7.5.1 QPCYWA Branch Monthly Workplace Inspection Checklist v3

• Document No.

• Audit Title

• Site

• Date inspection conducted on

  Date

• Prepared by

• Location
  Address

• Personnel conducting inspection

Form Completion Procedure and Action

• A. For all identified issues (those marked with "no" in this document).
  i. Document the action taken and review the Risk Assessment to ensure that the control measure enacted is adequate for the item identified.
  ii. If controls are deemed inadequate then complete a NEW Risk Assessment
  
  B. Branch Manager to include in each Minutes Package every month.

• ALL IDENTIFIED ACTIONS FROM THIS INSPECTION MUST BE ALLOCATED TO A PERSON AND GIVEN A TIMELINE FOR COMPLETION WITHIN 14 DAYS.
  You will not be able to finish this audit without making these notes.

General

• Is the general condition of walls, floors, floor coverings free of cracks, splinters, projecting nails mould and are ceilings in good conditions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are all external areas, pedestrian access and precincts free from clutter, paper or rubbish, redundant materials or other obstacles which may constitute a slip, trip or fall hazard?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Fire Safety & Emergency Procedures

• Are fire exits clear of obstructions ?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are fire extinguishers in place and in test date (less than 6 months since last inspection)?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are exit lights free of damage & operational?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Do exit doors open easily from inside with one hand?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are exit doors clear of obstructions by 2 meters?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are Fire Evacuation maps prominently displayed, and up to date?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Has a Chief Warden and Fire Wardens been appointed and names/contact details displayed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there a clear one metre pathway from any area to a fire door?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are Fire Alarms functional?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Last Fire Evacuation drill conducted on

  Date

• Must sight documents and take photo.

  Media

• Next Fire Evacuation drill due by

  Date

• Is the service emergency phone in working order (check phone)?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the Emergency Contact sheet clearly displayed near the service phone?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are all electrical outlets capped (check all outlets)?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Has the "One Person model Emergency Contact" been tested?

  Yes

  No

  N/A

• Date Tested

  Date

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

First Aid Supplies and Staff

• Are all first aid kits and contents complete?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Ice stocks sufficient and readily available?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are the names and contact details of first-aiders signposted in all areas? (Form 7.3.3)

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are all first aid kits checked at least quarterly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Record last documented inspection date

  Date

• Are all first aid kits checked at least quarterly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Record last documented inspection date

  Date

• Is the children's medication in a locked cabinet and key kept separately?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Toilets and Showers

• Are the toilets and/or urinals free from a strong odour?

  Yes

  No

  N/A

• Report detail to supervisor for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Toilets and urinals functioning correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Waste bins emptied at regular intervals?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there any obvious mould or mildew present?

  Yes

  No

  N/A

• Report detail to supervisor for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there any damage to tiles, sinks, walls and floors etc. ?

  Yes

  No

  N/A

• Report detail to supervisor for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are toilets and washing facilities kept clean and hygienic - including doors, walls and bench tops?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the floor free from water?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there adequate provision of soap, hand drying facilities and toilet paper?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Windows & Doors

• Protected against damage in activity areas?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• No broken glass panes/panels or mirrors within the branch/service?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Windows and doors open/close freely?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Storage of Hazardous Substances

• Chemicals locked in storeroom or cupboard?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are there Safety Data Sheets (SDS) less than 5 years old, for all materials used? And are all chemicals in use by date?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are all BBQ Gas Cylinders stored in well-ventilated areas and are they properly secured by chain?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Has a Hazardous Chemicals Register been established, and has it been updated within the last year?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is Personal Protective Equipment (PPE) available for all chemicals used? (Gloves, safety glasses etc)

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the club free of any chemicals stored in food or drink containers?

  Yes

  No

  N/A

• Remove and dispose of immediately.

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there a process/method for cleaning up spilled substances?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are there warning notices/signs for hazardous chemicals posted on doors or cupboards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Staff Spaces/Office Spaces/Front Counter Area

• Power points, power boards, electrical leads and plugs free of damage, such as cuts in cables, kinks in leads, frayed or exposed internal conductors (internal cables could be red, black, blue, brown, green/yellow)

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage (no obvious lights out)?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition, not frayed or worn

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Materials stored in a safe manner - no clutter

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the filing cabinet lockable and locked?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Kitchen

• Power points, power boards, electrical leads and plugs free of damage, such as cuts in cables, kinks in leads, frayed or exposed internal conductors (internal cables could be red, black, blue, brown, green/yellow

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• All fire exits clear of obstructions

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage (no obvious lights out)

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, door locks/catches working correctly

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition, not frayed or worn?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Free of insects and vermin? Must site and take photo of documents.

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Last treated - date

  Date

• Cleaning materials stored safely an separately away from kitchenware and utensils?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Appliances safely located - toasters, kettles, etc away from child access?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are all knives in a locked cupboard or draw?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there adequate provision of soap, dish cloths and tea towels?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are storage cupboards, fridges, , microwave ovens, dishwashers and other appliances kept clean, tidy and free from mould/mildew?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Equipment stored safely and general kitchen areas kept clean? Eg, removal of rubbish, cleaning of floors and surfaces.

