• Retail Only

  • Trolley in working order

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Maps present

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Clock present

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Non Compliance Sheet Present

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Vacuum

  • Bags Cleaned

  • Notes/action required

  • Risk rating

  • Responsible party

  • To be completed by Date:

  • Completed Date:

  • Cord

  • Notes

  • Risk Rating

  • Responsible Party

  • To be Completed by:

  • Completed Date:

  • Harness

  • Notes

  • Risk rating

  • Responsible partyto

  • To be completed by:

  • Completed date:

  • Hose and Floor Tool

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • General Conditions

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

Litter Vac

  • Oil Level

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • Bags Cleaned

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • Pads Cleaned

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • Filter Clean

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

Blower

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

Gazda

  • Gas Hose

  • Noted

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • Battery Electrolite

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by:

  • Completed date:

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Chemical dispenser

  • Dispenser Tampered

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Turned Off

  • Notes

  • Risk rating

  • Responsible Party

  • To be completed by

  • Completed date

  • General Condition

  • Note

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Leaking

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Polyvac & Auto Scrubber

  • Vacuums Bag Dry

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Cord

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Stored Correctly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Batteries on Charge

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Autoscrubber

  • Filter

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Charger

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Squeegee

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Battery Electrolite

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Trolley

  • Neat and Organised

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Wheels

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • PPE

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Overloaded

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Used Doors ?

  • Wheels Checked regularly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Wheels designed for surface

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Is surface hard & sealed

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Any surfaces soft? Eg sand/gravel

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • General Condition

  • Notes

  • Risk eating

  • Responsible party

  • To be completed by

  • Completed date

General Equipment

  • Cleaner's room secure

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Cleaners room neat and tidy

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Hazard and risks identified

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Cords

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Hose and floor tools

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Hoses

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Fire extinguisher

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Wet floor signs

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Ladder

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Ppe

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • First aid kit

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Chemical spill kit

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Containers correctly labelled

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Chemicals stored correctly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Sharp containers & tongs

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Chemical approved for use

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Environment

  • Suitable chemical disposal point

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Suitable chemical bunding

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Minimal stock on site

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • No air contamination

  • Notes

  • Risk Rating

  • Responsible party

  • To be completed by

  • Completed date

  • No water contamination

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • No contamination of plants and animals

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Documentation

  • Wall charts

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Schedule of duties

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Communication Book

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • HSEQ file

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • All MSDSs

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Emergency Procedure Charts

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Sign on/ off completed

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • General Condition

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

Personnel

  • Wearing ID Badge & Uniform

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Wearing Backpack correctly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Using RCD

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Using chemical correctly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Using equipment correctly

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Wearing appropriate PPE

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Can define a hazard

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

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

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Can give an example of a hazard

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

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

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Can find hazard reports

  • Note

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Can explain who to report an injury to

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Knows evacuation procedure

  • Notes

  • Risk rating

  • Responsible party

  • Completed date

  • Knows where to dispose of chemicals

  • Notes

  • Risk rating

  • Responsible party

  • To be completed by

  • Completed date

  • Warning required

  • Warning
  • Name:

  • Reason:

General comments

  • Inspector

  • Manager

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