Title Page
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Conducted on
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Prepared by
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Location
Inspection:
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Has the previous monthly workplace inspection been conducted, completed, signed off and any outstanding items transferred to this monthly inspection?
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Is appropriate H&S information readily available for staff? (Evidence of shift briefs, notice boards, top area risks, posters etc)
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Are computer workstations set up correctly and DSE assessments completed for individuals classified as ‘users’? (Individual or generic assessment recorded on eRA system)
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Are first aiders clearly identified with contact numbers displayed? (First aid assessment completed, First aid personnel with current training)
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Are first aid supplies available? (First aid kit content IAW minimum contents checklist (HS-A11-WI.1 Appendix 1. Time ex items within date)
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Are welfare facilities clean, tidy, adequate and in good repair? (Kitchen, toilets, disabled facilities, rest changing rooms, lighting, temperature)
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Are electrical installations & appliances free from damage? (Wall sockets, plugs, and cables free from damage. Where applicable – test/ guides & manuals > safety & security > H&S manual > section J4.2.5)
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Are break glass alarm points and fire fighting equipment easily accessible, free from obstructions? (Fire extinguishers in date)
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Are fire door vision panels clear and door closing mechanisms functioning correctly?
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Are safety signs correctly displayed, legible and in good condition? (Emergency evacuation, fire points, warning signs etc)
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Are floors, stairs, fire doors, walkways and evacuation routes free from obstructions and trip hazards?
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Is there defective equipment identified and reported?
Additional Comments
Action Report
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Item
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Finding
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Action taken (include defect number if applicable)
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Complete (Name/date) If not complete - Item to be transferred to following inspection form.
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Item
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Finding
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Action taken (include defect number if applicable)
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Complete (Name/date) If not complete - Item to be transferred to following inspection form.
Page 3 of 4
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Name of Manager/Nominee:
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Signature:
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Date:
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Name of Safety Rep:
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Signature:
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Date:
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Name of Operations/Team
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Signature:
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Date:
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NOTE: Workplace inspections to be stored locally for a minimum of 3 years. Operations Manager, or equivalent, participation required quarterly