Boden SAFE - MOT Inspections Form

• Person receiving the SAFE MOT

  Select

• Team

  Select Amesbury Commercial Finance Fire and Security FM Commercial HR Portsmouth SHEQ

  • Amesbury
  • Commercial
  • Finance
  • Fire and Security
  • FM Commercial
  • HR
  • Portsmouth
  • SHEQ

• Conducted on

  Date

• Checked by

• Location
  Address

SAFE Presentation

• Has this person received the SAFE Presentation?

  Yes

  No

• Has this person signed the SAFE Charter?

  Yes

  No

• Has this person got any ideas to improve health and safety or other operations?

  Yes

  Not at the moment

• Provide Details

PPE Check

• Has the person got PPE

  Yes

  N/A

• List PPE

  Select Hard Hat Bump Cap Ear defenders Ear plugs Safety Glasses Goggles RPE - face masks Waterproof coat Trousers Knee Pads Gloves Gauntlets Safety Boots Protective coveralls other

  • Hard Hat
  • Bump Cap
  • Ear defenders
  • Ear plugs
  • Safety Glasses
  • Goggles
  • RPE - face masks
  • Waterproof coat
  • Trousers
  • Knee Pads
  • Gloves
  • Gauntlets
  • Safety Boots
  • Protective coveralls
  • other

• List Other PPE Provided

• Has the person got PPE and is it in good order and matches the PPE Matrix requirements?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has the person got Respirators - is this suitable for work undertaken and person?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has the Respirator got an asset number, on safety culture register and inspected within the last month?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• If respirator is a half mask is there a valid face fit test - within last 2 years?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has the person holding a Safety Harness? If so is this stored correctly?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has the safety harness got an asset number, on safety culture register and been inspected in the last 3 months?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Any issues raised or PPE not covered in above questions -provide details here.

MOT

• Type of Worker

  Operational - Mobile Van

  Operational - Site Based Van

  Office Based person

• Does the person know where the Notice board is?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the person know what the emergency arrangements are for the office (first aid, fire, business continuity etc.?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the person know how to request a DSE assessment or eye test?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has the person had a DSE assessment in the last 2 years?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Have they got any issues with their work station?

• Do they know how to get on the QMS and where to find policy, procedures, standard forms and guidance?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Vehicles

• Do you drive a company vehicle?

  Yes

  N/A

• Does the vehicle have the drivers handbook in the glove compartment?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the driver have Quartix and undertaken a vehicle inspection in the last week?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the driver know how to report road traffic accidents?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the vehicle in good order and any issues already reported on Quartix?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the vehicle clean and tidy inside and outside?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Emergency Equipment

• What emergency equipment do you have?

  first aid kit

  spills kits

  fire extinguisher

  Asbestos emergency kit

  other

• Are all emergency equipment good condition and stored so it can be located quickly?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are First Aid kits and fire extinguishers inspected and in date -not tampered with?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide details of any other emergency equipment

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

COSHH

• Do they have COSHH items

  Yes

  N/A

• Photo of COSHH items

  Media

• Are all COSHH items covered by a Boden COSHH Assessment?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are all COSHH items stored correctly to prevent spills and prevent damage during storage?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Access Equipment

• Do they have any access equipment

  Yes

  N/A

• Do they have any access equipment?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has it been inspected in the last 6 months?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has it got a inspection tag on it which demonstrates the inspection?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the access equipment in good order and stored correctly?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Calibrated Tools

• Identify all calibrated tools (or tools which should be calibrated)

  Select N/A Kewtech Voltage Tester - KT1790 Anemometer 410 Flue Analiser -Testo Voltage Indicator -VI-13800 Voltage Indicator - Fluke T90 Fluke MFT 1600 Megger MFT 1700 Multimeter Fluke 115 Clamp meter Fluke 323 Kewtech Check Box Recovery Unit Refco Gauge - Refco Nitro Regulator Refco Manifold -Refco Manifold Javac Gauge Javac E-Manifold Refco Scales - SuperECO Leak Detector - Refrigerator - TekMate Leak Detector - Refrigerator Testo 316-3 Leak detector - Gas Kane Leak detector - Gas Testo 316-3 Gas Analyser Pro 1 Thermometer - DT-3630 Thermometer - Comark C48 Monmeter Anton APM155 Sound meter -Standard Light meter - EXTECH LT40 Light meter RS180-7133 Light meter ISO-TECH ILM1337 Vibration meter - Vb001 PAT Tester Megger other