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• All food (staff and service food) needs to be labelled in cupboards, fridge and freezer

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Open food items are kept in air sealed containers

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• No food containers stored on floor

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Use by date of food products - check dates, disgard food that has expired

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Has the cleaning list been completed for the last four weeks?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Machinery/Plant

• Is there a register of plant (equipment such as, backpack vacuum cleaner, lawn mower, floor polisher etc), and has it been updated within the last year?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there a timetable for plant and equipment maintenance?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Have staff received training in the safe use of plant and equipment?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Occupational Violence

• Has a work-related Violence Assessment been completed for this School Age Care service in the last 12 months (see document 8.7.4 n intranet)?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Security

• Is access controlled and restricted to staff only areas and are there signs or notices specifying/access requirements?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

WHS Procedures

• Do you have a local Health & Safety Representatives (HSR) record the name and contact details of HSR?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there a register of staff inductions for the Branch?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there a sign in sheet and induction checklist for visitors, contractors etc?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Do staff know the Accident/Incident procedures, and where to report accidents, incidents or safety problems to? (Ask 3 (names) staff members)

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Activity Spaces

Playgrounds and Playground Equipment

• Does the club/service have a playground or play equipment?

  Yes

  No

• Is the soft fall material under play equipment a minimum depth of 30cm?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the soft fall material under heavy traffic areas (eg. Base of slides) a minimum depth of 36cm?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are compacted areas of soft fall loosened/raked routinely?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the loose fill material clean, drained, and evenly distributed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are Guardrails and barriers in place on elevated platforms or landings that are higher than 50cm?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is all playground equipment appropriate for the age groups of users?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are different age groups separated when playing and actively supervised?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the playground equipment free of sharp edges or trip hazards?

  Yes

  No

  N/A

• Take a photo, barricade off and inform Supervisor for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is timber equipment free of splits or splinters?

  Yes

  No

  N/A

• Barricade off and inform supervisor for action.

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the playground free from very uneven surfaces, tree roots, stumps, rocks etc.

  Yes

  No

  N/A

• Barricade off and inform supervisor for action.

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are concrete footings on playground equipment below ground level and are covered with a soft fall?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the playground free of any bolts, nails, screws or other sharp elements that could cut or entangle children's clothing?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is there adequate shade at the times children play on the equipment?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are ropes properly secured top and bottom?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Is the loose fill material clean, drained, and evenly distributed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Outside Grass/Multipurpose Playing Fields (Soccer, Rugby, Netball, Basketball etc)

• Are there outside grass/multipurpose playing fields at this club/service?

  Yes

  No

• Are the fields or play spaces free of sharps, rubbish, litter or debris?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are the fields or play spaces free of potholes and uneven surfaces?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are the fields or play spaces free of excessive water or very wet areas?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are storage sheds safe, posing no threat to unsupervised children?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Has the grass been mown in the last month?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are goal posts, fences etc free of jagged or sharp points?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Are storage sheds safe? (They do not pose any danger to unsupervised children)

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Squash Courts & Hallway

• Are there squash courts at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Squash court glass panels secure and undamaged?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Martial Arts Room

• Are there martial arts rooms at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity area free of slip/trip hazards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Safety clearance maintained around activity mat?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Wall mirrors are not cracked or broken?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity mat secure and padding in place?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Boxing Room

• Are there boxing rooms at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity area free of slip/trip hazards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Safety clearance maintained around activity mat?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Wall mirrors are not cracked or broken?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity mat secure and padding in place?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity equipment stored safely and in serviceable condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Padding/ropes on Boxing Ring adequate and in place?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Weights Gym/Aerobics Room

• Are there weights gym/ aerobics rooms at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity area free of slip/trip hazards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Wall mirrors are not cracked or broken?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• System of weights and gym equipment safety checks in place and performed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Hygiene materials present and available for users?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Gymnastics

• Are there gymnastics rooms at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry, floor coverings in safe condition?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity area free of slip/trip hazards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Wall mirrors are not cracked or broken?

  Yes

  No

  N/A

• Report detail to manager for action

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Safety clearance maintained around activity mat?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity mat secure and padding in place

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• System for equipment safety checks in place and being performed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Basketball Hall

• Are there basketball halls at the club/service?

  Yes

  No

• Power points, power boards, electrical leads and plugs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Fire exits clear of obstructions?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Adequate lighting, fittings and bulbs free of damage?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Doors open/close freely, Door locks/catches working correctly?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Floors clean and dry?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• Activity area free of slip/trip hazards?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

• System for equipment safety checks in place and being performed?

  Yes

  No

  N/A

• Tap photo icon above to add picture of album. Describe below the action to be taken, allocate a person to this task and allocate a timeframe within 14 days.

Other

• Any other rooms, spaces or locations not named above within the branch/service?

Monthly Summary

• Form 7.2.1. (Incident, accident, injury or illness)

• Form 3 (7.2.2)

• Branch Manager Comments

• Is further action required on ANY item above?

  Yes

  No

• Immediate action required and management plan completed, work / maintenance expected completion date.

  Date

• Branch manager informed? Name and date.

• Select date

  Date

• Work / Maintenance actual completion date

  Date

• When is next Workplace Inspection due?

  Date

Acknowledgement/sign off

• Date inspection completed

  Date

• Date acknowledged

  Date

• Name and signature of Branch Manager

  Sign