Title Page
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Site
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Conducted on
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Prepared by
1. Site Walk Around
Service yard and perimeter
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Visit made?
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Any identified remedials?
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Work order number
Colleague car park
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Visit made?
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Any identified remedials?
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Work order number
VMU
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Visit made?
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Any identified remedials?
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Work order number
Canteen and Kitchen
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Visit made?
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Any identified remedials?
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Work order number
Frozen chamber
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Visit made?
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Any identified remedials?
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Work order number
Chill Chamber
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Visit made?
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Any identified remedials?
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Work order number
Ambient
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Visit made?
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Any identified remedials?
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Work order number
Office areas
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Visit made?
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Any identified remedials?
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Work order number
Toilets and Lockers
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Visit made?
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Any identified remedials?
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Work order number
Roof void (If safe to access)
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Visit made?
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Any identified remedials?
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Work order number
De-kit
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Visit made?
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Any identified remedials?
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Work order number
Baler Area
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Visit made?
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Any identified remedials?
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Work order number
Bay doors
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Visit made?
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Any identified remedials?
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Work order number
Fuel island
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Visit made?
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Any identified remedials?
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Work order number
Vehicle wash
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Visit made?
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Any identified remedials?
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Work order number
Vehicle wash dosing station
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Visit made?
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Any identified remedials?
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Work order number
Refrigeration plant
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Visit made?
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Any identified remedials?
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Work order number
Condenser
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Visit made?
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Any identified remedials?
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Work order number
Condenser dosing station
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Visit made?
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Any identified remedials?
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Work order number
Gererators
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Visit made?
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Any identified remedials?
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Work order number
Sprinkler plant room
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Visit made?
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Any identified remedials?
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Work order number
Comms room
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Visit made?
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Any identified remedials?
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Work order number
Electrical switch room
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Visit made?
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Any identified remedials?
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Work order number
1.5 Site Remedials
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Are there any identified remedials currently on site? (If yes please add works reference, detail and any updates).
2. Existing Issues
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Are there any existing issues on site? (If yes please add detail and any updates including images)
2.5 RFM Notes
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Have you observed or identified any issues to raise with the operations? (If yes, please add detail including the location, images and updates)
3. Escalated business critical Health and Safety work orders
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Have there been any escalated business critical Health and Safety work orders raised on site? (If yes please add the work order number, site and detail)
4. Contractor Health and Safety Audit
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Have you completed 3 x contractor Health and Safety audits in this period for this site? (If yes please add date, type of audit and additional detail) (If no please explain why)
5. Statutory compliance
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Please enter the Statutory compliance figure here.
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Please explain what the potential risks i.e. compliance checks that are due to expire?
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Please give detail on what the challenges are when completing compliance on non compliant items.
6. Risk Improvement Register
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Has the Risk Improvement report been reviewed and up to date?
7. Permit to work checks
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Have you completed 3 permit to work checks during this period on this site? (If yes please give detail on the permit to work number, type, contractor name, colleague name and any information in regards to supporting documentation and actions) (If no please explain why)
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(1) Verisae work order number
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(2) Verisae work order number
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(3) Verisae work order number
8. Regional ROM meeting
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Have you attended 1 meeting at this site during this quarter? (If yes please give detail of the DGM, date and whether minutes have been completed and circulated) (If no please explain why)
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Have you made your weekly update call to the DGM for the site? (If yes please give details below on week number, name of DGM, Issues raised and whether the detail has been handed over to the on call team) If no please explain why)
9. Pest and Cleaning
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Are there currently any cleaning problems on site? (If yes please give more detail)
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Are there any pest problems currently on site? (If yes please see escalation paperwork and complete the next section)
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Please enter the week number (in the escalation process stage, whilst referencing any relevant documents)
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Have all pest site visits been completed with the PPM schedule? (If no please give more detail)
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Has the pest portal and board been updated? (If no please give more detail)
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Have all remedials been achieved or in progress? (If no please give more detail)
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Work order number
9.5 Periodic pest and cleaning contractor meetings
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Have you attended the periodic pest contractor meeting at this site? (If yes please add more detail below stating contractor name, date and whether the minutes have been completed and circulated) (If no please explain why)
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Have you attended the periodic cleaning contractor meeting at this site? (If yes please add more detail below stating contractor name, date and whether the minutes have been completed and circulated) (If no please explain why)
10. Budgets
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Are there any capital expense requests needing to be applied for? (If yes please give more detail)
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Have all works been reviewed and discussed with the depot colleagues for code 7715 misuse and abuse?
11. Detail of any major project or capital works
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Are there any major project or capital works currently taking place on site? (If yes please give more detail on the project owner, current status and a brief overview)
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RFM Name -
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DGM Name -
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Select date