Co-op FM Reactive Health & Safety Audit v1.1

• Client / Site

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Contractor and Job Information

• Contractor Information

Enter Contractor Information

• Enter Contractor Name:

• Enter Work Order Number

• Enter details of work being carried out

Health & Safety Questions

• Did all operatives sign in and make themselves known to the Duty Manager?

  Yes

  No

  In Part

  n/a

• Did all operatives check and sign the asbestos register?

  Yes

  No

  In Part

  n/a

• Are all operatives wearing the appropriate PPE?

  Yes

  No

  In Part

  n/a

• Is the work area suitably Barriered off to prevent unauthorised access?

  Yes

  No

  In Part

  n/a

• Are hot works involved?

  Off

  On

• Has a Hot Works Permit been completed?

  Yes

  No

  In Part

  n/a

• Is appropriate fire fighting equipment in place?

  Yes

  No

  In Part

  n/a

• Does the contractor have a job specific Construction Phase Plan or Dynamic Risk Assessment?

  Yes

  No

  In Part

  n/a

• Are any power tools being used?

  Off

  On

• Are they 110V or Battery Powered?

  Yes

  No

  In Part

  n/a

• Are ladders being used?

  Off

  On

• Are they the contractors own ladders? i.e. Not the store's.

  Yes

  No

  In Part

  n/a

• Are they being used correctly and appropriately secured?

  Yes

  No

  In Part

  n/a

• Do the ladders have appropriate tags/evidence of inspection?

  Yes

  No

  In Part

  n/a

Sign-off

• Signature of Regional Facilities Manager

• RFM Signature

  Sign

• Signature of Store Representative

• Store Representative Signature

  Sign