Customer Maintenance and Field Note Report.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Car park

• Curbing in good condition

  Yes

  No

  N/A

• Car safety barriers in good condition

  Yes

  No

  N/A

• Pathways in good condition

  Yes

  No

  N/A

• Fencing and or surrounding barriers in good condition

  Yes

  No

  N/A

• Safety signage visible and in good condition

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

Trolley bays

• Trolley bays in good condition

  Yes

  No

  N/A

• Any additional items needing to be reported

External pathways

• Pathways in good condition

  Yes

  No

  N/A

• Walkways free from debris

  Yes

  No

  N/A

• Hand rails and safety rails in good condition

  Yes

  No

  N/A

• Steps in good condition

  Yes

  No

  N/A

• Safety signage visible and in good condition

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

Internal areas

• Floors in good condition

  Yes

  No

  N/A

• Walkways free from debris

  Yes

  No

  N/A

• Hand rails and safety rails in good condition

  Yes

  No

  N/A

• Steps in good condition

  Yes

  No

  N/A

• Safety signage visible and in good condition

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

Toilets

• Cisterns in working order

  Yes

  No

  N/A

• Hand basins in working order

  Yes

  No

  N/A

• Taps in working order

  Yes

  No

  N/A

• Soap dispensers in working order

  Yes

  No

  N/A

• Hand dryers or hand towel dispensers in working order

  Yes

  No

  N/A

• Toilet paper dispensers in working order

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

Entries

• Entry doors in good working condition

  Yes

  No

  N/A

• Entry door locks in good working condition

  Yes

  No

  N/A

• Entry walkways in good condition

  Yes

  No

  N/A

• Safety signage visible and in good condition

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

High areas

• Visible roof in good condition

  Yes

  No

  N/A

• Visible guttering in good condition

  Yes

  No

  N/A

• Signage in good condition

  Yes

  No

  N/A

• Lightning and electrics in working condition

  Yes

  No

  N/A

• Any additional items needing to be reported

Signatory

• I hereby acknowledge this report to be a fair and accurate reflection of the site.

  Sign