H[FDYDWLRQ DW PP IRU ¿UVW P GLJ DQG DW P GHSWKV WKHUHDIWHU
3.2 Genny No: 7.6 Is COSHH information available, understood and
#!" + ,,. + #%6 . % #) %#' , , ( Calibration due date: • Always use the Genny to locate street lighting
complied with?
6 6 / +" , ( 3.3 Fire Extinguisher: Kg: 7.7 Have spoil samples been taken for every trial holes +DQG GLJ WULDO KROHV DV PDQ\ DV QHFHVVDU\ WR FRQ¿UP ORFDWLRQ RI VHUYLFHV LQ DUHD WR EH GXJ +DQG GLJ XVLQJ VSDGHV VKRYHOV DQG QHYHU XVH SRLQWHG
Calibration due date: tools such as picks
, , ( and stored properly?
3.4 Lifting equipment in good order? • Ensure exposed services are supported and protected. Seek advice if vulnerable services are uncovered e.g. cast iron pipes, asbestos cement pipes,
- + , ( Calibration due date: pot ended cables etc.
0 + ! , ( Printed by PMT Digital Ltd, 01480 493666 ( [FDYDWRU LQ JRRG ZRUNLQJ RUGHU DQG ¿W IRU 8.0 Quality Yes No N/A 0DFKLQH GLJV PXVW DOZD\V EH DW OHDVW P DZD\ IURP H[LVWLQJ VHUYLFHV WKHUHIRUH DOO GLJV P IURP D ORFDWHG VHUYLFH PXVW EH E\ KDQG GLJ RQO\ :KHUH IRU
purpose? SUDFWLFDO UHDVRQV D PDFKLQH GLJ LV UHTXLUHG OHVV WKDQ P EXW QR FORVHU WKDQ P WKHQ D VSHFL¿F ULVN DVVHVVPHQW PXVW EH SURGXFHG DQG DSSURYHG
+ #' ! , ( 8.1 Trench at the correct depth & within spec? E\ WKH 6LWH 0DQDJHU SULRU WR XQGHUWDNLQJ WKH GLJ WR MXVWLI\ WKH XVH RI WKH PDFKLQH OHVV WKDQ P IURP WKH VHUYLFH
3 ODQW 0DFKLQHU\ LQ JRRG ZRUNLQJ RUGHU
-" + , ( Beacon etc? 8.2 Sand and Bedding correct as per spec? • Machine Excavation must only be used when safe to do so and only when the precautions above have been followed. Also consider overhead cables
in relation to the positioning and traversing of plant
3.7 Trailer in good order - Lights, Number plate, 8.3 Network Spacing correct as per spec?
% + -#(' ( . ) +/ #,(+6 '! + #!' -. + Break away cable etc? 8.4 Network undamaged with ends sealed/protected? Details of GENNY/CAT
8.5 Network tiles/marker tape at correct depth? Signature:
(' #+& -" -
" / + ,, '2 ' ! -#/ #,,. , # '-# # ' -" - %% ) +,(', 3.8 Gas Detection Unit (GDU) No: Operator Name: Date:
Calibration due date: 8.6 Network physical protection/steel plates if req’d?
0(+$#'! (' (+ 0"( & 2 - 2 -"#, - ,$ " / ' . %%2 +# (' -" Genny Serial No: Type: Calibration Date:
3.9 Are general and insulated hand tools in good 8.7 Exposed utilities supported?
+ * . #+ 5 condition? 8.8 Has any Non Compliance occurred and has it been Cat Serial No: Type: Calibration Date:
(' #+& -" - -" , 0(+$, + , -( )+( #' (+ ' 0#-" -" ('-+(% 3.10 Are all plant and tools in good condition with no reported?
VLJQL¿FDQW GDPDJH" 8.9 Has an or a few Inspection and Test Plan(s) been
3.11 Have all staff been trained in all tools & working completed for the work undertaken?
techniques?
& ,. + , # '-# # #' -"#, ) +& #- ' ,,( # - +#,$ ,, ,,& '-, ' & -"( 4.0 Excavations Yes No N/A ADDITIONAL INSTRUCTIONS & PRECAUTIONS
,- - & '-,5 4.1 Safe Access / Egress into excavation area? 3ULQWHG E\ 307 'LJLWDO /WG
4.2 Top Soil / Sub Soil stored separately? No. Comment and Action Required Action Completed / FORMAL RECEIPT (to be completed by Person in Charge of Ground Disturbance)
DATE:
4.3 Excavation adequately supported? Closed Off
4.4 Safe means of entry into excavations? NAME:
4.5 Spoil stored away from edge of excavation? SIGNATURE:
Permit to Work - A4 pads 4.6 Safe system of work as method statement? Site Agent Signature: Permit Closed - Person in Charge of ground disturbance, site is safe Site Manager/Agent
and secure
4.7 Has a Full Cat and Genny Survey been conducted Signature
and trial holes excavated?
31283 - PtD Template v1.0 - Portrait A4.indd 1 26/11/2019 13:28 Team Leader’s Signature: Date/Time Date/Time
4.8 Have all Services been clearly marked out with the
excavation area?
4.9 Have all excavations been recorded on the
Excavation Register (F91)?
REF: C065
Trams to Newhaven Managers Inspection Trams to Newhaven Excavation Permit Book
Report Book - A4 Pads REF: C066 - A4 Pads REF: C067
DATE OF ASSESSMENT
On Site Risk Assessment Operator Licence Compliance
Pre-use Vehicle Checks and Defect Record Book
Location, Job No: Yes No N/A Has the job been completed incident free? Vehicle/trailer number...................................................... Odometer reading .....................................................
YES Crane/Trailer Vehicle Contract........................................................................... Date...........................................................................
Must Be Completed Before Starting Work And Amended If Site Conditions Change Are you trained and competent (experienced) to carry out the work? IF NO then notify Depot............................................................................... Driver.........................................................................
Are your instructions (Job Pack) clear and understood? NO your supervisor and
Are your tools and plant in serviceable order and suitably tested?
submit this Risk
Assessment
No: HGV PRE START CHECK RECORD DEFECT REPORT - Detail of any faults noted should be entered below, include pre start check reference number (top left of sheet)
FLM:
Weather (HOT OR COLD) Falls From Height Use Of Hand Tools Sharps/Needles If anything has been ticked in the Driver Name: Driver Signature:
Manual Handling Lone Working COSHH Dust check list please refer to Team Safety Vehicle Registration: MONDAY TUESDAY WEDNESDAY W/C Date: FRIDAY SATURDAY SUNDAY
Vehicles (Loading/Unloading) Asbestos Sensitive Buildings (Hospitals, etc) Noise 3DFN ,I \RX KDYH LGHQWL¿HG DQ\WKLQJ
Animals Customers Environment 7UDI¿F ³6LWH 6SHFL¿F´ SOHDVH H[SODLQ Start Mileage: THURSDAY
Use Of Power Tools &RQ¿QHG 6SDFHV 6OLSV 7ULSV )DOOV Others Please Specify provide location and job number Stop Mileage:
below. Defects reported to ......................................................... Signature of driver.....................................................
Task & Hazards:
6LWH 6SHFL¿F Who Might be Harmed: Control Measures or Checks: Control’s Residual Risk HGV PRE START INSPECTION RECORD (INTERNAL AND EXTERNAL) CRANE AND TRAILER PRE START INSPECTION RECORD
Who might be harmed and what could the How can the hazard be prevented by measures in (tick box) ¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH ACTION TAKEN¥ FKHFNHG VHUYLFHDEOH ; 5HSRUWHG GHIHFW 1 $ 1RW $SSOLFDEOH
place? (tick)
consequences of that harm be? controls or safety checks? Responsibilities: No Item Mon Tue Wed Thu Fri Sat Sun No Item Mon Tue Wed Thu Fri Sat Sun
Who is going to take action?
IN CAB 1 +\GUDXOLF )OXLG 2LO /HYHO
YES NO L M H 1 'ULYHU 3DVVHQJHU VHDW VHDW EHOW IXQFWLRQ VHFXULW\ 2 &RQGLWLRQ RI 2LO YLVXDO FRORXU Defects rectified by (name).............................................. Dealer name ..............................................................
