Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Survey Details

  • Surveyor Name:

  • Survey Date:

  • Client

General Site Information

  • Store Name:

  • Store Number:

  • Store Address:

  • Store Telephone Number:

  • Store Opening Times:

Delivery Of Hardware

  • Any Delivery Restrictions, Yes or No? If Yes Specify:

  • Any Restrictions on Traffic? Yes/No. If Yes Specify:

  • Any Restrictions on Parking, Yes or No? If Yes Specify:

  • Location to Off Load:

  • Delivery via Scissor Lift, Yes or No? If Yes Note Weight Limit:

  • Photos Of Location for Delivery Vehicle To Off Load:

Special Delivery Equipment:

  • Specify Special Delivery Equipment Required, i.e. pallet truck, skates etc.

Obstacles On Route to ATM Position:

  • Kerb, Yes or No? If Yes Specify Height:

  • Stairs Yes or No? If Yes Specify Number of Steps and Height:

  • Mat Well Yes or No? If Yes Specify Size:

  • Any Other Obstacles On Route To ATM Position, Yes or No? If Yes Specify:

  • Photos Of Any Obstacles on Route To ATM Position:

  • Ceiling Height

Doors On Route To ATM Position

  • Minimum Door Size On Route To ATM Position:

Delivery Route External Floors:

  • External Floor Types:

  • Other:

  • Add media

Delivery Route Internal Floors:

  • Internal Floor Types:

  • Other:

  • Internal Floor Covering:

  • Add media

External Detail:

  • Is The Exterior Lighting Adequate In The ATM Area?

  • Add media

  • Are CCTV Cameras Facing Proposed ATM Area?

  • Add media

  • Are Bollards Required( 2000mm back from ATM)?

  • Add media

  • Do External Graphics Need Relocating - Yes/No. If Yes Specify

  • Add media

  • Are There Any Services Impeding ATM Location Yes/No If Yes Please Specify.

  • Add media

Internal Detail:

  • Location Of ATM:

  • Add media

  • What Material Will The Aperture Be Going Through?

  • Add media

  • What Is The Thickness Of Aperture?

  • Size Of Glazed Panel Where Aperture Will Go:

  • Is There A Difference in External and Internal Floor Levels?

  • Add media

  • Any Refrigeration Need Relocating, Yes or No? If Yes Specify

  • Add media

  • Any Tills Need Relocating, Yes or No? If Yes Specify?

  • Add media

  • Any Shelving/Gondola Need Relocating, Yes or No? If Yes Specify

  • Any Other Obstacles Need Relocation? Yes or No, If Yes Specify With Possible Relocation Position.

  • Add media

  • Any Internal Signage To be Relocated Yes or No? If Yes Specify

  • Add media

  • Any Internal Services To Be Relocated? Yes or No. If Yes Specify.

  • Add media

  • Aisle Width Measurement Created When Bastion Unit In Place If Applicable:

Electrical/Data Detail

  • Fuse board Location

  • Add media

  • Comms Cabinet Location

  • Add media

  • Location Of DP

  • Add media

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.