  • N/A
  • Kewtech Voltage Tester - KT1790
  • Anemometer 410
  • Flue Analiser -Testo
  • Voltage Indicator -VI-13800
  • Voltage Indicator - Fluke T90
  • Fluke MFT 1600
  • Megger MFT 1700
  • Multimeter Fluke 115
  • Clamp meter Fluke 323
  • Kewtech Check Box
  • Recovery Unit Refco
  • Gauge - Refco
  • Nitro Regulator Refco
  • Manifold -Refco
  • Manifold Javac
  • Gauge Javac
  • E-Manifold Refco
  • Scales - SuperECO
  • Leak Detector - Refrigerator - TekMate
  • Leak Detector - Refrigerator Testo 316-3
  • Leak detector - Gas Kane
  • Leak detector - Gas Testo 316-3
  • Gas Analyser Pro 1
  • Thermometer - DT-3630
  • Thermometer - Comark C48
  • Monmeter Anton APM155
  • Sound meter -Standard
  • Light meter - EXTECH LT40
  • Light meter RS180-7133
  • Light meter ISO-TECH ILM1337
  • Vibration meter - Vb001
  • PAT Tester Megger
  • other

• Provide details of any tool not listed

• Do the tools have an asset tag and a suitable calibration certificate with them?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are they stored securely and in good order?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide details of any issues not already covered.

Work Tools

• Identify all work power tools

  Select Angle Grinder Battery Charger Circular Saw - 240V Circular Saw 110V Clamp Meter Combi Drill Combination Hammer Drill Drain Jet (large) Drain Jet (small) Impact Driver Jigsaw 240V Jigsaw 110V Planner 240V Planner 110V Router 240V Router 110V Sander SDS Drill Wet and Dry Hoover Charger Transformers other No Tools present

  • Angle Grinder
  • Battery
  • Charger
  • Circular Saw - 240V
  • Circular Saw 110V
  • Clamp Meter
  • Combi Drill
  • Combination Hammer Drill
  • Drain Jet (large)
  • Drain Jet (small)
  • Impact Driver
  • Jigsaw 240V
  • Jigsaw 110V
  • Planner 240V
  • Planner 110V
  • Router 240V
  • Router 110V
  • Sander
  • SDS Drill
  • Wet and Dry Hoover
  • Charger
  • Transformers
  • other
  • No Tools present

• Provide details of any tool not listed

• Do the tools have an asset tag and a suitable inspections certificates or PAT test stickers with them as appropriate?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are they stored securely and in good order?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide details of any issues not already covered.

Vehicles

• Do you drive a company vehicle?

  Yes

  N/A

• Does the vehicle have the drivers handbook in glove compartment?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the drive have Quartix and undertaken vehicle inspection in the last week?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the driver know how to report road traffic accidents?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the vehicle in good order and any issues already reported on Quartix?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the vehicle clean and tidy inside and outside?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Emergency equipment

• What emergency equipment do you have?

  Select first aid kit spills kits fire extinguisher Asbestos emergency kit other

  • first aid kit
  • spills kits
  • fire extinguisher
  • Asbestos emergency kit
  • other

• Are all emergency equipment good condition and stored so it can be located quickly?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are First Aid kits and fire extinguishers inspected and in date -not tampered with?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide details of any other emergency equipment.

COSHH

• Do they have any COSHH items

  Yes

  N/A

• Photo all COSHH items

  Media

• Are all COSHH items covered by a Boden COSHH Assessment?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are all COSHH items stored correctly to prevent spills and prevent damage during storage?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Access Equipment

• Does they have ladders or access equipment?

