Title Page

  • Site conducted

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • INSTRUCTIONS

    1. Please answer "Yes", "No" or "N/A" on the questions below.
    2. Add Photos and Comment by clicking on the paperclip icon
    3. To add a Corrective Action click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

Technicians

  • 1 Appearance to high standard.

  • 2 Work standard to high standard.

  • 3 Correct PPE issued and inspected.

PPM

  • 4 Schedule up to Date.

  • 5 Plant Labels if Used.

  • 6 Sample PPM Tasks Checked and satisfactory.

  • 7 Contractor Authorisation to Work / Induction completed and satisfactory.

  • 8 Sample Contractor PPM Tasks Checked.

  • 9 Contractor appearance satisfactory.

  • 10 Contractor conduct satisfactory.

  • 11 Contractor punctuality satisfactory.

  • 12 Contractor work standard satisfactory.

Call-out

  • 13 Call out rota in place and valid.

  • 14 Call out rota known by Client/Security/Office.

  • 15 All areas clear, good standards observed.

Tools

  • 16 Technicians tools in safe condition.

  • 17 Tools lists up to date.

  • 18 Guarding in place.

  • 19 Emergency Stops operational.

  • 20 New calibration certificates sent to Regional Office.

Safety

  • 21 Incidents reviewed & results sent to H & S Manager.

  • 22 Risk Assessments/Method Statements up to date.

  • 23 New Hazards to assess.

  • 24 Permits in use where applicable.

  • 25 Work Areas (Access & Egress).

  • 26 Compressed Gas Cylinders stored according to in country legislation.

  • 27 Warning Notices / Emergency Procedures defined.

  • 28 Temperature, Ventilation & Lighting.

Training

  • 29 Training records up to date.

  • 30 Tool Box talks held.

Electrical

  • 31 Are Records of changes to installations carried out by a registered electrician.

  • 32 Where required, is the site Fixed Electrical Installation Certificate available.

  • 33 Are electricians competence records available.

  • 34 Are Lightning Protection Inspection records available for site.

  • 35 Are electricians competence records available.

  • 36 Are HV Equipment Operation records available for the site.

  • 37 Are Appointment Certificates in place for HV AC authorised Competent Engineers.

  • 38 Emergency Lighting Tested and Certificate available.

  • 39 Are LOTO Kits and Proving Equipment available.

Water Hygiene

  • 40 Where required, have Water Hygiene Risk Assessments been carried out.

  • 41 Are Cooling Towers notified to authorities where required by legislation.

  • 42 Are Dipslide / Bioscan results available for site?

  • 43 Are Clean / Chlorination Records (Cooling Towers) available for site.

  • 44 Are Legionella Test Records (Cooling Towers) available for site.

  • 45 Are TVC Test Records (Cooling Towers) available for site.

  • 46 Are Clean / Chlorinated Records (Domestic System) available for site.

  • 47 Are Legionella Test Records (Domestic System) available for site.

  • 48 Are TVC Test Records (Domestic Systems) available for site.

  • 49 Tap Temperatures taken and recorded, action taken if out of range.

  • 50 Are the calibration certificates on file.

  • 51 Flushing of little used outlets.

Fire

  • 52 Are Emergency Lighting Test Records available for site. √

  • 53 Are Fire / Smoke Detection, Alarm System Inspection / Maintenance records available for site.

  • 54 Are Sprinkler System Inspection / Maintenance records available for site.

  • 55 Are records of Sprinkler Main Pump Tests available for site.

  • 56 Are Fire Suppression System (Ansul / Mist / Gas) Test Records available for site.

  • 57 Are Room Integrity Test Records available for site.

  • 58 Are High Pressure Cylinder Inspection Records available for site.

  • 59 Are Fire Extinguisher / Fire Blanket Inspection / Maintenance records available for site.

  • 60 Are Hose Reel Inspection / Maintenance records available for site.

  • 61 Are Wet / Dry Riser Inspection / Maintenance records available for site.

  • 62 Are Fire Door Inspection / Maintenance records available for site.

  • 63 Are records of Stairwell Pressurisation System Checks available for site.

  • 64 Is a Fire Risk Assessment available for site and have all actions been addressed.

  • 65 If breaches in fire stopping have been identified has corrective action been taken.

  • 66 Fire Exits Clear, Evacuation Procedure in place.

Asbestos

  • 67 Has an Asbestos Survey been carried out where ACM's may be present on site.

  • 68 Is there an Asbestos Management Plan in place.

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

F-Gas

  • 70 Is there an FGas Register in place.

  • 71 Are Refrigeration System Maintenance Records in place.

  • 72 Are Leak Test Records in place for FGas Systems.