2 1R 6PRNLQJ 6LJQ YLVLEOH
3 +\GUDXOLF 2LO /HDNV
3 7DFKRJUDSK IXQFWLRQDO FRUUHFW WLPH HWF 4 &RQGLWLRQ RI $WWDFKPHQW H J %ULFN *UDE 5XEEHUV
4 7DFKRJUDSK UROOV DW OHDVW WZR UROOV LQ YHKLFOH 5 6WDELOLVHU %HDP 6HFRQGDU\ /RFNV Signature ................................................... Position....................................... Date ...........................................
5 )LUH H[WLQJXLVKHU LQ GDWH VHYLFHDEOH LI DSSOLFDEOH 6 6ZLQJ 8S 6WDELOLVHU /RFNV
6 1 6 ,QGLFDWRU $XGLEOH ZDUQLQJ DODUP RSHUDWLRQ 7 6WDELOLVHU +RVHV 3LSHZRUN
7 ,QWHULRU ZDUQLQJ GHYLFHV JR RXW ZKHQ VWDUWHG 8 2SHUDWLRQ RI &RQWURO /HYHUV 5HPRWHV
8 Fuel level 9 2SHUDWLRQ RI 5DWHG &DSDFLW\ ,QGLFDWRU
9 2LO IOXLG /HYHOV FKHFN 10 2SHUDWLRQ RI (PHUJHQF\ 6WRS 6ZLWFKHV
10 :DWHU OHYHO FKHFN 11 2SHUDWLRQ RI +HLJKW :DUQLQJ 'HYLFH
Signed by all “on site’ personnel before work is to commence 11 +RUQ RSHUDWLRQDO 12 &RQGLWLRQ RI +RVHV 3LSHZRUN
12 %UDNH SUHVVXUH QR OHDNV 13 &RQGLWLRQ RI +RRN 6DIHW\ &DWFK
First Name: Surname: Signature: 13 2SHUDWRUV /LFHQFH 'LVF FRUUHFW DQG YLVLEOH 14 /RDGHU 6WRZLQJ 'HYLFH 7UDQVSRUW 3RVLWLRQ
First Name: Surname: Signature:
First Name: Surname: Signature: Low Possible or slight<33% chance to cause minor cuts, abrasions, 14 5HYHUVLQJ DLGV FDPHUDV LI DSSOLFDEOH 15 $WWDFKPHQW RI /RDGHU WR 9HKLFOH
EUXLVLQJ RU GLVWUHVV ,QVLJQL¿FDQW SROOXWLRQ &$7 3ROOXWLRQ
15 :DVKHUV VFUHHQ ZDVK ZLSHUV LQ ZRUNLQJ RUGHU 16 &RQGLWLRQ RI /LIWLQJ $FFHVVRULHV
Good chance or >33%<66% likely of causing an accident to 16 6WHHULQJ ZHDU RSHUDWLRQ 17 /LIWLQJ $FFHVVRULHV 5HSRUW RI 7KRURXJK ([DPLQDWLRQ
occasion injury resulting in more than 3 days off work or a
Med RIDDOR reportable. Possible CAT 2 Pollution incident likely. 17 2Q ERDUG :HLJKHU IXQFWLRQ RSHUDWLRQ 18 7RZLQJ (\H %DOO +LWFK
High
Unacceptable Highly likely >66% chance to cause serious injury and/or long 18 2YHU KHDG ZDUQLQJ GHYLFHV ² RSHUDWLRQDO LQWHJULW\ 19 3RZHU &DEOH DQG 3OXJ
WHUP GLVDELOLW\ HYHQ GHDWK +6( SURVHFXWLRQ RU GH¿QLWH PDMRU
CAT 1 Pollution incident 19 372 &DE 6ZLWFK 2SHUDWLRQ 20 /LJKWV 7UDLOHU %RDUGV 1XPEHU 3ODWHV
ALL ACCIDENTS, INCIDENTS OR NEAR MISS EVENTS ARE TO BE REPORTED: 0330 123 1092 Residual Risk Rating is the operatives opinion of risk after the 20 +DQGEUDNH ,QWHUORFN LI ILWWHG 21 6LGH )URQW 0DUNHUV
Nothing we do at Morrison Utility Services is not so important that we cannot take time to do it safely control measures 21 Height Warning Signs 22 %UHDNDZD\ &DEOH
$Q\ PHGLXP RU KLJK ULVNV LGHQWL¿HG WKHQ FRQWDFW \RXU
If in doubt contact your supervisor or H&S advisor. Supervisor or HSE Advisor EXTERIOR OF VEHICLE 23 +DQG %UDNH
1 9XOQHUDEOH 5RDG 8VHU &\FOH 6DIHW\ VWLFNHU OHJLEOH 24 -RFNH\ :KHHO &ODPS 'URS /HJ
2 )XHO WDQN %DWWHU\ VHFXUH ZLWK ]HUR OHDNV 25 'HFNLQJ )ORRULQJ
3 :LQGVFUHHQ FKLSV FUDFNV YLHZ RI WKH URDG 26 Securing Straps
4 1R H[FHVVLYH VPRNH IURP H[KDXVW 27 :KHHOV :KHHO 1XW ,QGLFDWRUV 'XVW &DSV Printed by PMT Digital Ltd, 01480 493666
5 &ODVV 9 9, PLUURUV VHFXUH DQG YLVLEOH 28 7\UH &RQGLWLRQ 3UHVVXUH 9DOYHV
6 $OO /LJKWV ,QGLFDWRUV RSHUDWLRQ FOHDQ DQG OHJLEOH 29 /DVKLQJ 3RLQWV +RRNV
7 5HIOHFWRUV 0DUNHUV OHJLEOH DQG VHFXUH 30 7DLOJDWH 0XG *XDUGV
On Site Risk Assessment Pad A4 8 &RQVSLFXLW\ 0DUNLQJV UHIOHFWLYH WDSH VHFXUH OHJLEOH 31 7UDLOHU FRUUHFW IRU ZHLJKW RI ORDG
REF: C068 9 1XPEHU SODWHV OHJLEOH VHFXULW\ OHJDO 32 6HFXULQJ 3LQV &OLSV
10 0XGJXDUGV 6SUD\ VXSSUHVVLRQ VHFXUH
11 :KHHOV ZKHHO QXW LQGLFDWRUV GXVW FDSV :HHNO\ VLJQ RII 0 DQDJHU Date
12 7\UHV GDPDJH EXOJHV FXWV ZHDU
13 8QGHUUXQ EDUV VHFXUH GDPDJH Driver Date
14 5RDG VSULQJV VHFXULW\ FOHDU RI GHEULV
Note: Failure to carry out daily checks before leaving site may result in disciplinary action being taken. All damages/defects should be reported in writing before leaving site. Defects/breakdowns during your working day, must also be recorded
Crane and Trailer Pre Start Inspection Record Pad A4
REF: C069
General Permit to Work Permit issued by: Permit Number: SPECIFICATION &
1. Permit issued to: OPTIONS AVAILABLE
Time: Date:
2. This permit is valid from / to: Time: Date: • Various sizes available
(Max 7 consecutive days) • Paper or NCR pads available
• NCR (no carbon required) allows you to write
3. Location of work:
on top sheet and a copy(ies) through to the
4. Work to be carried out (Tick relevant box): next sheet
• Various colours of NCR available
Excavation Works Lifting Operations Confined Space Work at Height • Numerous layers possible 2 part, 3 part,
Hot Works Other 4 part
Trench Support Directional Drilling (HDD) • Board back to stiffen pad
• Glued edge to be easily separated if required
If ‘Other’ Specify: • Perforation optional so only certain pads are
removed
5. Risk Assessment available and relevant to task: 6. Relevant Competency Level acquired to carry out task: • Optional covers
• Pre-drilled for insertion into binders
Yes No Yes No N/A
Note: (If ‘No’) work must not proceed and permit will not be issued Note: (If ‘No’) work must not proceed and permit will not be issued
7. Describe Task to be undertaken: Permit Holder to document Control Measures to be put in
place:
8. Authorisation for Work to Proceed (Agent / Supervisor)
I am satisfied that the control measures noted above are in place and the permit holder understands
the task to be undertaken.
Print Name: Signature: Date:
9. Competent Person (Nominated permit holder – Team Leader)
I am fully aware of and understand the requirements stated on this permit and will ensure that they are
understood by and observed by all persons under my supervision. If conditions change this permit
shall be cancelled and a new one raised.
Print Name: Signature: Date:
10. Cancellation (Team Leader)
The work specified on this permit is now safely completed and the work location has been restored to
a safe condition / transferred to permit no: ________________ and I confirm appropriate checks have
been carried out.
