CGD - Merit Request Inspections

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Details of Merit Request

• Business Unit

  Yes

  No

  N/A

• Merit No

  Yes

  No

  N/A

• Date council notified of hazard / defect

  Yes

  No

  N/A

• Site name / Location

  Yes

  No

  N/A

• Customer Name

  Yes

  No

  N/A

• Customer Address

  Yes

  No

  N/A

• Customer contact details

  Yes

  No

  N/A

• Request details

  Yes

  No

  N/A

• Customer requested feedback

  Yes

  No

  N/A

• Feedback provided to customer

  Yes

  No

  N/A

• Quality of feedback provided

  Yes

  No

  N/A

• Factual comments no interpretation

  Yes

  No

  N/A

Inspection / Completion Details

• Inspected / Actioned by

  Yes

  No

  N/A

• Inspection / Action Date

  Yes

  No

  N/A

• Detail of action taken

  Yes

  No

  N/A

• Date work completed

  Yes

  No

  N/A

• Hazard / Defect Description & Risk Rating

Assessment details

• Percentage of job completed

  Yes

  No

  N/A

• Performed within time frames

  Yes

  No

  N/A

• Standard of work completed observation notes

  Yes

  No

  N/A

• Standard of work completed rating scale: 0 Not applicable 1 excellent. 2 very. good. 3 good. 4 poor. 5 very poor

• Storyboard comments clear and concise

  Yes

  No

  N/A

• Identified additional work required

  Yes

  No

  N/A

• Assessor's comments

  Yes

  No

  N/A

• Assessment Officer

  Yes

  No

  N/A

• Assessment officer signature

  Sign

• Date of Assessment

  Yes

  No

  N/A