Rams CCTV Inspection Survey l5 Qat 273a

L5-QAT-273C
RISK ASSESSMENT
CCTV INSPECTION SURVEY H&S Department
Rev.00
Date: 20 Sept. 2020
ENGINEER’S STAMP: CONTRACTOR’S STAMP:
PROJECT:
20-09-20
00 For Approval Velosi
REV. PREPARED CHECKED APPROVED DATE

ISSUED FOR
BY BY BY
Glennis Mark Thomas
Raja
Loughman
Krishnasamy
CLIENT:
CONTRACTOR VELOSI CERTIFICATION SERVICES LLC
DOCUMENT TITLE:
RISK ASSESSMENT FOR CCTV INSPECTION SURVEY
DOCUMENT NO.
Rev Page
AV-PLR-RA-00 0 1 of 22
Prepared By: Reviewed By: Approved By:

Raja Krishnasamy GLENNIS Mark Thomas Loughman
Safety Manager Project Manager

Doc. No. L5-QAT-273C Rev 00 Date: 20.09.2020
L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020
PRE-TASK CONSENTS TO Check (as applicable)

YES NO
1. Has the work activity been identified? X
Check that all foreseeable risks to health, safety and the environment have been assessed via a structured risk assessment procedure:
(a) Process been identified i.e. are all the specific hazards identified? X
2. (b) Are the persons who are at risk identified? X
(c) Have the risks been quantified i.e. High/Med/Low or 1, 2, 3 etc? X
(d) Have effective control measures been put into place? X
Check that adequate health, safety and environment arrangements have been specified in the Method Statement:
(a) Supervisor in charge of operations named? X
(b) Has a person(s) been appointed to take charge of SHE issues? X

3.
(c) Has communication with the Principal Contractor been established? X
(d) Has information, instruction and training been given due regard? X
(e) Are emergency arrangements detailed inc. rescue from height / confined space etc? X
Check that the Method Statement is compatible with the CPP & IEMP and addresses the following:
(a) Are emergency plans (including fire and environmental emergency) compatible? X
(b) Are measures for site security, storage and waste management as required? X
(c) Are Site SHE rules being given due consideration? X
(d) Has the scope/description of work been adequately identified? X
(e) Is the sequence of operations clearly detailed in logical steps? X

4.
(f) Do these steps have hold points for key requirements such as the issue of permits? X
(g) If Temporary Works are included, is there reference TW Process (Design, Approval& Permits?) X
(h) Do these steps cover all the activity from start to finish? X
(i) Is plant and equipment needed for the activity clearly detailed? X
(j) If lifting operations are included, is reference made to the Lifting Plan & Permit To Lift? N/A
(k) Is interface & coordination with other activities / operations covered? X


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020
Check that the Method Statement is compatible with the work of other contractors:
5. Are there any specific hazards required e.g. requirements for noise, COSHH, manual handling, welfare
(a) X
etc.
If there are specific hazards such as COSHH, manual handling, noise, vibration etc. Are there separate
(b) X
and suitable assessments?
Check that all Permits below have been identified as hold points stating that the permits must be in place before that activity can
commence
(a) Permit to Dig N/A
(b) Confined Space Permit X
6. (c) Temporary Works Permit to Load / Proceed
(d) Hot work Permit N/A
(e) Permit to Work Adjacent or Under H/V Overhead Cables X
(f) Permit to work on Electrical Equipment X
(g) Other permits (e.g. access permit from client) X
PPE
TYPE
PVC Rubber
Face Visor Muff Dry / Safety Jacket Fuel / Oil – Nitrile Safety
REF
Hard Hat waterproof or Coverall Shoes

General Handling
Carbon First Aid Cones & Signs

Dioxide Spill Kit Escape Mask
for type of road
On van
AFFF Foam
Gas Monitor, Tripod, Winch &
Confined Space Harness, Waders, 10-minute on vehicle. welfare unit
Welfare:
Entry: Escape Set, Head Lamps


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020
No Hazard Risk Description Inherent Controls Residual Notes