Print Name: Signature: Date:
11. This work permit is cancelled by the Authorised Person (Agent / Supervisor) MTS_PTW_V1
Print Name: Signature: Date:
Original – To be retained in the site file / job pack Printed by PMT Digital
Yellow – To be held by the Team Leader Tel 01480 493666
Pink – To be held by the Issuer
Permit to Work - A4 pads
REF: C070
37
38
AT SCENE BUMP CARD PMT Digital Ltd. 01480 493666 Section D – Cards
You should complete this bump card for all accidents, however minor Site Observation Record Card
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HAND IN TO SITE PERSON IN CHARGE/LINE MANAGER/SHEQ ADVISOR
(IMf dUeSliTv)e,rethdeapseMrsoornrisdoenlivUetriilnitgy Services Safety Talk The Gas
name here talk is to sign their Emergency Control
Version 10 is Located
24575 - Site Obs Card v10 i dd
39
40
Section D – Cards
Commercial Vehicle Fuel Cards Fuel Card Rules Crib Cards
REF: D001
REF: D002 REF: D003
Site Observation Record Card MUS Ref (if available): ....................Date: ........................ WEIL’S DISEASE
Contract: ........................................Depot:...................... (Leptospirosis Icterohaemorragica)
Site Address / Location:.................................................... Employer: ......................................
Print Name of Observer / Name of Person Delivering MUST: ..................................................... Weil’s Disease is caused by exposure to bacteria (leptospira)
Print Name of Person Being Observed / Name of Person Receiving MUST: ................................ which may be present in the urine of infected rats, dogs
or cattle. These bacteria can contaminate abrasions and
COMPLIANCE NEAR MISS HAZARD MUST cuts and can also penetrate punctured skin. To ensure
early diagnosis of Weil’s Disease:
Tick the boxes applicable to your site observation: INSTRUCTIONS TO PERSONS AT
1. Show your family doctor this card so that he knows of RISK FROM LEPTOSPIROSIS
Behaviour Access & Egress Site Security your occupational risk. (WEIL’S DISEASE)
PPE Excavation Work ObserTvhiardtiPoarnty/TAoctpiviitcies Immediate Action Taken: Site Observation Record Card 2. Report immediately to your family doctor if you 1. Complete the details inside the front cover.
Slips, Trips & Falls Plant & Equipment (What yMouansauwal /HTaonpdiclinogf MUST) (What you did e.g informed site/line develop the following symptoms (most of which
occur in many other diseases): 2. Keep this card in a safe place.
Supervision Work at Height Fire Precautions manager, safety discussion, recognised (a) Sudden onset of fever/muscle pains
(b) Headache, stiff neck 3. Whenever you go to your doctor or to a hospital
operative/site for positive contribution etc.) (c) Red eyes on account of illness, show this card and make sure
(d) Jaundice that those attending to you know your occupation.
COSHH Process Welfare Arrangements (e) Cloudy bloodstained urine
4. Every accident at work, however minor must be
Environmental Issues Mains or Service Laying House Keeping Should you suspect that the holder of this card is suffering reported to the Morrison Utility Services Incident
(Noise, Dust, Lighting) Confined Space Site Documentation from Weil’s Disease, please notify the Morrison Utility Line.
Electrical Safety Movement of Vehicles Services Incident Line.
Public Safety Waste Management Training / Competence 5. If your doctor suspects that you have developed
Printed by PMT Digital 01480 493666 an infection at work, you must notify your line
Signing, Lighting & manager immediately.
Guarding
HAND IN TO SITE PERSON IN CHARGE/LINE MANAGER/SHEQ ADVISOR Weil’s Disease Cards Site Induction Card
REF: D005 REF: D006
If delivered as Morrison Utility Services Safety Talk
(MUST), the person delivering talk is to sign their
name here
Version 10
Site Observation Cards v10
REF: D004
Date:
Location/Zone:
Employer:
Name (optional):
Tick the boxes applicable to the incident:
Behaviour Signing, lighting &Hazard / Near Miss Report Card Notes
guarding
PPE
Access & egress
Slips, trips & falls
Excavation work
Poor supervision
Plant & equipment
Lifting & carrying
Work at height
Environmental issues
(Noise, dust, lighting, Chemical spillage &
& material storage) leaks
Danger to the public Mains or service laying
Hazard / Near Miss Report Card Hand in to your Safety Advisor / Supervisor
Hampden House
Hitchin Road
Arlesey
Bedfordshire
SG15 6RT
Near Miss Cards Windscreen Sticker & Card for tyres National Grid Customer Service Cards
REF: D008 REF: D009
REF: D007
MUS Ref: ............................................................... IAccountability
On Site Inspection - Signing, Lighting & Guarding Date: ............................... Time: ............................ Be accountable for
Site Address:....................................................................................................................... Myour actions
PCourtesy
Auditor: ................................................... Auditee: ............................................................
Courtesy costs
Tick the boxes applicable to your site observation: Pass Fail Action
All significant risks have been identified and recorded with appropriate taken Anothing but reaps
control measures on site
rewards
Vehicle, plant, equipment and materials incorporated within the I
works or appropriately guarded CTime MInformative
Signs appropriately secured and weighted Timely completion of Inform the public
about the work
Signing, Lighting & Guarding erected in accordance with the Safety Tworks to schedule and
at Street Works and Road Works Code of Practice PMinimise
Comments Immediate Action Taken: On Site Inspection - Signing, Lighting & Guarding effective handling of
Detail any action you took to rectify a non queries Minimise disruption
Road plates, footway boards and kerb ramps in place where required compliant situation or where you identified
good practice Aand inconvenience
Minimum of 1.2 metre unobstructed pedestrian access provided. C
If not, has line manager / Street Works office been informed
TPoliteness
Appropriate system of traffic management in place e.g. traffic lights,
give and take etc. Politely respond
to questions and
Courtesy board present with correct reference displayed concerns
SOR Card / MUST Talk given
Safety Passport signed with appropriate comments
Printed by PMT Digital
National Grid & MUS Cards Auditors signature Impact Cards
REF: D010
HAND IN TO SHEQ ADVISOR REF: D012
Version 1
Site Observation Cards - Signing,
Lighting & Guarding
REF: D0011
On Site Inspection - Safe Excavating On Site Inspection - Jointing LV Reminder Cards
REF: D013 REF: D014
REF: D015
41
Section D – Cards
Crib Cards On Site Inspection - Backfill Operations On Site Inspection - Behavioural
REF: D017 REF: D018
REF: D016
On Site Inspection - Cable Laying On Site Inspection - CDM Notifiable Projests On Site Inspection - Customer Care
REF: D021
REF: D019 REF: D020
On Site Inspection - Documentational (Electrical) On Site Inspection - Environmental On Site Inspection - Excavation Safety
REF: D022 REF: D023 REF: D024
On Site Inspection - Job Documents (Planned) On Site Inspection - Job Documents (Unplanned) On Site Inspection - Office
REF: D027
REF: D025 REF: D026
On Site Inspection - Plant, Tools & Equipment On Site Inspection - PPE (Electrical) On Site Inspection - PPE
REF: D028 REF: D029 REF: D030
42
Section – D Cards
On Site Inspection Card - Reinstatement (verge) MUS Ref: ............................................................... MUS Ref: ...............................................................
On Site Inspection - Waste Management Date: .....................................................................
On Site Inspection - ScaffoldingDate: .....................................................................Site Address:...................................................................................................................
Auditor: ................................................... Auditee: ........................................................
Site Address:...................................................................................................................
Auditor: ................................................... Auditee: ........................................................
Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action
taken taken
on site on site
All significant risks have been identified and recorded with appropriate control measures? All significant risks have been identified and recorded with appropriate
control measures.
Are all the licenses present and in date for all the waste carriers and disposal sites being
used on the contract / project? Handover certificate completed and available.
Is the waste matrix accurate or is there evidence of new transfer stations, No unprotected edges without means of preventing a fall.
recycling centres or landfill sites being used? Scafftag completed and in place.
CommentsAre waste transfer notes & multi waste pick up sheets being completed and are all the
sections being completed correctly?
Does the site produce Hazardous waste and if so is it registered with the
Environmental Agency and are they displaying the number issued by the EA?
Is all waste on site being stored correctly i.e. skips in good condition etc.?
Are Duty of Care checks being carried out on all waste streams and recorded?
Is the general level of awareness for waste management at a good standard?
