Information

  • Conducted on

Weekly Panic Alarm Check

  • Date & Time Completed

Panic Alarm Check

  • Disabled Change

  • Poolside - Middle Of Pool; Male Change Side

  • Sauna - Outside

  • Sauna - Inside

  • Poolside - Middle Of Pool; Female Change Side

  • Lift - Local Alarm Only

  • Gym - Near To Evac+Chair

  • Functional Room

  • Studio

  • Ruby Slippers

  • Plant Room

  • Any Actions / Notes From Test

  • Write Name & Signature Of Person Completing Check

Weekly AED Check

  • Date & Time Completed

LifePak CR Plus AED Serial Number: -

  • Automatic Self-Test
    The LIFEPAK CR Plus Defibrillator tests itself each week and every time you turn it on. In addition,
    every month, the defibrillator performs a more extensive self-test. This self-test checks the defibrillator’s
    circuitry to verify that it is ready for use.

  • AED Rescue Ready (Showing OK On The LCD Screen) & No Faults Found

  • Check Physical Structure For Any Damage

  • Check Pads are In Date

  • In Correct Location, Response Kit Sealed & Attached To AED

  • Write Name & Signature Of Person Completing Check

Pool Extraction Board (PXB)

  • Date Completed

  • Royal Life Saving Society Pool Extraction Board

    347-500-347-500-0-0-10242.jpg

Pool Extraction Board (PXB) Readiness for Use Check Sheet

  • Straps - Ensure strap and stored in the closest position and are not rolled, wrapped, folded*. Ensure straps are free from damage

  • Head Blocks - Ensure blocks and VELCRO is in place. Ensure head blocks are free from damage

  • Head Block Strap - Ensure strap is attached to head block. Ensure head block strap are free from damage

  • Anchor Mat & Fixing Plate - Ensure Anchor mat is free from damage and fixing plate is secure

  • Back Pad - Ensure back pad is free from damage

  • Bungs - Ensure bungs are free from damage and secure

  • Bracket - Ensure bracket is free from damage and secure

  • Write Name & Signature Of Person Completing Check

Weekly First Aid Checks

  • Date & Time Completed

First Aid Box Checks

Reception - First Aid Kit

  • Is The Kit Sealed?

  • Accident Report Forms (5)

  • Sterile Dressing (Large) (2)

  • Sterile Dressing (Medium) (2)

  • Eye Pads (2)

  • Triangular Bandages (3)

  • A Selection of Plasters (20 / 2 Packs)

  • Medi Wipes (10)

  • Face Shield (2)

  • Pair of Gloves (6)

  • Eye Wash Sachet (2)

  • Tuff Cut Scizzors (1)

  • Ice Packs (2)

  • Yellow Bags (2)

  • Heat Retaining Blanket (2)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Staff Room - First Aid Kit

  • Is The Kit Sealed?

  • Accident Report Forms (5)

  • A Selection of Plasters (20 / 2 Packs)

  • Sterile Dressing (Medium) (2)

  • Sterile Dressing (Large) (2)

  • Eye Pads (2)

  • Triangular Bandages (3)

  • Medi Wipes (10)

  • Face Shield (2)

  • Pair of Gloves (6)

  • Eye Wash Sachet (2)

  • Tuff Cut Scizzors (1)

  • Ice Packs (2)

  • Yellow Bags (2)

  • Heat Retaining Blanket (2)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Staff Room - Bio hazard Kit

  • Is The Kit Sealed?

  • Disinfectant Trigger Spray

  • Super Absorbent Granules

  • Pair of Gloves (5)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Cleaning Cupboard - Eye Wash Station

  • Eye Wash Station - Is The Station Stocked & Safe To Use?

Poolside - First Aid Kit

  • Is The Kit Sealed?

