Title Page

  • Conducted on

  • Prepared by

  • Location
  • This checklist is to be completed by a Cushman & Wakefield Facilities Management, or suitably authorised person, in consultation with contractors or Cushman & Wakefield technicians who have completed or are in the process of performing works onsite

  • Any significant issues identified should be addressed immediately in consultation with the appropriate site/account director, or escalated to the senior account team for resolution. In these situations, works should not continue until items are adequately addressed and the IR/NCR – Corrective Action Procedure must be applied

  • Completed forms are to be retained in the pre-determined location for site records


  • Employee

  • Contractor

  • Client

  • Site Location

  • Date

  • Technician Name

  • Company

  • Work Order No

  • Description of works being undertaken:

  • Electrical

  • Mechanical

  • Plumbing

  • Building

  • Refrigeration

  • Fuel

  • HVAC

  • Carpentry

  • Asbestos

  • Other

Spot Check

  • Does the technician have current photo ID?

  • Record Details

  • Does the technician hold a current trade licence?

  • Record Licence details:

  • Has the technician completed an induction?

  • Site-specific induction?

  • Cushman & Wakefield Induction

  • Has the technician completed the site attendance book or client-specific sign in?

Does the technician have the following paperwork

  • Cushman & Wakefield Work Order?

  • Is appropriate safety documentation available and being followed? E.g. SWMS, JSA etc?

SWMS / JSA Check – if in use, verify the following

  • Details displayed, including: contractor name, task description, site/location, date applicable to works?

  • Steps within SWMS clearly outlined and applicable to scope of works?

  • Appropriate signatures available? (participants, manager)

Are the technician’s tools and equipment:

  • Fit for purpose? E.g. calibrated

  • Tested and Tagged? (List date) Including RCD units in use.

  • Is the required PPE being worn for the task at hand as per the SWMS/JSA/JHA?

  • Is the technician undertaking High Risk Work? (Specify)

  • When required has the technician completed appropriate permit?

Housekeeping & General Requirements

  • Are SDS's available for all substances being used and <5 years old?

  • #Record date of issue:

  • Do all chemicals conform to GHS labelling requirements?

  • Are spill kits available and persons trained on how to use them?

  • Is the area being worked on free of slip, trip and fall hazards?

  • Are barriers used / is traffic managed / signage erected?

  • Notes:

Sign Off

  • We acknowledge that any issues identified have been discussed and actions taken to initiate resolution

  • C&W Signature: C&W Name:

  • Technician Signature:

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.