Have all persons that may carry any form of company waste in their vehicle been issued
with the correct Waste Carriers license?
Is waste documentation being stored in accordance with statutory requirements (i.e. Transfer
notes for general waste - 2 years and consignment notes for hazardous waste - 3 years?)
SOR Card / MUST Talk given?
On Site Inspection - ScaffoldingImmediate Action Taken:CommentsImmediate Action Taken:
On Site Inspection - Waste ManagementDetail any action you took to rectify a non Detail any action you took to rectify a non
compliant situation or where you identified Recorded inspection undertaken after installation, an event likely to have affected compliant situation or where you identified
On Site Inspection Card - Reinstatement (verge) good practice its stability or within the last 7 days. good practice
In date safety harness worn.
Work being undertaken in accordance with safety documentation.
Safe Access and Egress.
SOR Card / MUST Talk given.
Safety Passport signed with appropriate comments.
On Site Inspection - Reinstatement Auditors signature Auditors signature
REF: D031
HAND IN TO SHEQ ADVISOR HAND IN TO SHEQ ADVISOR
Version 1 Version 1
On Site Inspection - Waste Management On Site Inspection - Scaffolding
REF: D032 REF: D033
MUS Ref: ...............................................................
Date: ............................... Depot: .........................
Site Address:...................................................................................................................
Auditor: ................................................... Auditee: ........................................................
Tick the boxes applicable to your site observation: Pass Fail Action
taken
All significant risks have been identified and recorded with appropriate on site
control measures
Has all spoil been removed from site?
Area adequately covered with top soil to meet the desired standard?
Has top soil been raked and levelled? Comments Immediate Action Taken:
Detail any action you took to rectify a non
Have all rocks & rubble in excess of 20mm been removed from the compliant situation or where you identified
surface area? good practice
Has the ground been covered with grass seed?
Is the site clean, tidy and free from defects?
If turf has been replaced, has it been rolled and replaced correctly?
SOR Card / MUST Talk given
Safety Passport signed with appropriate comments
Auditors signature Customer Card Bump Card
HAND IN TO SHEQ ADVISOR REF: D035 REF: D036
Version 1
On Site Inspection - Reinstatement
REF: D034
Emergency Temporary Repairs Card Grass Area Reinstatement Card Stages of Work Card
REF: D037 REF: D038 REF: D039
Cappagh Near Miss Cards On Site Inspection - Traffic Management Tree Protection Info Card
REF: D040 REF: D041 REF: D042
MUS/URN Site Observation Record Card CWA Ref (if available): ...................Date: ........................
Site Address Contract: ........................................Depot:......................
Site Address:.................................................................... Employer: ......................................
Print Name of Observer / Name of Person Delivering CWAT: .....................................................
Print Name of Person Being Observed / Name of Person Receiving CWAT: ...............................
COMPLIANCE NEAR MISS HAZARD MUST
Tick the boxes applicable to your site observation:
Time Behaviour Access & Egress Waste Management
ObseSritve aSetciournity/Topic
We’re really sorry... PPE Excavation Work (WhatTyhoiurdsPaawrt/yTAocptiicviotifesCWAT) Immediate Action Taken: Site Observation Record Card
Reinstatement Work (What you did e.g informed site/line
Date Slips, Trips & Falls Backfill Work Manual Handling manager, safety discussion, recognised
Whilst carrying out essential engineering works in your area, we believe we may have inadvertently Plant & Equipment Fire Precautions operative/site for positive contribution etc.)
Supervision Work at Height Welfare Arrangements
Site Agent Namedamaged one of the following supplies to this property: Process House Keeping
COSHH Mains or Service Laying Site Documentation
Job No. Electric Confined Space Movement of Vehicles
Gas Environmental Issues Electrical Safety Training / Competence
Telecoms (Noise, Dust, Lighting)
Water
Other (please state........................................................................) Public Safety
Please check to see if your supply has been restored. Signing, Lighting &
Guarding
If you are experiencing a loss of telecoms supply, please contact your provider. For
all other supplies, please contact us on 0845 3425 687 quoting the MUS/URN (Unique
Reference Number), or site address stated overleaf.
On Site Inspection - Vehicle Gate Check NPG Customer Card HAND IN TO SITE PERSON IN CHARGE/LINE MANAGER/SHEQ ADVISOR
REF: D043 Loss of Supply REF: D044
If delivered as Caledonia Water Alliance Safety Talk
(CWAT), the person delivering talk is to sign their
name here
Version 1 Printed by PMT Digital Ltd 01480 493666
Caledonia Site Obs Cards
REF: D045
43
Section D – Cards
MUS ref Phil Dyson-Smith SHEQ Manager Tel: 07843 634933
Site address
Time
Date Melanie Brown Senior SHEQ Advisor Tel: 07850 722484
Site agent name
Job No. Stuart Hannah SHEQ Advisor Tel: 07850 722467
Peter Davies SHEQ Advisor Tel: 07702 512501
Lewis Binfield SHEQ Advisor Electrical Tel: 07809 084835
We’re really sorry... George Smith SHEQ Advisor Tel: 07834 583023
Whilst carrying out essential engineering works in your area, we believe we Ann Campbell SHEQ Training/Inductions Tel: 07894 811658
may have inadvertently damaged one of the following supplies to this property:
Electric
Gas Delivering what we promise
Telecoms
Water
Other (please state.........................................................................................)
Please check to see if your supply has been restored.
If you are experiencing a loss of telecoms supply, please contact your provider.
For all other supplies, please contact us on 08000 420 850 quoting the MUS ref or site
address stated overleaf.
Loss of Supply Customer Card Printed by PMT Digital Ltd 01480 493666 Zero Harm Contact Cards
REF: D046 REF: D048
Thames Water
Safety Feature Cards REF: D047
Site Address MUS Ref What do they mean.
Date
We’re really sorry... Site Address Passionate about everything we do: We commit ourselves wholeheartedly to
everything we do. We approach our work with enthusiasm, energy and positivity.
TimWehilst carrying out essential engineering works in your area, we believe we may have inadvertently Delivering what we promise
damaged one of the following supplies to this property: Take ownership: We take responsibility, take action, and never walk on by. We are
Emergency Temporary Repairs
Date Western Power Distribution, the company which looks after the electricity N O V A T I N G L I Fproactive -focusing only on solutions instead of problems.
Electric network in the area, has carried out some urgent out of hours work to maintain FOR
your electricity supply. They have handed over to us to reinstate the ground, Take care: We look after ourselves, our customers and our business. We have a zero
Job No. Gas ensuring it is safe and accessible for the public. compromise approach to health, safety anPdASwSIOeNllAbTeEing.
Telecoms While the work is essential, we are very aware of the potential inconvenience and will do our Be respectful and value everyone: We tAEaVBkOEeURYTtTimHINeGto listen to each other and treat
Water best to keep the noise and disruption to an absolute minimum. Due to the timescales and
Other (please state........................................................................) circumstances we are operating under, the surface is only temporary. We aim to return within HEREpeople in the way they want to be treated.WE DO
Please check to see if your supply has been restored. the next few weeks, during normal working hours, to make a full and permanent reinstatement. FORReach higher, be better: We are always learning and challenging ourselves and each
If you require any assistance please contact us on 0344 902 0876. Our telephone lines If you have any concerns or questions relating to these works, please contact us on YOUother to be the very best we can be.
are open Monday to Friday 0800 - 1900 and Saturday 0900 - 1700. 0844 5670 917 quoting the reference number stated overleaf. Alternatively, please email
[email protected] Be proud, be blue: We celebrate our past, we are proud of what we do today and we
Yorkshire Water Loss of Suppy Card
REF: D049 WPD Emergency Temporary Repairs Card owneTrAsKhEip N G I N G E N V I Rare excited about our future.
REF: D050 IN
ONMENT
E BE PROUD,
IN A CHA BE BLUE
REACH
HIGHER,
BE BETTER
Take
care be respectful
and value
everyone
Vision & Value Cards A6
REF: D051
W A R N I N G If You Think You Can Smell Gas The conversation cycle
Making conversation easy.
Your new gas meter Safety Notice
0800 096 1554 DANGERWe hope you are happy with the work we have completed. If you have any Dear Customer, Inform Invite
• Give information.
questions please call: It appears that the gas installation pipework fitted at your property may not have • Keep it clear, concise • By asking a question.
Electrical Equipotential bonding correctly fitted. • Keep control whilst
and jargon free.
