Title Page

  • Client

  • Site

  • Conducted on

  • Prepared by

  • Location

Electrical

  • Q.1 - Are Records of changes to installations carried out by a registered electrician?

  • Q.2 - Where required, is the site Fixed Electrical Installation Certificate available?

  • Q.3 - Where required, are records available for the testing of earthing systems?

  • Q.4 - Are Lightning Protection Inspection records available for site?

  • Q.5 - Are electricians competence records available?

  • Q.6 - Are HV Equipment Operation records available for the site?

  • Q.7 - Are Appointment Certificates in place for HV Authorised Competent Engineers?

  • Q.8 - Are LOTO kits and proving equipment available?

Water Hygiene

  • Q.1 - Where required, have Water Hygiene Risk Assessments been carried out?

  • Q.2 - Are Cooling Towers notified to authorities where required by legislation?

  • Q.3 - Are Dipslide / Bioscan results available for site?

  • Q.4 - Are Clean / Chlorination Records (Cooling Towers) available for site?

  • Q.5 - Are Legionella Test Records (Cooling Towers) available for site?

  • Q.6 - Are TVC Test Records (Cooling Towers) available for site?

  • Q.7 - Are Clean / Chlorinated Records (Domestic System) available for site?

  • Q.8 - Are Legionella Test Records (Domestic System) available for site?

  • Q.9 - Are TVC Test Records (Domestic Systems) available for site?

  • Q.10 Tap Temperatures

  • Q.11 Flushing of Little used Outlets

Fire

  • Q.1 - Are Emergency Lighting Test Records available for site?

  • Q.2 - Are Fire / Smoke Detection, Alarm System Inspection / Maintenance records available for site?

  • Q.3 - Are Sprinkler System Inspection / Maintenance records available for site?

  • Q.4 - Are records of Sprinkler Main Pump Tests available for site?

  • Q.5 - Are Fire Suppression System (Ansul / Mist / Gas) Test Records available for site?

  • Q.6 - Are Room Integrity Test Records available for site?

  • Q.7 - Are High Pressure Cylinder Inspection Records available for site?

  • Q.8 - Are Fire Extinguisher / Fire Blanket Inspection / Maintenance records available for site?

  • Q.9 - Are Hose Reel Inspection / Maintenance records available for site?

  • Q.10 - Are Wet / Dry Riser Inspection / Maintenance records available for site?

  • Q.11 - Are Fire Door Inspection / Maintenance records available for site?

  • Q.12 - Are records of Stairwell Pressurisation System Checks available for site?

  • Q.13 - Is a Fire Risk Assessment available for site and have all actions been addressed?

  • Q.14 - If breaches in fire stopping have been identified has corrective action been taken?

Asbestos

  • Q.1 - Has an Asbestos Survey been carried out where ACM's may be present on site?

  • Q.2 - Is there an Asbestos Management Plan in place?

  • Q.3 - Are Re-Inspections against the Asbestos Register carried out as per the Asbestos Management Plan?

F Gas

  • Q.1 - Is there an FGas Register in place?

  • Q.2 - Are Refrigeration System Maintenance Records in place?

  • Q.3 - Are Leak Test Records in place for FGas Systems

  • Q.4 - Is Refrigerant Usage for FGas Systems recorded?

Environmental/Waste

  • Q.1 - Has an Initial Environmental Review for the site been been undertaken?

  • Q.2 - Have Operational Control Procedures been documented for significant aspects?

  • Q.3 - Is there a Pollution Prevention Response Plan in place?

  • Q.4 - Are Environmental Permits in place (Discharge Consent, Abstraction Licence, Fuel Storage, etc)?

  • Q.5 - Have relevant Waste Producers Notifications been obtained?

  • Q.6 - Are Vendors' Waste Carriers Licences available?

  • Q.7 - Is an Annual Transfer Note / Season Ticket in place for general waste streams / recycling?

Lifting Equipment

  • Q.1 - Inspection & Examination of Lifts & Escalators

  • Q.2 - Inspection & Examination of Lifting Equipment

  • Q.3 - Inspection & Examination of Lifting Accessories

  • Q.4 - Maintenance, Inspection & Examination of MEWPs

Other Services

  • Q.1 - Are Written Schemes of Examination for Pressure Systems in place and valid?

  • Q.2 - Have Insurance Inspections been carried out for Pressure Systems as per the Written Scheme?

  • Q.3 - Are Maintenance records in place for Combustion Systems / Boilers

  • Q.4 - Has the maintenance of Combustion Systems / Boilers been carried out by Competent Persons?

  • Q.5 - Are Maintenance records in place for Latchway Systems?

  • Q.6 - Are Maintenance records in place for Runway Systems / Cradles?

  • Q.7 - Are Maintenance records in place for Eyebolts?

  • Q.8 - Are Maintenance records in place for Local Exhaust Ventilation (LEV)?

  • Q.9 - Has a Noise Survey / Noise Risk Assessment been carried out where noise levels may exceed 85db(A)?

  • Q.10 - Are Indoor Air Quality Testing Records available where required by Risk Assessment / in country legislation?

QHSE Site Walk

  • Q.1 - Are Emergency Exits available and properly identified?

  • Q.2 - Are Emergency Routes clear and free from obstruction?

  • Q.3 - Are fire extinguishers easily located and unobstructed?

  • Q.4 - Are fire extinguishers located at their designated points?

  • Q.5 - Are overhead sprinkler/detectors clear of obstructions, stores etc.?

  • Q.6 - Are electrical plugs, leads, sockets and switches in good repair?

  • Q.7 - Is there adequate lighting for the work undertaken?

  • Q.8 - Is mechanical equipment available for lifting heavy loads?

  • Q.9 - Are materials stored on shelves or in storage rooms as appropriate?

  • Q.10 - Are hazardous materials clearly and correctly marked?

  • Q. 11 - Are minimum quantities of hazardous materials stored in the workplace, in proper bunded storage areas?

  • Q. 12 - Are sufficient supplies of absorbent material for treating oil/fuel spillages available?

  • Q.13 - Are plant rooms clear of rubbish, materials and locked?

  • Q. 14 - Is roofing in good condition, with safe access to plant, and appropriate edge protection in place?

  • Q. 15 - Are fragile surfaces clearly marked and protected if requried?

  • Q.16 - Do floors have even surfaces [no cracks or holes]?

  • Q.17 - Are the floors and aisles clear of rubbish, materials and equipment?

  • Q. 18 - Are walkways free of trip hazards ?

  • Q. 19 - Are stairs in good condition?

  • Q. 20 - Are handrails in good repair?

  • Q. 21 - Are carpets and floor coverings in good condition?

  • Q. 22 - Can all plant be safely accessed?

  • Q.23 - Is safe access/egress available to all plant rooms e.g. steps in place if needed?

  • Q. 24 - Area roads clear and without debris?

  • Q. 25 - Are pedestrian routes and roads free from build up of water?

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.