Airlite Group HSEQ Report - Duplicate Checklist

• Retail Only

• Trolley in working order

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Maps present

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Clock present

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Non Compliance Sheet Present

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Vacuum

• Bags Cleaned

  Compliant

  Non-compliant

  N/A

• Notes/action required

• Risk rating

• Responsible party

• To be completed by Date:

  Date

• Completed Date:

  Date

• Cord

  Compliant

  Non-compliant

  N/A

• Notes

• Risk Rating

• Responsible Party

• To be Completed by:

  Date

• Completed Date:

  Date

• Harness

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible partyto

• To be completed by:

  Date

• Completed date:

  Date

• Hose and Floor Tool

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• General Conditions

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

Litter Vac

• Oil Level

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• Bags Cleaned

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• Pads Cleaned

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• Filter Clean

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

Blower

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

Gazda

• Gas Hose

  Compliant

  Non-compliant

  N/A

• Noted

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• Battery Electrolite

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by:

  Date

• Completed date:

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Chemical dispenser

• Dispenser Tampered

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Turned Off

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible Party

• To be completed by

  Date

• Completed date

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Note

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Leaking

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Polyvac & Auto Scrubber

• Vacuums Bag Dry

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Cord

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Stored Correctly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Batteries on Charge

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Autoscrubber

• Filter

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Charger

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Squeegee

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Battery Electrolite

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Trolley

• Neat and Organised

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Wheels

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• PPE

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Overloaded

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Used Doors ?

  Yes

  No

  N/A

• Wheels Checked regularly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Wheels designed for surface

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Is surface hard & sealed

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Any surfaces soft? Eg sand/gravel

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk eating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

General Equipment

• Cleaner's room secure

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Cleaners room neat and tidy

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Hazard and risks identified

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Cords

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Hose and floor tools

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Hoses

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Fire extinguisher

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Wet floor signs

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Ladder

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Ppe

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• First aid kit

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Chemical spill kit

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Containers correctly labelled

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Chemicals stored correctly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Sharp containers & tongs

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Chemical approved for use

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Environment

• Suitable chemical disposal point

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Suitable chemical bunding

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Minimal stock on site

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• No air contamination

  Compliant

  Non-compliant

  N/A

• Notes

• Risk Rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• No water contamination

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• No contamination of plants and animals

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Documentation

• Wall charts

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Schedule of duties

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Communication Book

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• HSEQ file

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• All MSDSs

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Emergency Procedure Charts

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Sign on/ off completed

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• General Condition

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

Personnel

• Wearing ID Badge & Uniform

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Wearing Backpack correctly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Using RCD

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Using chemical correctly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Using equipment correctly

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Wearing appropriate PPE

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Can define a hazard

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Know what to do if they feel they have been bullied or harassed

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Can give an example of a hazard

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Can explain how to report a hazard / near miss / injury

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Can find hazard reports

  Compliant

  Non-compliant

  N/A

• Note

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Can explain who to report an injury to

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Knows evacuation procedure

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

  Date

• Completed date

  Date

• Knows where to dispose of chemicals

  Compliant

  Non-compliant

  N/A

• Notes

• Risk rating

• Responsible party

• To be completed by

  Date

• Completed date

  Date

• Warning required
Warning

• Name:

• Reason:

General comments

• Inspector

  Sign

• Manager

  Sign