Please keep this card in case you have a query on your bill or statement. If you I am required under section 18(2) of the Gas Safety (Installation and Use) • Signpost. allowing the other Our accountability ladder
need to contact your gas supplier the telephone number can be found on your bill Regulations 1998 to advise you that the Electrical Installation should be checked person to speak.
or statement. by a competent electrical contractor. Acknowledge • Avoid over talking or Where do you stand?
• Show you have been awkward pauses.
Serial Number of Meter Removed: Reading: SAFETY We Called TodayIf you are a tenant of this property, would you please bring this card to the Make it happen
Serial Number of Meter Installed: Reading: attention of the owner or their agent. listening. Listen
• Show you have
• Without interrupting.
understood. • Remain curious.
• Empathise. • Be present.
Installation Date:
WARNINGG4 ELECTRICAL EARTH BONDING Find solutions
Accountable behaviours Own it
Things happen because of you. Acknowledge reality
DO NOT USE brilliant batons Wait and hope Victim behaviours
Excuses (I can’t) Things happen to you.
Blame others
Danger Warning Cards A6 I didn’t know
REF: D052
Here for Customers Cards A6
REF: D053
! Now keep looking...
Caution Treat as Live www.talentsourcenetwork.co.uk Please accept our invitation to
DO NOT INTERFERE DANGER join Talent Source Network.
Find out more about us, the
Point of Isolation energy and utility sector and
the types of careers and job roles
which could take you anywhere.
Create your profile, look at
job opportunities and key
employers in the sector and keep
up to date with industry news.
Above all, please keep in touch!
Interference Cards/Stickers A5 and A8 www.morrisonrecruit.com
REF: D054
Careers Fair Postcards A6
44 REF: D055
Section – D Cards
THANK YOU WE ARE POSITION OF MAIN EQUIPOTENTIAL BONDING CONNECTION AT SCENE BUMP CARD
600mm maximum
BURSTING You should complete this bump card for all accidents, however minor
WITH APPRECIAT I O N
FOR
ACCIDENT DETAILS
YOUR Date: ............................................................... Time (24 hour clock): .....................
STAR-STUDDED
Location: ....................................................................................................................
Road Conditions: ........................................... Speed Limit: .....................................
Company driver name: ...............................................................................................
Company vehicle registration/fleet number:.............................................................
Depot: .........................................................................................................................
Contact telephone number: ......................................................................................
Safety Notice POLICE DETAILS
Police in attendance Y / N: ........................................................................................
EFFORT! Dear Customer, Reporting officer name: ............................... Number: ..........................................
Reporting officer station: ............................. Telephone: .......................................
Internal meter installation It appears that the gas installation pipework fitted at your property may not have DAMAGE TO OTHER VEHICLES / PROPERTY (use additional bump cards if necessary)
Electrical EquipMoetteernintsitaalllabtoionn dininexgtercnoarl rbeoxc/tcloymfipatrttemden.t Vehicle type: .................... Make/model: ........................ Reg Number:..................
Key Key
1 = Installation pipework 1 = Bonding connection (non-preferred position) Driver name: ................................................... Telephone: .......................................
2 = Bonding connection I am required2 u= nPidpeesrleseevect(sieoanled1)8(2) of the Gas Safety (Installation and Use)
3 = Green-yellow cable to consumer earth terminRael gulations 139=9In8sttaollaatiodnvpisipeewyooruk that the Electrical Installation should be checked Address: .......................................................................................................................
by a compete4n=tBeonledcintgriccoannl eccotinontr(parcetfeorrr.ed position)
Third party insurer: Policy number:.................................
Camera Pictures / Footage taken Y / N: .....................................................................
If you are a tenant of this property, would you please bring this card to the Description of damage to other vehicle/property: ..................................................
attention of the owner or their agent.
......................................................................................................................................
......................................................................................................................................
ELECTRICAL EARTH BONDING WITNESSES (where possible take details of any witnessess) PMT Digital Ltd. 01480 493666
Witness 1 name: .......................................... Witness 1 telephone:...........................
Witness 1 address: .......................................................................................................
Witness 2 name: .......................................... Witness 2 telephone:...........................
Witness 2 address: ........................................................................................................
Picture Cards 85x55mm Earth Bonding Cards A6 Bump Card A5
REF: D056 REF: D057 REF: D058
AT SCENE BUMP CARD MPRN NUMBER N.M.R.O. METER ACCURACY TEST
CUSTOMER NAME:
You should complete this bump card for all accidents, however minor ADDRESS: TECHNICIAN NAME:
ATTACH THIS CARD
ACCIDENT DETAILS TO THE METER
Date: ............................................................... Time (24 hour clock): .....................
Location: .................................................................................................................... x
Road Conditions: ........................................... Speed Limit: .....................................
Company driver name: ...............................................................................................
Company vehicle registration/fleet number:.............................................................
Depot: .........................................................................................................................
Contact telephone number: ......................................................................................
POLICE DETAILS The Gas
Police in attendance Y / N: ........................................................................................ Emergency Control
Reporting officer name: ............................... Number: ..........................................
Reporting officer station: ............................. Telephone: ....................................... is Located
DAMAGE TO OTHER VEHICLES / PROPERTY (use additional bump cards if necessary) Printed by PMT Digital Ltd 01480 493666
Vehicle type: .................... Make/model: ........................ Reg Number:..................
Driver name: ................................................... Telephone: .......................................
Address: ....................................................................................................................... POSTCODE:
Third party insurer: Policy number:.................................
Camera Pictures / Footage taken Y / N: .....................................................................
Description of damage to other vehicle/property: ..................................................
...................................................................................................................................... METER DETAILS
......................................................................................................................................
WITNESSES (where possible take details of any witnessess) METER SERIAL NUMBER MODULE SERIAL NUMBER REMOVAL INDEX CAPACITY OF YEAR OF
Witness 1 name: .......................................... Witness 1 telephone:........................... METER MANUFACTURE
Witness 1 address: .......................................................................................................
PMT Digital Ltd. 01480 493666
Witness 2 name: .......................................... Witness 2 telephone:...........................
Witness 2 address: ........................................................................................................
Bump Card A5 Emergency Control Cards Meter Accuracy Test Cards A5
REF: D059 REF: D061
100x70mm REF: D060
Comments Immediate Action Taken: Comments Immediate Action Taken: On Site Inspection – Commissioning Comments Immediate Action Taken:
Detail any action you took to rectify a non Detail any action you took to rectify a non Detail any action you took to rectify a non
compliant situation or where you identified On Site Inspection – Buttfusion compliant situation or where you identified compliant situation or where you identified On Site Inspection – Electrofusion
good practice good practice good practice
MUS Ref: ............................................................... MUS Ref: ............................................................... MUS Ref: ...............................................................
Date: ............................... Time: ............................ On Site Inspection – Commissioning Date: ............................... Time: ............................ On Site Inspection – Electrofusion Date: ............................... Time: ............................
On Site Inspection – Buttfusion Site Address:....................................................................................................................... Site Address:....................................................................................................................... Site Address:.......................................................................................................................
Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................
Tick the boxes applicable to your site observation:
Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action Pass Fail Action taken
All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken on site
control measures? on site control measures? on site
All significant risks have been identified and recorded with appropriate control measures?
Buttfusion box is in good condition and within its calibration date? Is the joint incorrectly or not anchored? Electrofusion box is in good condition and within its calibration date? (write date in comments)
(write date in comments) Pipe shows no indication of damage and pipe ends straight and square?
Have swabs been undertaken? (re-rounding clamp and Pipe Exposure tool available for specialist pipe.)
Auditors signature Pipe shows no indication of damage and pipe ends straight and square? Auditors signature Auditors signature Pipe coupling position marked and pipe scraped using the correct method?
(re-rounding clamp and Pipe Exposure tool available for specialist pipe.) Has main been tested as per clients requirements and standards? Fittings are in sealed bags until required and free from contamination?
HAND IN TO SHEQ ADVISOR HAND IN TO SHEQ ADVISOR HAND IN TO SHEQ ADVISOR Pipe clamps for the required pipe diameters and fittings available and ready for use?
Is Buttfusion area and pipe been protected against the Weather / Environment Has main been chlorinated as per requirements? Pipe aligned and clamped prior to fusion?
Version 1 and extreme temperatures? Version 1 Version 1 Have number of fittings used been kept to a minimum and service pipe laid
Has inspection results been received prior to Commissioning / Connection? 90 degrees to Main where possible?