Risk Risk
S P S P
R R
1 Poor hygiene Leptospirosis / weils 4 4 16  Good hygiene standards – wash hands 4 1 4
disease prior to eating/ drinking etc avoid
contact with face/mouth during works.
 Food and drink only to be consumed in
designated welfare areas.
 Smoking only permitted in designated
areas.
 Waste food to be disposed of in
designated bins. Pest control to carry
out regular inspections.
 All Cuts/abrasions open wounds to be
covered with water resistant plasters
before entry
2 Site Plant & Exhaust Fumes from 5 4 20  No plant vehicles to be left switched on 5 1 5
Vehicles Plant & Vehicles near entry hole.
adjacent to Inspection
Chamber
3 Materials & Falls of Materials 4 4 16  Ensure all plant and materials are kept 4 1 4
Plant away from edge of shaft
4 Manhole Cover Manual Handling 3 3 9  Frames and covers to be lifted using 3 1 3
Removal mechanical aids or lifting keys
 The seal between the cover and the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
surround will be broken by inserting
the point of a crowbar and moving it, if
need be using a rubber mallet.
 If a small manhole joint lifting by two
operatives will be carried out using the
long handled ‘keys’ and the manhole
moved aside.
 If a large manhole the lifting will be
done using the wheeled manhole lifter
device after the keys have engaged on
the cover.
 Replacement of the cover should be
the reverse of above
5 Working with Exposure to infection 4 4 16  All staff have waterproof clothing, 4 1 4
sewerage from Leptospirosis / industrial gloves, face mask and
Weils Disease, Tetanus, disposable breathing masks.
Typhoid, Hepatitis B, Operatives change out of
Hepatitis C or other contaminated clothing at end of work.
Bacterium exposure.  Work is carried out to avoid
contamination of clothing or skin as far
as possible and equipment and
clothing is washed down after use.
 All exposed wounds or grazes are
cleaned and covered by a waterproof
plaster.

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
 Operatives wash exposed skin before
eating
 Hand cleanser supplied in trucks to be
used.
 A safe area will be designated for all
PPE worn in the sewer
(decontamination area).
6. Environmental Contamination of 3 3 9  Tanker trucks carrying oils, fuels or 3 1 3 Public Statements
Spillage – watercourses; sewage will have the following basic  Any public
Sewerage / Oil / contamination of land / emergency equipment: statements or
Resins drainage; slipping  Mobile phone for summoning aid. media interviews
hazards on roads  PPE including rubber boots, WP regarding a spill
trousers, chemical resistant gloves, involving a
visibility clothing and eye protection company vehicle
goggles. or depot will be
 Bag of oil absorbent granules made by the
 Spill cover for drains Managing Director
 Suitable shovel and liquid scraper. or in his absence
 Suitable hand wash gels and wipes one of the other
directors with his
approval. The
 In the event of a spill incident the truck
Managing Director
driver will contact his Project Manager
or Director may
who will arrange suitable emergency
consult the
response.
company legal or

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
H&S/PR
 The driver will attempt to prevent the consultants for
spill reaching the public drains or advice and
waterways using the basic emergency assistance before
equipment and any sand or soil to making any
hand. If the vehicle is a suction tanker statement.
the vacuum pump will be used to lift
the spill. The Jet Vac equipment can
be used to hose down the road
 The driver has the equipment and

training to deal with small spills
 Sand for blocking run away

 Spill covers for gutter drains and
manholes
 Shovels and liquid scraper
 Suitable PPE including rubber boots,
WP trousers, chemical resistant
gloves, visibility clothing and eye
protection goggles.
 Suitable handwash gels and wipes.
 A suction tanker/Jet Vac unit will be
despatched if liquid or semi-solids
have to be lifted and hose down the

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
road in the event of sewage
contamination. Suitable BS
environmentally approved disinfectants
will be used to decontaminate the road
or site and any PPE.
7. CCTV Survey Manual handling Injuries 3 3 9  CCTV Survey operators to be fully 3 1 3

from lowering camera trained in Pipe Sewer Condition
into sewer. Classification.
 Cameras vary in weight with size and
Injury from plant and are lowered and raised using an
equipment electric winch on the rear of the CCTV
van.
 Care is taken not to snag the winch
cable on the manhole side or
protrusions as it could release from the
hook and fall suddenly.
 All Plant and Equipment operated is
subject to a Planned Preventative
Maintenance regime. All Plant and
Equipment is subject to pre-use
inspection. Defect Reporting
Procedures exist for Reporting
Defects.


