Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

JOB SPECIFICS

  • Owners Name, Address & Contact Details

  • Occupants Name & Contact Details

  • Claim Number:

  • Purchase Order Number:

  • Work Order Number:

  • Insurance Company:

  • Insurers Reference:

  • Assessing Company:

  • Assessors Reference:

  • Assigned Assessor & Contact Number

  • JAE Dwelling Reference:

  • JAE Contents Reference:

  • The person in control of the job is :

  • The person in control of the job is :

  • Approved By

  • Type of claim

EXCESS

  • Dwelling Excess to collect?

  • Technician Who Collected Excess

  • Contents Excess to collect?

  • Technician Who Collected Excess

DETAILS FROM THE OWNERS/OCCUPANTS

  • Do we know what caused the incident?

  • Has anyone tried cleaning/fixing the area prior to us arriving?

  • Are the occupants having health affects? (describe)

  • Are Occupants still living in the damaged property?

  • Access to property (describe who,where,photograph keys, and/or location)

  • Has the client and/or occupant been given a copy of the 'Client Health & Safety Induction' and signed it?

  • Signature of client/occupant confirming that they have received a copy of the 'Client Health & Safety Induction' and agree to the requirements laid out within.

INITIAL INSPECTION

  • ENTRANCEWAY

  • Entranceway Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Entranceway Contents

  • Other Entranceway Notes

  • Photos of Entranceway

  • KITCHEN

  • Kitchen Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Kitchen Contents

  • Other Kitchen Notes

  • Photos of Kitchen

  • LOUNGE

  • Lounge Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Lounge Contents

  • Other Notes

  • Photos of Lounge

  • DINING

  • Dining Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Dining Contents

  • Other Dining Notes

  • Photos of Dining

  • HALLWAY

  • Hallway Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Hallway Contents

  • Other Hallway Notes

  • Photos of Hallway

  • MASTER BEDROOM

  • Master Bedroom Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Master Bedroom Contents

  • Other Master Bedroom Notes

  • Photos of Master Bedroom

  • BEDROOM 2

  • Bedroom 2 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Bedroom 2 Contents

  • Other Bedroom 2 Notes

  • Photos of Bedroom 2

  • BEDROOM 3

  • Bedroom 3 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Bedroom 3 Contents

  • Other Bedroom 3 Notes

  • Photos of Bedroom 3

  • BEDROOM 4

  • Bedroom 4 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Bedroom 4 Contents

  • Other Bedroom 4 Notes

  • Photos of Bedroom 4

  • BEDROOM 5

  • Bedroom 5 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Bedroom 5 Contents

  • Other Bedroom 5 Notes

  • Photos of Bedroom 5

  • MAIN BATHROOM

  • Main Bathroom Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Main Bathroom Contents

  • Other Main Bathroom Notes

  • Photos of Main Bathroom

  • BATHROOM 2

  • Bathroom 2 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Bathroom 2 Contents

  • Other Bathroom 2 Notes

  • Photos of Bathroom 2

  • MASTER ENSUITE

  • Master Ensuite Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Master Ensuite Contents

  • Other Master Ensuite Notes

  • Photos of Master Ensuite

  • SEPARATE TOILET

  • Separate Toilet Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Separate Toilet Contents

  • Other Separate Toilet Notes

  • Photos of Separate Toilet

  • SEPARATE TOILET 2

  • Separate Toilet 2 Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Separate Toilet 2 Contents

  • Other Separate Toilet 2 Notes

  • Photos of Separate Toilet 2

  • LAUNDRY

  • Laundry Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Laundry Contents

  • Other Laundry Notes

  • Photos of Laundry

  • OFFICE

  • Office Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Office Contents

  • Other Office Notes

  • Photos of Office

  • GAMES/FAMILY ROOM

  • Games/Family Room Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Games/Family Room Contents

