Information
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Document No.
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Audit Title
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Manager
- North Metro
- South Metro
- East Metro
- South East Metro
- CBD 1
- CBD 2
- Murdoch University
- Lakeside Joondalup SC
- Karrinyup SC
- Galleria SC
- Garden City
- Ocean Keys
- Armadale SC
- One40William
- Raine Square
- Operations Manager
- Governor Stirling Complex
- Defence
- Claremont Quarters
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Conducted on
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Prepared by
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Site
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Location
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Retail Only
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Trolley in working order
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Maps present
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Clock present
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Non Compliance Sheet Present
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Vacuum
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Bags Cleaned
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Notes/action required
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Risk rating
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Responsible party
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To be completed by Date:
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Completed Date:
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Cord
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Notes
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Risk Rating
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Responsible Party
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To be Completed by:
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Completed Date:
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Harness
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Notes
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Risk rating
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Responsible partyto
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To be completed by:
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Completed date:
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Hose and Floor Tool
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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General Conditions
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
Litter Vac
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Oil Level
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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Bags Cleaned
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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Pads Cleaned
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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Filter Clean
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
Blower
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
Gazda
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Gas Hose
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Noted
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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Battery Electrolite
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Notes
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Risk rating
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Responsible party
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To be completed by:
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Completed date:
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Chemical dispenser
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Dispenser Tampered
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Turned Off
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Notes
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Risk rating
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Responsible Party
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To be completed by
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Completed date
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General Condition
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Note
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Leaking
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Polyvac & Auto Scrubber
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Vacuums Bag Dry
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Cord
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Stored Correctly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Batteries on Charge
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Autoscrubber
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Filter
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Charger
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Squeegee
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Battery Electrolite
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Trolley
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Neat and Organised
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Wheels
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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PPE
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Overloaded
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Used Doors ?
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Wheels Checked regularly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Wheels designed for surface
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Is surface hard & sealed
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Any surfaces soft? Eg sand/gravel
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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General Condition
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Notes
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Risk eating
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Responsible party
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To be completed by
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Completed date
General Equipment
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Cleaner's room secure
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Cleaners room neat and tidy
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Hazard and risks identified
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Cords
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Hose and floor tools
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Hoses
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Fire extinguisher
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Wet floor signs
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Ladder
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Ppe
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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First aid kit
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Chemical spill kit
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Containers correctly labelled
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Chemicals stored correctly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Sharp containers & tongs
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Chemical approved for use
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Environment
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Suitable chemical disposal point
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Suitable chemical bunding
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Minimal stock on site
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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No air contamination
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Notes
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Risk Rating
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Responsible party
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To be completed by
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Completed date
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No water contamination
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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No contamination of plants and animals
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Documentation
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Wall charts
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Schedule of duties
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Communication Book
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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HSEQ file
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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All MSDSs
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Emergency Procedure Charts
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Sign on/ off completed
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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General Condition
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
Personnel
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Wearing ID Badge & Uniform
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Wearing Backpack correctly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Using RCD
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Using chemical correctly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Using equipment correctly
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Wearing appropriate PPE
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Can define a hazard
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Know what to do if they feel they have been bullied or harassed
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Can give an example of a hazard
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Can explain how to report a hazard / near miss / injury
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Can find hazard reports
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Note
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Can explain who to report an injury to
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Knows evacuation procedure
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Notes
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Risk rating
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Responsible party
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Completed date
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Knows where to dispose of chemicals
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Notes
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Risk rating
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Responsible party
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To be completed by
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Completed date
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Warning required
Warning
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Name:
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Reason:
General comments
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Inspector
-
Manager