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
8. Use of Carbon Monoxide 3 4 12  In one of the vans, Generator is fitted 3 1 3 Supervisor to ensure
generators in Poisoning with a Quick Lift device which enables that generator is to be
the van it to be lifted out of the van and set lifted out of van when
away from the works area. in use. (if possible)
 Generator is to be fitted with a long
hose which will take all fumes away
from the works area.
 Gas monitor to be used in the works
area to ensure carbon monoxide
fumes are at a minimum.
 In the other vans, generator is built in
to van and fumes are filtered out
through hose connected to vehicle
exhaust.
 For the vans with the generator built in,
carbon monoxide monitors are fitted to
each van. Additionally all built in
generators will be ventilated with
exhaust fumes directed outside the
van.
 Battery Invertors to be used where
possible to eliminate the use of
generators .
Injuries re Manual 3 2 6  Generator is only to be lifted by two 3 1 3 Supervisor to ensure
handling persons – proper manual handling that generator is lifted

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
techniques to be used. by two operatives.
 All operatives have manual handling
training.
Failure of generator due 3 2 6  Generator to be regularly serviced 3 1 3 Daily checks to be
to wear, tear, damage, carried out on
etc. generator by
operatives. All defects
to be reported to
supervisor
immediately.
9. High Pressure Impact with displaced 4 3 12  All Jetting Operatives wear protective 4 1 4
Water Jetting articles face visors, when operating HPW
Works  All Water Jetting activities will be
Impact injuries to other controlled and will be carried out
persons signed and guarded and all personnel
will be trained in the procedures for
Injury from unauthorised Operation Stop.
use of HPWJ  Only suitably qualified and
equipment. experienced persons will be authorised
to carry out High Pressure Water
Injury from plant and Jetting Operations. All Plant and
equipment equipment will be secured when not in
use, and monitored when in use.
 All Plant and Equipment operated is
subject to a Planned Preventative

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
Maintenance regime. All Plant and
Equipment is subject to pre-use
inspection. Defect Reporting
Procedures exist for Reporting
Defects.
10 Working in Presence of Toxic 5 4 20  Permit to Enter System to be in 5 1 5 Defined situations

Confined Space /Flammable or place requiring immediate
asphyxiating gases  All Operatives entering inspection vacation of the
chamber to be confined space sewer:
trained
 Inspection Chamber to be vented  If the Gas monitors
for at least 20-minute, Atmosphere indicate a
to be monitored before entry for at dangerous
least 5 minutes and continually atmosphere;
whist in chamber  If the Topman says
 Gas monitors as a minimum to be that the Breathing
3 in 1 (H2S, Co2 &O2) Apparatus Tank
 Harness to be worn by operative has indicated that
and attached to winch on Tripod at it is time for the
all times (6 monthly testing is entrant to leave
carried out of Tripod and Winch, the sewer or
which should be ensured is within manhole;
date). Top man to be present at all  If any member of
times. No inflammable materials the team feels

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
including matches or lighters to be unwell;
used on site. All Torches or  If depth or velocity
Lamps, Gas Detectors or other of flow increases
electrical devices to be in significantly;
accordance with approved QCS  There will always
Regulations for the Zones of entry be a competent
undertaken. and responsible
 Other necessary surveying person in the
equipment such as cameras or team; this will be
electronic surveying instruments the site supervisor.
will only be used during periods of He will be able to
continuous atmosphere monitoring take full control in
where no adverse conditions are the event of an
indicated. emergency. He
should not ever be
in a position where
he could be out of
action. He should
not generally enter
the confined
space, but if he
does he must first
pass responsibility
to another
competent person


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
on site.
Site Specific Self -

Rescue Procedures
 If a hazard
arises within
the manhole or
sewer,
personnel in
both will
immediately
exit and
contact the
Site
Supervisor.
The Site
Supervisor will
re-evaluate the
space to
determine the
appropriate
course of
action.
 If the alarm


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
from the
entrant in the
sewer is
activated, the
sewer entrant
will
immediately
exit the sewer
and the
manhole
 If the alarm
from the
worker in the
manhole (if
only manhole
work is being
carried out) is
activated the
manhole
entrant will
immediately
exit the
manhole
 If the alarm
from the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
Bottom man (if
there is an
entrant in the
sewer) is
activated the
manhole
entrant will
immediately
exit the
manhole. The
sewer entrant
will be
informed by
the Topman
that the alarm
of the Bottom
Man has been
activated and
the sewer
entrant will be
informed to
evacuate the
sewer also.
 If at any time
there is any


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
questionable
action or non-
movement by
any of the
Authorized
Entrants, the
Top Man will
make a verbal
check. If there
is no response
or a
questionable
response, the
worker in the
space will be
ordered to
evacuate the
space
immediately.
 If possible,
Authorized
Entrants will
initiate self-
rescue by
climbing out of


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
the space
Site Specific Rescue

Procedures using
Rescue Team
(Manhole Worker or
Bottom Man)
 If self-rescue is
not possible
for the
Manhole
Worker or the
Bottom Man,
one of the
rescue team
will don Full
Breathing
Apparatus,
enter the
manhole and
attempt to
retrieve the
entrant via
connecting the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
retrieval line to
his harness.
 The entrant
will then be
winched to
ground level
by the
Topman.
Site Specific Rescue

