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
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
- Front Entrance (1)
- Male Changing Room (26)
- Female Changing Room (31)
- Pool Plant Room (?)
- Bottom Of Functional Stairs (46)
- Functional Room (77)
- Studio (72)
- Bottom Of Studio Stairs (34)
- Top Of Gym Stairs By Lift (100)
- Entrance To Functional Room (67)
- Entrance To Studio Room (53)
- Ruby Slippers (Main Entrance) (91)
- Ruby Slippers (Store Room) (90)
- 3rd Floor Old Auditorium (?)
- Top Of Building - Roof (?)
-
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