  Yes

  N/A

• Has it been asset tagged and listed on SafetyCulture ?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has it been inspected in the last 6 months?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Has it got a inspection tag on it which demonstrates the inspection?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Is the access equipment in good order and stored correctly?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Calibrated tools

• identify all calibrated tools (or tools which should be calibrated)

  Select N/A Kewtech Voltage Tester - KT1790 Anemometer 410 Flue Analiser -Testo Voltage Indicator -VI-13800 Voltage Indicator - Fluke T90 Fluke MFT 1600 Megger MFT 1700 Multimeter Fluke 115 Clamp meter Fluke 323 Kewtech Check Box Recovery Unit Refco Gauge - Refco Nitro Regulator Refco Manifold -Refco Manifold Javac Gauge Javac E-Manifold Refco Scales - SuperECO Leak Detector - Refrigerator - TekMate Leak Detector - Refrigerator Testo 316-3 Leak detector - Gas Kane Leak detector - Gas Testo 316-3 Gas Analyser Pro 1 Thermometer - DT-3630 Thermometer - Comark C48 Monmeter Anton APM155 Sound meter -Standard Light meter - EXTECH LT40 Light meter RS180-7133 Light meter ISO-TECH ILM1337 Vibration meter - Vb001 PAT Tester Megger other

  • N/A
  • Kewtech Voltage Tester - KT1790
  • Anemometer 410
  • Flue Analiser -Testo
  • Voltage Indicator -VI-13800
  • Voltage Indicator - Fluke T90
  • Fluke MFT 1600
  • Megger MFT 1700
  • Multimeter Fluke 115
  • Clamp meter Fluke 323
  • Kewtech Check Box
  • Recovery Unit Refco
  • Gauge - Refco
  • Nitro Regulator Refco
  • Manifold -Refco
  • Manifold Javac
  • Gauge Javac
  • E-Manifold Refco
  • Scales - SuperECO
  • Leak Detector - Refrigerator - TekMate
  • Leak Detector - Refrigerator Testo 316-3
  • Leak detector - Gas Kane
  • Leak detector - Gas Testo 316-3
  • Gas Analyser Pro 1
  • Thermometer - DT-3630
  • Thermometer - Comark C48
  • Monmeter Anton APM155
  • Sound meter -Standard
  • Light meter - EXTECH LT40
  • Light meter RS180-7133
  • Light meter ISO-TECH ILM1337
  • Vibration meter - Vb001
  • PAT Tester Megger
  • other

• provide details of any tool not listed

• Do the tools have an asset tag and a suitable calibration certificate with them?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are they stored securely and in good order?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide any issues not already covered?

Work Tools

• identify all work power tools

  Select Angle Grinder Battery Charger Circular Saw - 240V Circular Saw 110V Clamp Meter Combi Drill Combination Hammer Drill Drain Jet (large) Drain Jet (small) Impact Driver Jigsaw 240V Jigsaw 110V Planner 240V Planner 110V Router 240V Router 110V Sander SDS Drill Wet and Dry Hoover Charger Transformers other No Tools present

  • Angle Grinder
  • Battery
  • Charger
  • Circular Saw - 240V
  • Circular Saw 110V
  • Clamp Meter
  • Combi Drill
  • Combination Hammer Drill
  • Drain Jet (large)
  • Drain Jet (small)
  • Impact Driver
  • Jigsaw 240V
  • Jigsaw 110V
  • Planner 240V
  • Planner 110V
  • Router 240V
  • Router 110V
  • Sander
  • SDS Drill
  • Wet and Dry Hoover
  • Charger
  • Transformers
  • other
  • No Tools present

• provide details of any tool not listed

• Do the tools have an asset tag and PAT test?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Are they stored securely and in good order?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Provide any issues not already covered.

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

General MOT Section

• Has the person completed all training on matrix?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• List training required - action where training is needed

• Has the person got any concerns or comments on training?

• Has the person got access to all relevant risk assessments, safe systems of work, Method Statements or site rules relevant to their work and location?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

• Does the person know how to report injuries, incidents, hazards/shout outs?

  Select best practice compliant issues which could be resolved at time of MOT fail repeat failures N/A

  • best practice
  • compliant
  • issues which could be resolved at time of MOT
  • fail
  • repeat failures
  • N/A

Sign Off

• Has the person got any questions, comments or suggestions for improving health and safety?

  Yes

  Not at the moment

• Provide details

• Signature of Person receiving the MOT

  Sign