Barwon Valley Activity Centre - duplicate

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Front Entry & Main Walkway

• Level surface?

  Yes

  No

  N/A

• Are all floor surfaces clean and up to standard?

  Yes

  No

  N/A

• Is floor surface free from cracking, lifting or damage?

  Yes

  No

  N/A

• Surface not slippery?

  Yes

  No

  N/A

• Clean & free of producing objects

  Yes

  No

  N/A

• Walls from cracks

  Yes

  No

  N/A

• Doors operational, safe & secure?

  Yes

  No

  N/A

• Press no and explain if there are other items that require attention. Press yes if compliant

  Yes

  No

  N/A

• All areas free of cobwebs and dust?

  Yes

  No

  N/A

Courts 1&2

• Level Surface?

  Yes

  No

  N/A

• Surface not slippery?

  Yes

  No

  N/A

• Floor surface free from cracking, lifting or other damage?

  Yes

  No

  N/A

• Futsal goals safe & secure?

  Yes

  No

  N/A

• Stadium seating safe & secure?

  Yes

  No

  N/A

• Divider curtain safe & secure?

  Yes

  No

  N/A

• Score bench equipment safe & operational?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Press no and explain if there are other items that require attention. Press yes if compliant

  Yes

  No

  N/A

• Other equipment in working order & clean?

  Yes

  No

  N/A

Courts 3 & 4

• Level Surface?

  Yes

  No

  N/A

• Floor surface free from cracking, lifting or other damage?

  Yes

  No

  N/A

• Are all cobwebs and dust removed?

  Yes

  No

  N/A

• Surface not slippery?

  Yes

  No

  N/A

• Stadium seating safe & secure?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Basketball rings safe and secure?

  Yes

  No

  N/A

• Walls free from defect or protruding objects?

  Yes

  No

  N/A

• Doors operational, safe & secure?

  Yes

  No

  N/A

• Press no and explain if there are other items that require attention. Press yes if compliant

  Yes

  No

  N/A

Office / Canteen

• Level surface?

  Yes

  No

  N/A

• Floor surface free from cracking, lifting or frayed edges?

  Yes

  No

  N/A

• Walls & windows clean & free from defect or protruding objects?

  Yes

  No

  N/A

• Windows clean from posters?

  Yes

  No

  N/A

• Windows free of cracks?

  Yes

  No

  N/A

• Window frames & seals in good condition?

  Yes

  No

  N/A

• Doors operational, safe & secure?

  Yes

  No

  N/A

• Light fittings in place & secure?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

• Press no and explain if there are other items that require attention. Press yes if compliant

  Yes

  No

  N/A

• Emergency lighting in working order & available?

  Yes

  No

  N/A

Change rooms & toilets

• Level surface?

  Yes

  No

  N/A

• Floor surface and free from cracking, lifting or frayed edges?

  Yes

  No

  N/A

• Walls free from defect or protruding objects?

  Yes

  No

  N/A

• Walls and windows free from poster

  Yes

  No

  N/A

• Window frames & seals in good condition?

  Yes

  No

  N/A

• Hand dryers safe and in working condition?

  Yes

  No

  N/A

• Press no and explain if there are other items that require attention. Press yes if compliant

  Yes

  No

  N/A

Emergency Operations

• Fire extinguishers in place, pressure checked & serviced?

  Yes

  No

  N/A

• Smoke detectors in place & operational?

  Yes

  No

  N/A

• Evacuation instructions clearly displayed?

  Yes

  No

  N/A

• Emergency evacuation training carried out in the last 12 months?

  Yes

  No

  N/A

Evacuation kits checklist

• Safery manual (red folder)

• Emergency phone numbers (in red folder)

• Emergency Evacuation Plan (in red folder)

• Evacuation Checklist (in red folder)

• Chief Warden caps

• Area Warden caps

• Torch with batteries

• Permanent Marker

• Adult Resuscitation mask x 1

• Gloves x 2 pairs

• Band aids x 10

• Dressing Strip 7.5 x 1m

• Triangular bandage x 1

• Eye wash solution x 5

• Eye pad x 1

• Crepe bandage 7.5cm x 1.5m x1

• Heavy crepe bandage 7.5cm x 2.3m x 1

• Leucoplast tape 2.5cm x 1

• Dressing sterile 7.5cm x 10cm x 1

• Dressing sterile 7.5 x 5cm x 1

• Gauze swabs x 15

• Gauze bandage 5cm x 1

• Gauze bandage 7.5cm 1.8m x 1

• Steri stips x 1 sheet

• Transparent island dressing 7.2cm x 5cm

• Combine pad x 1

• Cotton tips x 3

• Blood spill kit x 1

• Burns Module x 1

• Wound Dressing No. 13 x 1

• Wound dressing No 14 x 1

• Would dressing no. 15 x 1

• Liquid Antiseptic spray x 1

• Safety pins x 3

• Surgical scissors x 1

• Tweezers x 1

• Splinter probes x 1

• Pen x 1

• Notepad x 1

• Permanent Marker

• Audit completed by:

• Signature

  Sign