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

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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
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.