Have pipe rollers been used as required? Distances between Fittings / Squeeze off correct?
Management and disposal of water on site being controlled during flashing? Fittings checked to ensure fusion has been completed successfully.
Has First / Second welds been aborted? Fitting allowed to cool before clamp removed?
Is all commissioning documentation available and stored as per requirements? Team can demonstrate the correct heating and cooling times have been
Bead removal tool available and used to remove bead? adhered to and marked on pipe?
Safety Passport signed with appropriate comments? Is Electrofusion area and pipe been protected against the Weather / Environment
Has bead inspection and bend back test been completed? and extreme temperatures?
Is Electrofusion machine print out available for each cycle, including aborted welds
Is Buttfusion machine print out available for each cycle, including aborted SHEQ Discussion / Talk given? and detail of Scheme / Operator?
welds and detail of Scheme / Operator? Is beads and machine print outs stored appropriately to demonstrate compliance
with Electrofusion requirements?
Is beads and machine print outs stored appropriately to demonstrate SHEQ Discussion / Talk given?
compliance with Buttfusion requirements?
Team can demonstrate the correct heating and cooling times have been adhered to?
SHEQ Discussion / Talk given?
On site Inspection cards On site Inspection cards On site Inspection cards
125x90mm Buttfusion 125x90mm Commissioning 125x90mm Electrofusion
REF: D062 REF: D063 REF: D064
Comments Immediate Action Taken: Comments Immediate Action Taken: Comments Immediate Action Taken: On Site Inspection – Impact Moling
Detail any action you took to rectify a non Detail any action you took to rectify a non Detail any action you took to rectify a non
compliant situation or where you identified On Site Inspection – Hygiene compliant situation or where you identified On Site Inspection – Ice Pigging compliant situation or where you identified
good practice good practice good practice
MUS Ref: ............................................................... MUS Ref: ............................................................... MUS Ref: ...............................................................
Date: ............................... Time: ............................ Date: ............................... Time: ............................ On Site Inspection – Impact Moling Date: ............................... Time: ............................
On Site Inspection – Hygiene Site Address:.......................................................................................................................
On Site Inspection – Ice Pigging
Site Address:....................................................................................................................... Site Address:.......................................................................................................................
Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................
Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action
All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken
control measures? on site control measures? on site control measures? on site
Team has National Water Hygiene Card and in date? Team has relevant competencies and in date? Are team competent to operate impact mole?
Auditors signature Team has hand washing facilities and cleansing wipes available (90/10)? Auditors signature Team has a copy of the Risk assessment and Method Statement Auditors signature Is moling equipment in good condition?
and is familiar with its contents?
HAND IN TO SHEQ ADVISOR Vehicle segregated to allow Plant / Equipment / Tools to be stored away from fittings? HAND IN TO SHEQ ADVISOR HAND IN TO SHEQ ADVISOR Are all underground utility plans present, in colour and in date?
Team are wearing correct Personal protective Equipment as per Risk
Version 1 Vehicle is in a clean and tidy condition? Version 1 assessment and Method Statement? Version 1 Have all underground utilities been traced and identified?
Tools used for installation of Pipe / Fittings are in a clean condition? Vehicles parked safely within Site / Traffic Management and Traffic Management Have all utilities on the line of the proposed route been positively exposed?
in accordance with NRSWA?
Team is aware of chlorination process and has all the required equipment Are dielectric boots and gloves present, in good condition and within calibration date?
to undertake the process?
Isolation permit in place? Has a launch cradle been used?
All fittings are stored within sealed bags and are clean? Equipment in good condition and within calibration, including standpipes? Are all personnel outside of the excavation during the operation?
(pre-use check completed)
Pipe ends covered and coils of pipes stored in bags? Is mole launched away from known underground utilities?
Does team have suitable Personal Protective Equipment which is in a clean condition? Confirmation of valves Open / Closed in correct sequence? SHEQ Discussion / Talk given?
SHEQ Discussion / Talk given? Management and disposal of water on site being controlled?
Pre and Post testing of water completed?
SHEQ Discussion / Talk given?
On site Inspection cards On site Inspection cards On site Inspection cards
125x90mm Impact Moling
125x90mm Hygiene 125x90mm Ice Pigging
REF: D065 REF: D066 REF: D067
45
Section D – Cards
Comments Immediate Action Taken: Comments Immediate Action Taken: On Site Inspection – Mechanical Joints Comments Immediate Action Taken:
Detail any action you took to rectify a non Detail any action you took to rectify a non Detail any action you took to rectify a non
compliant situation or where you identified On Site Inspection – Jetting Hoses compliant situation or where you identified compliant situation or where you identified On Site Inspection – Pipe Bursting
good practice good practice good practice
MUS Ref: ............................................................... On Site Inspection – Mechanical Joints MUS Ref: ............................................................... MUS Ref: ...............................................................
On Site Inspection – Jetting Hoses Date: ............................... Time: ............................ Date: ............................... Time: ............................ On Site Inspection – Pipe Bursting Date: ............................... Time: ............................
Site Address:....................................................................................................................... Site Address:....................................................................................................................... Site Address:.......................................................................................................................
Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................
Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action
All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken
control measures? on site control measures? on site control measures? on site
Condition of Leading Hose? Is the joint incorrectly or not anchored? Is pipe bursting equipment in good condition?
Auditors signature Condition of Main hose? Auditors signature Is the joint miss aligned? Auditors signature Are gang competent to operate pipe bursting equipment?
HAND IN TO SHEQ ADVISOR Condition of Hose Fittings? HAND IN TO SHEQ ADVISOR Has the joint been corrosion protected? HAND IN TO SHEQ ADVISOR Has the equipment being lowered into the excavation using approved lifting
Equipment / Accessories and lift plan in place?
Version 1 Condition of hose around point of connection onto Leader Hose and Joint? Version 1 Torque Wrench Available? Version 1
Have all underground utilities been traced and identified?
Condition of Hydraulic Hose Fittings? Torque Wrench Used?
Have all utilities crossing or running parallel in close proximity to the main
Condition of Hydraulic Hose? Torque Wrench Calibrated? been positively exposed or the risk of ground heave been fully assessed?
Condition of hose reel housing?. Flange Matrix Available and used? Are dielectric boots and gloves present, in good condition and within calibration date?
Tiger tails available and in good condition? SHEQ Discussion / Talk given? Has the pipe bursting machine been adequately anchored to prevent movement?
Emergency Stop functioning correctly? Where practical are the moving parts of equipment suitably guarded?
Remote control functioning correctly? Are all personnel standing in a safe location during the operation of the equipment?
Level of antifreeze suitable? Is mole launched away from underground utilities?
SHEQ Discussion / Talk given? SHEQ Discussion / Talk given?
On site Inspection cards On site Inspection cards On site Inspection cards
125x90mm Jetting Hoses 125x90mm Mechanical Joints 125x90mm Pipe Bursting
REF: D068 REF: D069 REF: D070
Comments Immediate Action Taken: Comments Immediate Action Taken: On Site Inspection – Pressurised Mains Comments Immediate Action Taken: On Site Inspection – Working on ACM Mains
Detail any action you took to rectify a non Detail any action you took to rectify a non Detail any action you took to rectify a non
compliant situation or where you identified On Site Inspection – Pipe Trailers compliant situation or where you identified compliant situation or where you identified
good practice good practice good practice
MUS Ref: ............................................................... On Site Inspection – Pressurised Mains MUS Ref: ............................................................... On Site Inspection – Working on ACM Mains MUS Ref: ...............................................................
On Site Inspection – Pipe Trailers Date: ............................... Time: ............................ Date: ............................... Time: ............................ Date: ............................... Time: ............................
Site Address:....................................................................................................................... Site Address:....................................................................................................................... Site Address:.......................................................................................................................
Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................ Auditor: ................................................... Auditee: ............................................................
Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action Tick the boxes applicable to your site observation: Pass Fail Action
All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken All significant risks have been identified and recorded with appropriate taken
control measures? on site control measures? on site control measures? on site
Is driver competent to tow trailer and aware of height Restrictions / Weight Gang aware of clients procedure for pressurised systems? Team has relevant competencies and in date?
of trailer when loaded?
Isolation Permit issued and on site? Team has a copy of the Risk assessment and Method Statement for the removal of
Auditors signature Is trailer in good condition and road worthy with a recorded pre-use checks? Auditors signature Auditors signature and are familiar with its contents, including safety control measures?
