Title Page

  • Site conducted

  • Job / Document No.

  • Site Name

  • Site Address
  • Conducted on

  • Prepared by

  • Additional Information If Required:

GENERAL (to enter notes and pictures, select the space under the option to open up the fields)

  • Confirm the area affected by the leak has been made safe i.e. use of using barriers etc

  • List the area(s) of the store that has been affected by the leak? Please provide as much detail as possible

  • Is the leak coming from the air conditioning or other associated refrigeration / HVAC pipework

  • Is the leak close to any refrigeration systems or equipment that may present immediate danger requiring the refrigeration tech to attend

  • Is the leak close to any electrical systems or equipment that may present immediate danger requiring the electrician to attend

  • Add here pictures of the leak within the building

  • Confirm you have inspected all the gutters and that they are running clear

  • Provide picture of the guttering

  • Confirm you have inspected all the down spouts and that they are running clear

  • Add here pictures of the gutters and downpipes (include a picture from afar so that the complete area can be taken in)

  • If applicable make a simple sketch

  • Do you have any comments or recommendations?

ACCESS / EGRESS (to enter notes and pictures, select the space under the option to open up the fields)

  • Enter here as much information as possible so that the correct roof access / egress equipment can be organised

  • Take pictures of the space around all four sides of the building (include pictures from afar so that the complete area can be taken in)

WORKS COMPLETED (to enter notes and pictures, select the space under the option to open up the fields)

  • What work has been completed during this visit?

MANAGER COMMENTS (to enter notes and pictures, select the space under the option to open up the fields)

  • Confirm you have spoken to the manager (or their deputy) and agreed a course of action

  • Add here comments from the manager (or their deputy)

SIGNATURES

  • Signature of Fabric Tech:

  • Signature of the Site Manager (deputy):

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.