  • 73 Is Refrigerant Usage for FGas Systems recorded.

  • 74 Has an Initial Environmental Review for the site been been undertaken.

  • 75 Have Operational Control Procedures been documented for significant aspects.

  • 76 Is there a Pollution Prevention Response Plan in place.

  • 77 Are Environmental Permits in place (Discharge Consent, Abstraction Licence, Fuel Storage, etc).

  • 78 Have relevant Waste Producers Notifications been obtained.

  • 79 Are Vendors' Waste Carriers Licences available.

  • 80 Is an Annual Transfer Note / Season Ticket in place for general waste streams / recycling.

  • 81 Copies of all Consignment Notes & Controlled Waste Transfer Notes on file (covering a minimum of 3 years).

  • 82 Descriptions of waste correct.

  • 83 Waste adequately stored.

  • 84 Waste removed appropriately.

  • 85 Staff instructed to carry company Registered Waste Carrier certificate if transporting waste.

  • 86 Staff aware of procedures for safe removal of waste.

  • 87 Staff aware of emergency procedures relating to waste removal.

  • 88 Is site registered as producer of hazardous waste (office blocks & shops are exempt if hazardous waste weighs less than 500kg/year).

Lifting Equipment

  • 89 Inspection & Examination of Lifts & Escalators records available.

  • 90 Insection & Examination of Lifting Equipment records available.

  • 91 Insection & Examination of Lifting Accessories records available.

  • 92 Maintenance, Inspection & Examination of MEWPs records available.

Other Services

  • 93 Are Written Schemes of Examination for Pressure Systems in place and valid if applicable following in country legislation.

  • 94 Have Insurance Inspections been carried out for Pressure Systems as per the Written Scheme or in country equivalent.

  • 95 Are Maintenance records in place for Combustion Systems / Boilers.

  • 96 Has the maintenance of Combustion Systems / Boilers been carried out by Competent Persons.

  • 97 Are Maintenance records in place for Latchway Systems.

  • 98 Are Maintenance records in place for Runway Systems / Cradles.

  • 99 Are Maintenance records in place for Eyebolts.

  • 100 Are Maintenance records in place for Local Exhaust Ventilation (LEV).

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

  • 102 Are Indoor Air Quality Testing Records available where required by Risk Assessment / in country legislation.

Spill control

  • 103 Are bunds in place.

  • 104 Are Spill Kits available.

  • 105 Is PPE available.

  • 106 Are washing facilities available.

  • 107 Are Site Drainage Plans available.

  • 108 Are Drains identified to show foul & surface water.

  • 109 Are Pollution Prevention Procedures in place.

  • 110 Are emergency contact details available.

  • 111 Are Hazardous Substances Assessments available.

  • 112 Are Consignment Notes / Controlled Waste Transfer Notes available.

  • 113 Are incidents recorded / reported.

Hazardous Substances

  • 114 Inventory list of hazardous substances complied for site.

  • 115 Material Safety Data Sheets available for each item on the inventory list.

  • 116 Hazardous Substances Assessments available for each item on the inventory list.

  • 117 Hazardous Substances Assessment available at the storage location and/or points of use.

  • 118 Is appropriate PPE available.

  • 119 Are employees exposed to hazardous substances monitored where applicable.

  • 120 Is Health Surveillance of employees monitored and recorded where applicable.

Clean Air

  • 121 Is contract in an Air Quality Management Area or Smoke Control Area (check with Local Authority)? If yes, no smoke to be emitted.

  • 122 Are new boilers notified to local authority or other government body following in country legislation.

  • 123 Are there any Local Authority emission limits in place? If yes, are limits adhered to. (where issue arises e.g. boilers advised the client).

  • 124 Are boilers regularly serviced.

Ozone Depleting Substances

  • 125 Is all equipment containing ozone depleting substances properly serviced to prevent leaks.

  • 126 Are all ozone depleting substances recovered and recycled?

Tap Water

  • 127 Is an Operational Control in place.

  • 128 Has a water-sampling regime been established where necessary.

  • 129 Are the water sampling records in place.

  • 130 Are the calibration certificates on file?

Local/Third Party/Other Requirements

  • 131 Are Local/third party/other requirements being adhered to.

Operational Controls

  • 132 Are Operational Controls documented where applicable.

  • 133 Are Operational Controls communicated to staff.

  • 134 Are Operational Controls used & effective.

Hazards

  • 135 Hazard reporting records available and actions closed out.

Completion

  • General Comments/Observations:

  • Customer Comments:

  • Manager: (Name and Signature)

  • Customer: (Name and Signature)

  • On a scale of 1-10 (10 most likely), How likely would you be to recommend our services? Please select relevant number

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.