• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Details of Merit Request

  • Business Unit

  • Merit No

  • Date council notified of hazard / defect

  • Site name / Location

  • Customer Name

  • Customer Address

  • Customer contact details

  • Request details

  • Customer requested feedback

  • Feedback provided to customer

  • Quality of feedback provided

  • Factual comments no interpretation

Inspection / Completion Details

  • Inspected / Actioned by

  • Inspection / Action Date

  • Detail of action taken

  • Date work completed

  • Hazard / Defect Description & Risk Rating

Assessment details

  • Percentage of job completed

  • Performed within time frames

  • Standard of work completed observation notes

  • 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

  • Identified additional work required

  • Assessor's comments

  • Assessment Officer

  • Assessment officer signature

  • Date of Assessment

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.