Procedures using
Rescue Team (Sewer
Worker)
 If self-rescue is
not possible
for the entrant
to the sewer,
both bottom
men will enter
the sewer at
both the upper
and lower
manholes
(they are


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
already in the
manholes at
this stage) to
investigate
what the
problem is;
 If the entrant
for any reason
is unable to
initiate self-
rescue, if they
are able to
retrieve the
sewer entrant
via the
retrieval line,
he will be
connected to it
and winched to
safety by the
Topman.
 If the Bottom
men are
unable to
retrieve the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
sewer entrant
via the
retrieval line,
another 2 men
will enter the
sewer via both
the upstream
and
downstream
manholes,
again wearing
full BA Kits
and being
lowered by the
Topmen (if
lowering via
the winch is
applicable)
 The two men
(one of who
will have a
stretcher) will
enter the
sewer to the
point that the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
original sewer
entrant is.
 He will be lifted
and strapped
to the stretcher
with the four
men (space
permitting)
lifting / pushing
him to the
closest
manhole.
 Once in the
manhole, he
will be
connected to
the retrieval
line and
winched to
ground by the
Topman.
 Emergency
services will
have already
been called by

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
the Site
Supervisor
when the
Topman lost
communication
with the sewer
entrant.
 If any of the
entrants are
disabled due
to falling or
impact, he will
not be
removed from
the confined
space unless
there is
immediate
danger to his
life.
 In this case,
Emergency
services are
used to
recover injured


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
man – the Site
Supervisor will
give details of
sewer layout,
position of
injured man
and other use
of specialized
equipment if
required
11. Working in Injuries caused by 3 3 9  Insure lighting is used when 3 1 3

Shaft falling materials, or due required.
to poor lighting  The Top Man will take all
conditions measures necessary to ensure
tools, objects or loose materials
are kept clear of the open manhole
or access and that the manhole is
protected by a barrier to prevent
members of the public or other
workers from standing too close to
the shaft and accidentally knocking
items onto the person or persons
below. All tools required will be
lowered in to chamber before

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
operatives enter and after
operatives leave.
12. 110V electric Electrocution 5 3 15  All portable electrical plant and 5 1 5
portable tools tools to be used by trained and
and plant competent operatives. Portable
electrical equipment to be tested
with identification tag attached. No
damaged tools / equipment to be
used.
13. Night Working Exceeding consented 3 3 9  Portable task lighting shall be 3 1 3
noise requirements. provided. If work progresses into the
Sprains. Crushing evening
injuries. Trips and falls.  Operatives shall ensure that the task
lighting is pointed away from sensitive
receptors.
 Ensure that there is a supply of spare
bulbs.
 Each gang shall have a torch with
batteries in case of light failure.
14. Lowering and Injuring lower back 3 2 6  Cameras vary in weight and size. 3 1 3
raising of Operatives to take care when
camera units lowering the camera and if it
into and from releases and falls not to catch the
manholes co axel cable to stop it as the


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
resulting jolt may injure the back. A
full and specific manual handling
assessment will be carried out on
site prior to works commencement.
15. All site works Slips. Trips & Falls 3 3 9  Good housekeeping and suitable 3 1 3
lighting
16. All site works Manual Handling 4 4 16 Mechanical lifting aids to be used where 4 2 8
possible. Maximum weight for single
person lift to be 25kg. Items heavier than
this or longer than 2m to be carried by at
least 2 operatives. Operatives to be trained
in manual handling
17. Working at Fall from Heights, Strike 5 3 15 Secure Barriered and Signed Exclusion 5 1 5
Height by falling object Zone: Placed around the base of the
access equipment to prevent unauthorised
entry into the area below the work site.
Areas Beneath Work Areas: Where
equipment or materials could fall barriers,
nets or other equipment to protect persons
underneath or prevent persons accessing
hazardous areas will be used. Access:
shall be made in reference to the
applicable Safe System of Work. Where
work is undertaken within 2 metres of

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
edges: edge protection in the form of a
guard rail of height not less than 950mm
shall be installed where reasonably
practicable Fall Arrest: Where edge
protection is not provided then fall arrest
devices or other suitable protection must
be provided and used by persons working
within 2 metres of such areas.
18. Environmental Contamination of 3 3 9  All Applus tanker trucks carrying oils, 3 1 3
Spillage – watercourses; fuels or sewage will have the following
Sewerage / Oil / contamination of land / basic emergency equipment:
Resins drainage; slipping  Mobile phone for summoning aid.
hazards on roads  PPE including rubber boots, WP
trousers, chemical resistant gloves,
visibility clothing and eye protection
goggles.
 Bag of oil absorbent granules
 Spill cover for drains
 Suitable shovel and liquid scraper.
 Suitable hand wash gels and wipes
 In the event of a spill incident the truck

driver will contact his Divisional
Manager who will arrange suitable
emergency response.