  • Other Games/Family Room Notes

  • Photos of Games/Family Room

  • SUNROOM

  • Sunroom Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Sunroom Contents

  • Other Sunroom Notes

  • Photos of Sunroom

  • STAIRS

  • Stairs Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Stairs Contents

  • Other Stairs Notes

  • Photos of Stairs

  • GARAGE

  • Garage Affected

  • Type of floor covering

  • Floor Condition

  • Type Of Wall Finish

  • Wall Condition

  • Type Of Ceiling Finish

  • Ceiling Condition

  • Interior of Cupboards & Inbuilt Cabinetry

  • Garage Contents

  • Other Garage Notes

  • Photos of Garage

  • EXTERIOR

  • Exterior Affected

  • Type Of Wall Finish

  • Wall Condition

  • Other Notes

  • Photos of Exterior

  • CONTENTS

  • Furniture

  • Electrical Items

  • Kitchen Items

  • Food Items

  • General Contents

  • Fabrics and Clothing

  • Recommended Disposal Items

  • Photos of some Damaged Contents

SSSP - SITE SPECIFIC SAFETY PLAN

1. WORKPLACE CONTROL AND HEALTH AND SAFETY MANAGEMENT

  • The person in control of the workplace is :

  • Our Designated Warden/First Aid person is

  • We will maintain an onside Hazard Register of all existing and new hazards and appropriate controls

  • Appropriate Safety Data Sheets have been are available on site?

2. EMERGENCIES/EVACUATION PLAN

  • Emergency Kit One (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

  • Emergency Kit Two (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

  • EMERGENCY PLAN AND PROCEDURES FOR HAZARDOUS WORK

  • In the event of a site emergency or evacuation our personnel will...

  • Evacuation Plan for all Emergency Situations: Alarm Evacuation, Unsound Building, Earthquake, Fire, Tsunami, Other

  • Evacuation Plan 3: Other

  • Evacuation Plan 3: Other

3. COMMUNICATION/EMPLOYEE PARTICIPATION

  • The methods we use to communicate safety information to our employees are:

  • Daily Toolbox Talks - including covering site hazards and emergency/evacuation procedures

  • Monthly Health and Safety Meetings - covering use of equipment, hazards encountered

  • Pre-task Planning Meetings - Done first Visit to site post quote approval

  • Other

  • Urgent Safety Updates are e-mailed and/or TXT to all staff and put on the router for the next Health and Safety Meeting

4. ACCIDENT/INCIDENT: REPORTING/INVESTIGATION/RECORDING

  • We have an accident/incident reporting/investigation system in place and keep an Accident/Incident Register

5. TRAINING/INDUCTION

  • All persons under our control on site are given a site specific safety induction

  • All persons under our control on site are appropriately qualified, competent or fully supervised

6. TASK/JOB ANALYSIS

  • INITIAL INSPECTION

  • Step 1: Assess property for external hazards

  • Step 2: Familiarise customer with process and requirements

  • Step 3: Record observations including clients comments

  • Step 4: Erect signs and barricades and/or check existing signs and barricades

  • Potential Hazard:

  • Control Methods:

  • Step 5: Don PPE according to Hazard Requirements

  • GENERAL CLEANING/REMOVALS

  • Step 6: Pre-task planning Meeting and/or daily toolbox talk to discuss current hazards and potential hazards

  • Step 7: Load in equipment/product required

  • Potential Hazard:

  • Control Methods:

  • Step 8: Take swabbs/samples as required

  • Potential Hazard:

  • Control Methods:

  • Step 9: Apply surface treatments

  • Potential Hazard:

  • Control Methods:

  • Step 10: Cataloguing as required

  • Step 11: Remove Damaged goods offsite

  • Potential Hazard:

  • Control Methods

  • Step 12: Remove equipment not being left onsite

  • Potential Hazard:

  • Control Methods

  • Step 13: Remove PPE

  • Potential Hazard:

  • Control Methods

  • Step 14: Ensure any signage being left onside is secure and visible

  • Step 15: Remove signage not being left onsite

  • Step 16: Check site and leave

  • OZONING

  • Step 17: Ensure all occupants and pets are out of the area to be decontaminated

  • Potential Hazard:

  • Control Methods:

  • Step 18: Ensure all occupants and pets are out of the area to be treated

  • Potential Hazard:

  • Control Methods:

  • Step 19: Ensure warning signage has been secured and is visible

  • Step 20: Post Ozone Treatment

  • Potential Hazard:

  • Control Methods:

SIGNATURES

  • Signature of Technician Compiling Task Analysis

  • Time and date Initial Inspection and Task Analysis Complete

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.