Daily Site Risk Assessment- Underground

Map Group (UK) Daily Site Risk Assessment

Underground
Please complete each section & answer ALL of the questions correctly. If at any stage you realise that you do NOT have the correct equipment or training to complete the task, then you must STOP work & contact your manager/supervisor immediately.
RNDID
Are you working in a confined space?*

Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Time1*

DayMonthYear
Date
Date*

- Lets get a few more details of who you are inspecting. Please fill out the required fields below so that we know who we are dealing with
- How many operatives on Site?*
- Team Member 1*
  
  First NameLast Name
- Team Member 2*
  
  First NameLast Name
- Team Member 3
  
  First NameLast Name
- Team Member 4
  
  First NameLast Name
- Team Member Email *
  Please Enter any of the Team Member's Email Address
- Team Manager*
  Choose Other if the TM isn't listed
- Find the managers email address
- Other Team Manager
- Manager Email*
- Client Name*
- Are you a Direct Labor or Sub-contractor?*
- Sub-Contractor *
  If not listed select Other
- Vehicle Registration
  Please use the format in capitals without spaces i.e NU18UOV

- 2.1 Do you have the required accreditations/qualifications to undertake the task?*
- 3.1 Access to MAP APP for vehicle pack?*
- 3.3 Confined Space Equipment used and within test LOLER test date (LOLER inspections are required every 6 months)*
- 3.4 4 headed gas tester charged and calibrated and without errors*
- Calibration Days Remaining*
- 3.5 Water Test Kit*
- 3.6 PPE Required and sufficient for the task *
- 3.7 ID/SMART Awards Card*
- 3.8 LMC4 Mechanical Pitlifter*
- 3.9 No.5 Key Lifter & Roller Bar *
- 3.10 First Aid Kit & Eyewash*
- 3.11 Sufficient Signs, Lights & Guarding*
- 3.13 Safety Boots *
- 3.14 High Vis class 3 (Long Sleeve)*
- 3.15 Waterproof Clothing*
- 4.1 Relevant Job Pack available.*
- 4.2 Is there the required accreditation and training available on site to work on all streets and roads? (Minimum requirement is NRSWA Streetworks unit 2) If no, STOP work and contact manager immediately?*
- 4.3 Have you identified the speed of the road you are working on?*
- 4.4 If the road is less than 50mph speed limit and a single carriageway or 40mph and a dual carriageway, is there NRSWA Streetworks Unit 2 accreditation on site, correct PPE and relevant Sign, Lighting, Guarding (SLG) so work can continue? *
- 4.6 If the road is 50mph speed limit or above? Is there additional traffic management accreditation on site. If the additional accreditation is not available then work must STOP and referred back to the manager for Traffic Management (TM) provisions? *
- 4.7 Suitable Sign, Lighting, Guarding (SLG) used on site to protect the opertives and the public, inc. courtesy boards?*
- 4.8 Have you identified, assessed and controlled all local hazards, such as schools, hospitals, junctions etc. and is traffic management required on site ? (INSERT ALL LOCAL HAZARDS IDENTIFIED IN ADDITIONAL HAZARD BOX)?*
- 4.9 Has any chamber/pit lid been lifted using the correct equipment and training?*
- 4.10 Have you tested all chambers/pits/manholes for gaseous vapour using the provided 4 headed gas monitor- If the gas test is positive stop immediately and folow the Map Group positive gas test procedure?*
- 4.11 Have you used correct manual handling techniques when rodding and roping cables?*
- 4.12 Is all cable kept within the working area?*
- 4.13 If there is Confined Space Entry, has the Confined Space been assessed and hazards controlled?*
- 4.14 Manual Handling tasks- Have the operatives had relevant training within induction?*
- 4.15 Are hand tools being used and the correct tools available for the task?*
- 4.16 Is there a trailer being used?*
- 4.17 If YES, has the trailer been inspected before use by the driver and is the trailer within service date?*
- 4.18 If YES, does the driver have the correct classification of licence to be able to tow the trailer legally?*
- 4.19 Is there water present within the chamber?*
- 4.20 If YES, have you completed the water test and happy to continue work (If water is deemed CONTAMINATED, stop work and contact manager (relevant water pump facilities would need to be sourced)? *
- 4.21 Is all equipment used on site suitable for the activity, maintained and serviced?*
- 4.22 Was the site left clean and tidy with all waste removed (approximate length of cable removed from site recorded)?*
- 4.23 Has a site induction been carried out if required ?*
- 4.24 Weather (Give Summary)*

- Optional Photo 1
- Optional Photo 2
- Optional Photo 3
- Optional Photo 4
- Optional Photo 5
- Is the chamber Low, Medium or High Risk?
- Do operatives have Medium Risk Training?
- Have all operatives completed Confined space Risk Assessment?
- Have all operatives signed off on Emergency Procedures?
- Do all operatives have access to RAMS?
- Risk Assessment paper document
  
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- First Aid Kit
  
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- Emergency breathing equipment.
  
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  Cancelof
- Emergency Breating Equipment (MAPID)
- 2 x 2 way radios
  
  Browse Files
  
  Cancelof
- 2 Way Radio (MAPID)
- 2 x Gas testers
  
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- Gas Tester (MAPID)
- Blowing unit
  
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- Blowing Unit (MAPID)
- Generator
  
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- Generator (MAPID)
- Fall Arrest & Recovery Block
  
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- Fall Arrest & Recovery block (MAPIDS)
- Top mans fall arrest lanyard
  
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- Top mans fall arrest lanyard (MAPID)
- Tripod in position with both TopMan and UG operative secured with harnesses. ( Top man should be connected with fall restrain and harness. UG Operative should be connected with recue line and harness. Both should have hard hats on.
  
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- Tripod (MAPID)

Technician Signature *

Clear
Please verify that you are human*
Pass
Fail
Score
Should be Empty:

Rows	Yes	No
Oil Levels Checked & Correct?
Coolant Levels Checked & Correct?
Screen wash Levels Checked & Correct?
Tyre Pressure Levels Checked & Correct?
Tyre Tread Depth Checked & Correct?
Wheel Bolts Checked and Tight?
Glass & Mirrors (Free from Cracks, Chips etc...)?
Indicators & lights Present and working?
Amber Beacon Present & Working?
Spare Wheel, Jack & Wheel Brace present?

Rows	Yes	No
Lights working?
Number plate
Handbrake working?
Breakaway Cable in Use?
Tyres?
Wheel Bolts Checked and Secure?
Tow Bar, Tow Pins, Split Pins present and in use?
Trailer Legs present and working?
Hydraulic System working and locked off correctly?
Cable drum stay pin's & locking bars in use?
Rubber Bumper Stops in place and not perished?

Map Group (UK) Daily Site Risk Assessment