Site Specific RAMs has been completed and present on site?
HAND IN TO SHEQ ADVISOR Has the coil been loaded safely and correctly with coil sitting on rollers? HAND IN TO SHEQ ADVISOR HAND IN TO SHEQ ADVISOR Team wearing correct Personal protective Equipment for working with asbestos?
RAMs detail control measures to ensure a Safe System of Work?
Version 1 Has banding been cut in sequence when being dispensed? Version 1 Version 1 Where possible pipe has been removed in sections to reduce Cutting / Damage?
Emergency arrangements in place in the event of a leak?
Have pipe ends been secured? Asbestos Containing Material Main damped down prior to removal?
Confirmation that the main has been positively identified and isolated?
Is the trailer positioned safely within the Site / Barrier system? Approved tools being used for the Cutting / Removal of the Asbestos Containing
Approved method for cutting into Main used with approved PPE? Material Main?
Is trailer positioned to allow the pipe to be dispensed safely without applying
additional pressure on the pipe as it is inserted? Management and disposal of water on site being controlled? Asbestos is double bagged or wrapped and sealed to prevent release of dust?
Is pipe Attachments / Equipment (ie insertion equipment) in good condition, Safety Passport signed with appropriate comments? Disposable Personal protective Equipment is double bagged, Wellington boots
suitable for the pipe and fitting correctly? and tools are washed down safely?
SHEQ Discussion / Talk given?
Is pipe secured before cutting and gang aware of risk of stored pressures? Bagged asbestos is stored safely for transportation, where the bag cannot be
punctured / damaged?
Is any spare pipe secured on trailer before being transported?
SHEQ Discussion / Talk given?
SHEQ Discussion / Talk given?
On site Inspection cards On site Inspection cards On site Inspection cards
125x90mm Pipe Trailers 125x90mm Pressurised Mains 125x90mm Working on ACM Mains
REF: D071 REF: D072 REF: D073
ß Plant & Equipment ß Chemicals spillage ß Manual handling Leptospirosis (Weils Disease)
& leaks The bacteria can sometimes enter into your body through breaks
HAZARD IDENTIFICATION CARD in the skin or through the lining of the mouth, throat or eyes after
contact with infected urine or contaminated areas such as sewers,
ß Slips & trips ß Work at height %ULHI GHVFULSWLRQ RI WKH KD]DUG LGHQWL¿HG Sign up foHreylopuur sonimlinperove our
............................................................................................................ ditches, ponds, slow-flowing rivers. accountcbuystvoismiteinrgservice
............................................................................................................
............ß...P..P..E......................................................................................... Avoid rubbing your eyes, nose or mouth with your thameswateIrf.ycoou.’vuekre/creeivgedisgtreeart service today,
............................................................................................................ hands during work.
............................................................................................................ and you would like to nominate me for
Practice good personal hygiene, always wash your hands before an award or give feedback, please visit
'DWH ............................................................................ smoking or handling food or drink metering.thewowawards.co.uk
or tel. 0800 316 3487
ß Signing, lighting & /RFDWLRQ RQ VLWH ............................................................................ Cover any cuts or grazes wInitshtrwuactteiropnrosotfodpreesrssinognss. a. t risk from Leptospirosis
guarding Thorough first aid treatment of all wounds is es(sWenetiialsl.Disease) Today your
ß Environment 1DßPPHo o rRSSuWLpReQrDviOs i o n ............................................................................ engineer was
Those working in certain occupations (sewer work is one) may
Please complete and hand in to the site management. Thank you. Report all incidents at wovrekrytooscicteasmioannaalglyemcoennttact a form of jaundice known as WOW cards 85x55
REF: D076
ß Behavioural ß Danger to the $FWLRQ WDNHQ WR EH FRPSOHWHG E\ VXSHUYLVRU leptospirosis. (Weils Disease) 13814
public ............................................................................................................
ß Underground .....ß...A..c..c.e..s..s..E..g..r.e.s..s................................................................................. The early stages of the disease may be rather like influenza, so
service avoidance ß Mains or Service ............................................................................................................ whenever you go to your doctor or to a hospital on account of
Laying ............................................................................................................ illness or injury, always show this card and make sure those
............................................................................................................
............................................................................................................ PRODUCED BY PMT DIGITAL LTD. TEL. 01480 493666 attending you, know your occupation.
............................................................................................................
...........ß....O..t.h..e.r....................................................................................... Weils Disease Card 85x55
REF: D075
NOTHING IS SO IMPORTANT THAT IT CAN NOT6BXESHDUOYNLVERUS QADFPELHY ...............................................................................
'DWH ...................................................................................................
NOTHING IS SO IMPORTANT THAT IT CAN NOT BE DONE SAFELY
Hazard ID card A5
REF: D074
UNSAFE APPLIANCE UNSAFE INSTALLATION
DO NOT USE DO NOT USE
This appliance must not be used until it is repaired and This equipment is dangerous and has been
tested by a competent person. disconnected. It must not be reconnected until the
reported gas escape has been traced and repaired
It is an offence to continue using an unsafe appliance. by a competent person.
Contact a gas safe registered installer. DANGER DANGERContact a Gas Safe registered installer.
Gas Safety (Installation and Use) Regulations 1998.
The Gas Safety (Installation and Use) Regulations 1998.
Morrison Utility Services SAFETY Morrison Utility Services SAFETY Your gas
6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ WARNING 6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ WARNING emergency
Registered in England 4530602 DO NOT USE Registered in England 4530602 DO NOT USE control location
Cards for engineers Cards for engineers Morrison Utility Services
Danger Safety Warning Danger Safety Warning 6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ
Registered in England 4530602
Unsafe Appliance A6 Unsafe Installation A6
REF: D077 REF: D078 Cards for engineers
Emergency control A6
46
REF: D079
Section – D Cards
Turn the gas supply off at the emergency Before we started work, we completed a safety check which After completion of work on your gas
control valve. indicated there may be a fault on your electrical system, installation, the safety check indicated that there
causing an electrical voltage on the gas installation. We were may be a fault on the electrical system, causing
• Open doors and windows therefore unable to continue work. an electrical voltage on the gas installation.
• Do not use a naked flame You need to get your electrical installation checked by an
• Do not smoke approved electrical contractor. Please get the electrical installation checked by
• Do not turn electrical switches on or off Once this check is complete please contact your gas supplier an Approved Electrical Contractor.
to arrange a new appointment. The telephone number you
If you think you can smell has call If you think need to call is on your bill or statement. Possible If you are a tenant, please show this card to your
you can If you are a tenant, please show this card to your landlord. Electrical landlord.
0800 111 999
smell gas Morrison Utility Services Fault Possible
Do not open the supply until remedial 6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ
action has been taken by a competent Registered in England 4530602 Electrical
person to prevent gas escaping again. Morrison Utility Services
6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ Fault
Morrison Utility Services Registered in England 4530602
6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ
Registered in England 4530602
Cards for engineers Cards for engineers Cards for engineers
If you think you can smell gas A6 Possible electrical fault (before) A6 Possible electrical fault (after) A6
REF: D080 REF: D081 REF: D082
Position of main equipotential bonding connection About your new gas meter WARNING
Serial number of Meter removed The gas supply to this property has been disconnected.
Reading
Serial number of Meter Installed Attempts by unauthorised persons to restore the supply are
Reading both DANGEROUS and ILLEGAL.
Installation Date
Safety To have the gas supply restored, please contact your gas
notice Smell gas?Keep this card in case you have a query on your bill or statement. supplier. The telephone number to contact can be found on
your bill or statement.
If you need to contact your gas supplier the telephone number
I am required under section 18(2) of the Gas Safety can be found on your bill or statement. Serial number of removed meter WARNING
(Installations and Use) Regulations 1998 to advise Final meter reading
you that the Electrical Installation should be Call 0800 111 999 Date of removal This pipe
checked by a competent person.
Any questions please call Morrison Utility Services contains gas
The gas installation pipework fitted at your 6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ
property may not have Electrical Equipotential 0800 096 1554 now for the Gas Registered in England 4530602
bonding correctly fitted. It should be checked Emergency ServiceMorrison Utility Services
by a competent electrical contractor. under pressure
6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ
If you are a tenant of this property, please Registered in England 4530602
show this card to the owner or their agent.
