Title Page

  • Arriving/Departing Flight Numbers

  • Aircraft Registration

  • Airport

  • Stand

  • Conducted on

  • Prepared by

  • Operator/Truck Number

  • 1. Does the operator perform a brake check before positioning onto the aircraft?

  • 2. Does the duration of the procedure last more than 2 minutes 30 seconds for A320/321 aircraft, or more than 5 minutes for A330 aircraft? (time from panel open to panel closed)

  • 3. Is the rinse/charge hose connected

  • 4. Is the rinsing procedure carried out for a minimum or 90 seconds, or 57 litres discharged? (ask operator if necessary)

  • 5. Do staff wear all necessary clothing and P.P.E (overalls, mask, hi-visibility clothes, gloves etc.)?

  • 6. Are staff in posession of company issued hearing protection?

  • 6. Do staff close the gate after climbing onto the operator platform of toilet service units?

  • 7. Do staff close the valve before disconnecting the discharge hose?

  • 8. Do staff close and check panels before leaving?

  • 9. Do staff fully lower the cage before exiting?

  • 10. Do staff double check that all hoses are disconnected before leaving the cage?

  • 11. Do staff secure the hose before leaving the cage?

  • 12. Do staff take their gloves off before opening cab doors?

  • 13. If any non-conformities were observed were they discussed with the operator on site?

  • Any other observations/comments

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.