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
 The driver will attempt to prevent the

spill reaching the public drains or
waterways using the basic emergency
equipment and any sand or soil to
hand. If the vehicle is a suction tanker
the vacuum pump will be used to lift
the spill. The Jet Vac equipment can
be used to hose down the road
 The driver has the equipment and

training to deal with small spills
 Absorbent granules in bags

 Sand for blocking run away
 Spill covers for gutter drains and
manholes
 Shovels and liquid scraper
 Suitable PPE including rubber boots,
WP trousers, chemical resistant
gloves, visibility clothing and eye
protection goggles.
 Suitable handwash gels and wipes.
19 Plant Collision with workers or 4 3 12  All operators are to be competent and 4 1 4
Operations other plant. Roll over

L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
causing serious injury. trained.
Unauthorised use  All moving plant is to have a
leading to serious injury recognisable flashing light when in
or damage. operation.
 Seat belts are to be worn when
operating the plant.
 Pedestrian routes around the site are
to be clearly defined.
 Keys are to be removed from plant and
equipment when left unattended.
20 Use of lifting Failure of lifting 3 3 9  All lifting accessories are to be certified 3 1 3
accessories accessories with the correct documentation.
 All lifting equipment is to be inspected
prior to use by site supervisor and
inspections recorded.
21 Material/Spoil Excavation collapse 4 2 8  All materials/spoil is to be stored away 4 1 4
Storage from excavation to avoid
backfill/collapse/fall.
22 Lifting Insufficient length of 4 2 8  Dummy lifts with no load attached will 4 1 4
operations hoist rope/chain leading be carried out as the trench extends
below ground to load being dropped or deeper underground
level becoming unbalanced
23 Storage and Illness or disease 3 3 9  All COSHH items are to be stored in 3 2 6
use of materials caused by exposure to accordance with COSHH data sheets,


L5-QAT-273C
RISK ASSESSMENT
Rev.00
Date: 20 Sept. 2020

Risk Risk
S P S P
R R
harmful substances written assessments for all materials,
kept in COSHH files outlining the
correct use, exposure and PPE.
 Never decant into unmarked
containers.
 Emergency procedures to be briefed to
all site personnel and procedure to be
kept in site safety manual.
24 Materials Fire risk associated with 4 2 8  Minimise storage of flammable 4 1 4
storage storage of materials materials such as diesel and petrol



Rams CCTV Inspection Survey l5 Qat 273a

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Rams CCTV Inspection Survey l5 Qat 273a

Uploaded by

Copyright:

Available Formats

L5-QAT-273C

ENGINEER’S STAMP: CONTRACTOR’S STAMP:

REV. PREPARED CHECKED APPROVED DATE

CONTRACTOR VELOSI CERTIFICATION SERVICES LLC

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

PRE-TASK CONSENTS TO Check (as applicable)

1. Has the work activity been identified? X

2. (b) Are the persons who are at risk identified? X

(c) Have the risks been quantified i.e. High/Med/Low or 1, 2, 3 etc? X

(d) Have effective control measures been put into place? X

(a) Supervisor in charge of operations named? X

(b) Has a person(s) been appointed to take charge of SHE issues? X

(c) Are Site SHE rules being given due consideration? X

(d) Has the scope/description of work been adequately identified? X

(e) Is the sequence of operations clearly detailed in logical steps? X

(k) Is interface & coordination with other activities / operations covered? X

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

(a) Permit to Dig N/A

(b) Confined Space Permit X

6. (c) Temporary Works Permit to Load / Proceed

(d) Hot work Permit N/A

(e) Permit to Work Adjacent or Under H/V Overhead Cables X

(f) Permit to work on Electrical Equipment X

(g) Other permits (e.g. access permit from client) X

Hard Hat waterproof or Coverall Shoes

Carbon First Aid Cones & Signs

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

 The driver has the equipment and

 Sand for blocking run away

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

7. CCTV Survey Manual handling Injuries 3 3 9  CCTV Survey operators to be fully 3 1 3

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

10 Working in Presence of Toxic 5 4 20  Permit to Enter System to be in 5 1 5 Defined situations

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Site Specific Self -

Prepared By: Reviewed By: Approved By:

Safety Manager Project Manager

No Hazard Risk Description Inherent Controls Residual Notes

Prepared By: Reviewed By: Approved By: