Template

Planned Assurance Inspection Record Form

by David Sogeke, from the Community

Use this Planned Assurance Inspection Record Form to document vegetation management works around rail assets. The checklist covers supervision details, site safety controls, required documents and competencies, PPE and equipment, and work activities. Verify specification within and outside the 6.5m clearance zone, treatment of stumps, correct pruning, eco-plug or herbicide use, handling of arisings, and environmental considerations. Record findings, signatures, and assign actions for follow-up and continuous improvement.

With SafetyCulture you can

Digitize team workflows

Turn your workflows into digital templates or checklists so your team can conduct inspections efficiently and access them from any device.

Reduce manual errors

Help your team complete tasks more accurately with digital templates that minimize errors from manual processes.

Create and share inspection reports

Generate inspection reports and share them with your team and stakeholders to keep everyone informed.

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Contractor Completion and Snagging Form
This contractor completion and snagging form supports rail infrastructure handover, especially vegetation management works near the running rail. It guides contractors and Network Rail representatives through verifying scope completion, safe handling of arisings, removal or stacking of timber and brash, fencing reinstatement, stump treatment and herbicide recording, and tree work to BS3998. It prompts evidence of permissions and documentation such as TEF3069, captures photos and notes for any snags, and records final approvals with signatures and dates for both contractor and client.
by Jamie Marks, from the Community
Downloads: 0
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Template
HSEQ Site Surveillance and Staff Assurance Checklist
This HSEQ site surveillance and staff assurance checklist helps supervisors document briefings, verify competencies and authorities to work, confirm Safe Work Packs, PPE and permits, assess task risk controls and COSHH, and capture environmental, equipment and housekeeping checks. Use it to note unsafe acts, record actions taken, and attach evidence such as photos and maintenance records for rail infrastructure works.
by Dale Thomas, from the Community
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Work Clearance Form Template
This work clearance form template helps teams plan and authorize daily tasks by documenting permit and work order details, site and station information, assigned personnel, and planned activities. It supports hazard identification for traffic exposure, electric shock, and working at heights, and prompts required controls such as PPE verification and area barricading with cones or tape. The form includes arrival briefings, acknowledgment of risks, and completion sign-offs with signatures from the station representative and contractor to confirm work done and site handover.
by Morten Petersen, from the Community
Downloads: 20+
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Template
Worksite Safety and Assurance Inspection Checklist
Streamline rail worksite audits with this comprehensive safety and assurance inspection template. It guides teams through authorisations, RAMS, permits to work, staff sign-on and safety briefings, site setup and housekeeping, vehicle safety, environmental controls, tools and plant checks, first aid and fire equipment. Assess human factors, training and competency, PPE and accident reporting, then review high-risk activities including working at height, lifting, confined spaces, manual handling, chemicals, noise and dust, hot works, electrical and mechanical hazards, RRV movements and overhead risks. Rail specific sections cover track maintenance, signalling, power supplies, lifts and escalators, communications and premises. Capture photos, record defects and root causes, and confirm rectification and documentation to keep assets safe and operational.
by Derek Day, from the Community
Downloads: 10+
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Planned Assurance Inspection Record Form

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

You might also like

Contractor Completion and Snagging Form

HSEQ Site Surveillance and Staff Assurance Checklist

Work Clearance Form Template

Worksite Safety and Assurance Inspection Checklist

You might also like

Contractor Completion and Snagging Form

HSEQ Site Surveillance and Staff Assurance Checklist

Work Clearance Form Template

Worksite Safety and Assurance Inspection Checklist