Cards for engineers
Morrison Utility Services Smell gas? A6 Cards for engineers
6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ REF: D084
Registered in England 4530602 Warning A6
REF: D085
Cards for engineers
Safety notice A6
REF: D083
WARNING UNCOMMISSIONED GAS APPLIANCE WARNING CONTACT INFORMATION :LY]PJL 4HPU[LUHUJL 9LWHPY
THE OUTLET Breakdowns – 24 Hours 365 Days
CONNECTION TO THIS It is a legal requirement that any newly installed Please use for all vehicle enquiries Support Line
METER CONTAINS gas appliance must be commissioned and checked Service Bookings
A SEALING DISC before use. GENERAL COMMERCIAL VEHICLE ENQUIRIES / Statutory Inspections
VAN & TRUCK HIRE ORDERS & OFF HIRES Calibrations
THE REMOVAL OF THE SEALING DISC, CONNECTION, This appliance must not be used until it has been [email protected] For all your Vans / Plant / HGVs
TESTING, PURGING AND COMMISSIONING OF THE checked by the installer for safe operation. 0333 234 2201
(Includes all Re-Hired Plant & Vehicles)
INSTALLATION PIPEWORK AND APPLIANCES MUST BE Anyone who carries out work on a gas installation GENERAL CAR ENQUIRIES / CAR ORDERS /
CARRIED OUT BY A GAS SAFE REGISTERED INSTALLER must be registered with the Gas Safe Register. SHORT-TERM CAR HIRES Compliance Service Centre
(THE GAS SAFETY (INSTALLATION & USE) REGULATIONS 1998) [email protected] 0333 999 7781
Gas Safety (Installation and Use) Regulations 1998.
WARNING INSURANCE & DAMAGE ENQUIRIES / DRIVER
[email protected]
Uncommissioned COMPLAINTS / ROAD RISK ENQUIRIES / DRIVER
Cards for engineers LICENCE ENQUIRIES / TELEMATICS / CLAIMS & CSC contact card
Warning A6 Morrison Utility Services Gas Appliance DAMAGE INVOICES 85mmx55mm
REF: D086 6th Floor, St Hughs House, Trinity Road, Bootle L20 3QQ FleetInsurance&[email protected] REF: D089
Registered in England 4530602
ADMIN-RELATED ENQUIRIES / FUEL CARD
Cards for engineers ENQUIRIES / TOLL & PERMIT REQUESTS
Uncommissioned Gas Appliance A6 Useful contact
REF: D087 numbers card A5
REF: D088
MUS Ref MUS Ref contact us on 0845 279 669
Date Date [email protected]
Site Address
To report a loss of power, or if you are concerned about the safety of our equipment, MUS Ref
To report a loss of power, or if you are concerned about the safety of our equipment, please contact SP Energy Networks Customer Services Line: 0800 092 9290 Date
please contact SP Energy Networks Customer Services Line: 0800 092 9290
Completion of reinstatement to grass area To report a loss of power, or if you are concerned about the safety of our equipment,
SP Energy Networks have had to carry out some urgent works in order to maintain Working on behalf of SP Energy Networks, we have now finished reinstating please contact SP Energy Networks Customer Services Line: 0800 092 9290
your supply. We have carried out the excavation works and we will reinstate the area the grass area at your property, following essential works carried out to your
to ensure safety and access. electricity supply. We hope you are happy with the work. Start Stage 1 Stage 2 Stage 3
While the work is essential, we are very aware of the potential inconvenience and will do our We have used a mixture of topsoil and seed which, if possible, could you water regularly for
best to keep the noise and disruption to an absolute minimum and due to the timescales and the seed or turf to grow. We’ve called today Our team will remove the excavated we will restore the Once the job is complete,
circumstances we are operating under, the surface is only temporary. We aim to return within If you have any concerns or questions relating to these works, please do not hesitate to material, where possible we will use site to its previous we will remove all barriers
the next few weeks, during normal working hours, to make a full and permanent reinstatement. contact us on 0845 279 669 quoting the MUS ref stated overleaf. Working on behalf of SP Energy surface.
If you have any concerns or questions relating to these works, please do not hesitate to Alternatively, email: [email protected] Networks, we have excavated on or recycled material to and signage from the
contact us on 0845 279 669 quoting the MUS ref stated overleaf. near your property. We apologise for help reduce our carbon site and ensure the site
Alternatively, email: [email protected] Grass Area Reinstatement Card any inconvenience this may cause, footprint. is clean.
REF: D091 but we can assure you that we will
Emergency Temporary Repairs Card do our utmost to complete the work
REF: D090 with the minimum disruption to you.
Stages of Work Card
REF: D092
47
Section D – Cards
Safe System of Work – HSG47 Observation/Topic Immediate Action Taken: Site Observation Record Card
(What you saw / Topic of MUST) (What you did e.g informed site/line
manager, safety discussion, recognised
operative/site for positive contribution etc.)
Working safely Safe Digging – SBS
A safe system of work has three Survey – check drawings/your environment/street
basic elements: furniture and ground scarring
MUS Ref: ............................................................... • Planning the work Scan – CAT+Genny all modes-power, radio, MUS Ref (if available): ....................Date: ........................
Date: ..................................................................... • Detecting, identifying and marking avoidance Induction. Locate direction Contract: ........................................Depot:......................
Site Address:.......................................................... Site Address / Location:.................................................... Employer: ......................................
underground services Print Name of Observer / Name of Person Delivering MUST: .....................................................
Customer Information Card Print Name of Person Being Observed / Name of Person Receiving MUST: ................................
Printed by PMT DIGITAL LTD 01480 493666
Site Observation Record Card
Feedback Card• Safe excavation/digging practices
Spray – mark detected services at least 500mm
either side of excavation
Morrison Utility Services working on behalf of SP Energy Networks have excavated on your Safe excavation must take into account: STOP – re-assess the task/site before next step
Delivering what we promiseproperty. • The nature and scope of the work
We apologise for any inconvenience this may cause but can assure you that we will do our
utmost to complete within 7 working days and with the minimum disruption to you. Topic Comments• Type, position & nature of underground
services
Segregate the work (SLG) area before excavating HAND IN TO SITE PERSON IN CHARGEC/LOINME MPALINAANGECRE/SHEQNAEDAVIRSOMR ISS HAZARD MUST
The works will be undertaken in the following stages • The ground conditions Break ground – hand tools or mechanical aids Tick the boxes applicable to your site observation:
• Site constraints
If delivered as Morrison Utility Services Safety Talk
Stage 1: Electrical site set up and excavation works (MUST), the person delivering talk is to sign theirBehaviour Access & Egress Site Security
1. Safe dig – insulated tools, horizontal digging Third Party Activities
Stage 2: Backfilling of open excavations Scan – continuous use whilst excavating down name here PPE Excavation Work Manual Handling
Do not begin work if you identify Fire Precautions
hazards that cannot be safely risk Version 10 Slips, Trips & Falls Plant & Equipment Welfare Arrangements
House Keeping
Stage 3: Reinstatement (as per existing surface) assessed and controlled STOP – re-assess the task before repair works begin Supervision Work at Height Site Documentation
Stage 4: Barriers and signs cleared from site Movement of Vehicles
Delivering What We Promise: Training / Competence
Communication • Minimise Disruption 2. Delivering what we promise COSHH Process
Professionalism • Quality of Work Environmental Issues Mains or Service Laying
Keeping to Timescale (Noise, Dust, Lighting) Confined Space
Electrical Safety
If you have any concerns or questions relating to 3. Public Safety Waste Management
resurfacing of these works please do not hesitate to
contact us on Tel: 0845 279 669 Monday - Friday Signing, Lighting &
8:00am - 5:00pm quoting the MUS ref stated above. Guarding
Email: [email protected]
On site Inspection Card125x90mm Delivering what we promise On site Inspection Cards 125x90mm
SP Energy Networks Feedback Card A5L Anglian Water
REF: D093 REF: D094 REF: D095
SPECIFICATION &
OPTIONS AVAILABLE
• Any size or shape available
• Printed on card or durable plastics
• Single or double sided
48
Section E – Labels/Stickers
Itsmis oakgeaiinnstthtihsevleahwiclteoReMpoort ArLrLiUstoilitny DUaTmteaiglle:ist,0yIn3ciSd3ee0ntrs1,vA2iccc3iedes1nt0sI,n9Nce2airdMeissnest&LHianzaerds
Nothing we do is so important that we cannot take the time to do it safely
49
50
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