  • Accident Report Forms (5)

  • A Selection of Plasters (20 / 2 Packs)

  • Sterile Dressing (Medium) (2)

  • Sterile Dressing (Large) (2)

  • Eye Pads (2)

  • Triangular Bandages (3)

  • Medi Wipes (10)

  • Face Shield (2)

  • Pair of Gloves (6)

  • Eye Wash Sachet (2)

  • Tuff Cut Scizzors (1)

  • Ice Packs (2)

  • Yellow Bags (2)

  • Heat Retaining Blanket (2)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Gym - First Aid Kit

  • Is The Kit Sealed?

  • Accident Report Forms (5)

  • A Selection of Plasters (20 / 2 Packs)

  • Sterile Dressing (Medium) (2)

  • Sterile Dressing (Large) (2)

  • Eye Pads (2)

  • Triangular Bandages (3)

  • Medi Wipes (10)

  • Face Shield (2)

  • Pair of Gloves (6)

  • Safety Pins (6 / 1 Pack)

  • Eye Wash Sachet (2)

  • Tuff Cut Scizzors (1)

  • Ice Packs (2)

  • Yellow Bags (2)

  • Heat Retaining Blanket (2)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Plant Room - Eye Wash Station

  • Eye Wash Station - Is The Station Stocked & Safe To Use?

  • Write Name & Signature Of Person Completing Check

Weekly Call Point Test

  • Date & Time Completed

Call Point Test

  • Schedule:-
    Week 1: - Front Entrance, Male Changing Room, Female Changing Room & Pool Plant Room
    Week 2: - Bottom Of Functional Stairs, Function Room, Studio, Bottom Of Studio Stairs
    Week 3: - Top Of Gym Stairs By Lift, Entrance To Functional Room, Entrance To Studio
    Week 4: - Ruby Slippers Entrance, Rub Slippers Store Room, 3rd Floor, Roof Top
    Week 5: - Catch Up For Any Missed Tests

  • Select Call Point Tested

  • Audibility Indicators Working (Sounders)

  • Visual Indicators Working (Beacons)

  • Any Faults

  • Take A Picture Of The Fault

  • Contact Forward Control And Arrange An Engineer To Attend Site

  • Any Further Comments / Actions Needed? - Record N/A If Not

  • Write Name & Signature Of Person Completing Check

Weekly EEB Check

  • Date & Time Completed

Emergency Evacuation Bag Check; Including the SIMP

Serious Incident Management Pack, Emergency Action Plan & Building Plans

  • ENSURE THE PACK IS READ & CHECKED THOROUGHLY

  • Check That It's Up To Date, Not Defaced, Not Missing Anything, In Good Condition

  • Check The EAP is the most up to date copy, Not Defaced, Not Missing Anything, In Good Condition

  • Check The Building Plans are present, Not Defaced, Not Missing Anything, In Good Condition

Reception - First Aid Kit

  • Is The Kit Sealed?

  • Accident Report Forms (5)

  • Sterile Dressing (Large) (2)

  • Sterile Dressing (Medium) (2)

  • Eye Pads (2)

  • Triangular Bandages (3)

  • A Selection of Plasters (20 / 2 Packs)

  • Medi Wipes (10)

  • Face Shield (2)

  • Pair of Gloves (6)

  • Eye Wash Sachet (2)

  • Tuff Cut Scizzors (1)

  • Ice Packs (2)

  • Yellow Bags (2)

  • Heat Retaining Blanket (2)

  • Has The Kit Been Re-Stocked & Re-Sealed?

Emergency Equipment - Check Quantities (In Zipped Pocket)

  • 5x High Visibility Vests - Checking That They Are In Good Condition, Clean Etc

  • 4x Main Torch - Check Is In Good Working Order, Casing Not Cracked & Clean

Consumables / Supporting Equipment - Check Quantities

  • Notepad & Paper - Check In Good Condition, 2x Pens Working

  • Any Issues Highlighted, Corrected & Kit Fully Stocked

  • Write Name & Signature Of Person Completing Check

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.