B&K Systems Ltd

• Client / Site

• Prepared by

• Select date

  Date

WELFARE

• Mess facility

  Satisfactory

  Unsatisfactory

  N/A

• Changing/Drying Rooms

  Satisfactory

  Unsatisfactory

  N/A

• Washing/Sanitation

  Satisfactory

  Unsatisfactory

  N/A

• Toilets Clean

  Satisfactory

  Unsatisfactory

  N/A

• First Aid Box Adequate

  Satisfactory

  Unsatisfactory

  N/A

• Fire Extinguishers Site & Office

  Satisfactory

  Unsatisfactory

  N/A

STORAGE

• Materials Store

  Satisfactory

  Unsatisfactory

  N/A

• Hazardous Substances

  Satisfactory

  Unsatisfactory

  N/A

• Harness/Lanyard

  Satisfactory

  Unsatisfactory

  N/A

• Access Equipment Keys Removed

  Satisfactory

  Unsatisfactory

  N/A

• Materials On Site Stored Safely

  Satisfactory

  Unsatisfactory

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hats Being Worn

  Satisfactory

  Unsatisfactory

  N/A

• Safety Footwear Being Worn

  Satisfactory

  Unsatisfactory

  N/A

• Eye/Ear Protection - Correct Grade/Worn

  Satisfactory

  Unsatisfactory

  N/A

• High Visibility Clothing

  Satisfactory

  Unsatisfactory

  N/A

• Harness Worn/Weekly Check

  Satisfactory

  Unsatisfactory

  N/A

• Replacement PPE Available

  Satisfactory

  Unsatisfactory

  N/A

• PPE Issue Form Completed & Signed

  Satisfactory

  Unsatisfactory

  N/A

PLANT & EQUIPMENT

• Ladders/Steps

  Satisfactory

  Unsatisfactory

  N/A

• Fixed Scaffolds

  Satisfactory

  Unsatisfactory

  N/A

• Mobile Towers

  Satisfactory

  Unsatisfactory

  N/A

• Portable/Hand Tools

  Satisfactory

  Unsatisfactory

  N/A

• Power Cables Routed Safely

  Satisfactory

  Unsatisfactory

  N/A

• Scissor Lifts/Cherry Pickers

  Satisfactory

  Unsatisfactory

  N/A

WORKPLACE

• Safe Access/Egress From

  Satisfactory

  Unsatisfactory

  N/A

• Lighting General/Task

  Satisfactory

  Unsatisfactory

  N/A

• Site Tidiness/Waste Disposal

  Satisfactory

  Unsatisfactory

  N/A

• Fire Escape Routes Marked & Clear

  Satisfactory

  Unsatisfactory

  N/A

• Excavations Barriers

  Satisfactory

  Unsatisfactory

  N/A

ADMINISTRATION

• Method Statement Correct

  Satisfactory

  Unsatisfactory

  N/A

• Risk Assessment Communicated

  Satisfactory

  Unsatisfactory

  N/A

• Plant/Equipment Inspection Records

  Satisfactory

  Unsatisfactory

  N/A

• Site Inductions

  Satisfactory

  Unsatisfactory

  N/A

• Training Records

  Satisfactory

  Unsatisfactory

  N/A

• Tool Box Talks Completed

  Satisfactory

  Unsatisfactory

  N/A

• All Accidents Reported/Recorded

  Satisfactory

  Unsatisfactory

  N/A

• Select date

  Date

• Inspectors Signature

  Sign