CVM Safety Inspection (Weekly)

• Site

  Select

• Date & Time

  Date

• I acknowledge that the answers attached and any additional information provided are accurate and true.

• Person Completing Inspection

  Sign

Personal Protective Equipment (PPE)

• Each plant room or chemical storage area must have reasonably available Personal Protective Equipment. This equipment should be easily located and have an available PPE Here sign. All PPE must be kept in a sealed container.

• PPE is in a suitable location, with signage, and is sealed

  Compliant

  Non-Compliant

• Location of PPE Equipment on Site

  Select All Plant Rooms Plant Room Cleaning Storeroom Other

  • All Plant Rooms
  • Plant Room
  • Cleaning Storeroom
  • Other

• Number of Aprons (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Goggles / Eye Wear (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Ear Plugs / Ear Muffs (Minimum: 0 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Face Masks / Shields (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Rubber Gloves (Arm Length) (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of Gum Boots (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Note Respirators must be housed inside their own single container, inside of the larger PPE container. This is to prevent dust build up in the ventilators.

• Number of Respirators (Minimum: 1 per Plant Room)

  Select 0 1 2 3 4 5 6 7 8 9 10

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• All PPE equipment listed above is in good condition and available for use

  Good Condition

  Needs Replacing/Repair

  N/A

Eye Wash Stations | Emergency Showers

• Each plant room or chemical storage area must have reasonably available Eye Wash Station / Emergency Shower

• Plant Rooms have reasonable access to an Eye Wash Station or Emergency Shower

  Compliant

  Non-Compliant

• Please test the eye wash section and drop shower section of the shower quickly to ensure working condition

• Eye Wash Stations / Emergency Showers are in good working condition

  Good Condition

  Needs Replacing/Repair

  N/A

• Portable Eye Wash Stations not plumbed into a water source do not required regular test and tagging.

• Eye Wash Station / Emergency Shower is tested and tagged (within last 12 months) - Portable Systems Exempt

  Compliant

  Non-Compliant

Fire Extinguishers

• All fire extinguishers on site must be checked and tested and tagged by a service provider every 6 months. You can find the small yellow tags on the handle of the extinguisher, with imprints aligning with the month and year tested. If the gauge pin is not in the green middle section, or the safety pin tag has been removed, the extinguisher needs replacement.

• All Fire extinguishers on site are tested/tagged within 6 months, have their pins in place, and have gauges at appropriate levels

  Compliant

  Non-Compliant

• Location of all Fire Extinguishers match any evacuation diagrams on site

  Compliant

  Non-Compliant

• All Fire Exits have a 1 meter clearance, and all Emergency Exit lights are in working order

  Compliant

  Non-Compliant

First Aid Equipment

• Required First Aid provisions on site may vary due to size. Below is the minimum recommended resources for sites. Order up to fill base levels.

• First aid boxes are stocked and available on site

  Compliant

  Non-Compliant

• First aid boxes are in locations that make sense for incident response and match documentation

  Compliant

  Non-Compliant

• Number of Adhesive Strips (Min 50)

  0-49

  49-100

  100+

• Number of Splinter Probes (Min 10)

  0-9

  10-19

  20+

• Number of Hypo-Allergenic Adhesive Tape (Min 1)

  0

  1+

• Number of Sterile Eye Pads (Min 5)

  0-4

  5-20

  20+

• Number of Triangular Bandages (Min 2)

  0-1

  2+

• Number of Crepe Bandages (Min 2)

  0-1

  2+

• Number of Combine/Wound Dressing Pads (Min 2)

  0-1

  2+

• Number of Non-Stick Dressing Pads (Min 2)

  0-1

  2+

• Number of Safety Pins (Min 10)

  0-9

  10+

• Number of Scissors (Min 1)

  0

  1+

• Number of Kidney Dishes (Min 1)

  0

  1+

• Number of Dressing Bowl (Min 1)

  0

  1+

• Number of Gauze Swabs (Min 2)

  0-1

  2+

• Number of Tweezers (Min 1)

  0

  1+

• Number of Disposable Gloves (Min 50)

  0-49

  49-100

  100+

• Number of Saline Tubes (Min 5)

  0-4

  5+

• Number of Antiseptic Skin Swabs (Min 20)

  0-19

  20+

• Number of Sharps Containers (Min 1)

  0

  1+

• Number of Thermal Blankets (Min 1)

  0

  1+

• Number of Ice Packs (Min 1)

  0

  1+

Lifeguarding Equipment

• Items in the section will be N/A for Rackley Swimming Only Sites

• Spinal Board | Head Blocks in Place & Fit for Use

  Good Condition

  Needs Replacing/Repair

  N/A

• Throw Ropes | Rescue Tubes in Place & Fit for Use

  Good Condition

  Needs Replacing/Repair

  N/A

• Two-Way Radios in Place & Fit for Use

  Good Condition

  Needs Replacing/Repair

  N/A

• Bum-Bags, Whistles and all other personal Lifeguarding equipment is fit for use

  Good Condition

  Needs Replacing/Repair

  N/A

Person With Disability (PWD) Equipment

• Please test the below equipment by using the controllers to test up/down and left/right movement and ensure slings/accessories are in good condition/able to be used by clients.

• PWD Hoists on site are functioning correctly, are in good working condition, ready for use by clients.

  Good Condition

  Needs Replacing/Repair

  N/A

• PWD Water Wheelchairs on site are in good working condition, ready for use by clients.

  Good Condition

  Needs Replacing/Repair

  N/A

• Hoist Slings & Accessories are in good condition, ready for use by clients.

  Good Condition

  Needs Replacing/Repair

  N/A

General Use Equipment

• Please take the time to check all equipment on site and find any that needs to be taken out of service. Such as chairs, tables, benches, baby change tables at risk of injuring patrons.

• Chairs | Seats | Benches used on site are in good condition and are not at risk of breaking under the weight of a patron.

  Good Condition

  Needs Replacing/Repair

  N/A

• Tables | Desks used on site are in good condition and are not at risk of breaking.

  Good Condition

  Needs Replacing/Repair

  N/A

• Baby Change Tables used on site are in good condition and are not at risk of breaking under the weight of a patron.

  Good Condition

  Needs Replacing/Repair

  N/A

Pool Equipment

• Please take the time to check all equipment on site and find any that needs to be taken out of service.

• FOR POOL VACUUMS
  Is there enough slack in the cable inside the unit? If not, loosen screws on the fastener, slide cable along and retighten the fastener.
  
  Is the cable secured in the fastener on the inside of the crank reel? If not, Mojo a ticket for a new fastener and cable tie the power cable to the reel casing as a temporary measure, to release pressure on the terminal until the new fastener is installed.
  
  Is the pull handle clear of the power cable? If not, untangle it and ensure it is free of any obstruction.
  
  Have the filter socks been cleaned and the propeller cover removed and cleared of debris?
  
  Are the rollers clear of debris and are there any obstructions on the underside of the vacuum?
  
  Is the pull handle properly attached to the power cable and is there any damage? If there is damage, loosed the screws and slide the handle upwards slightly.

• Pool Vacuums used on site are stored correctly, in good condition and the above checks have been made.

  Good Condition

  Needs Replacing/Repair

  N/A

• Pool Cover Butlers used on site are stored correctly, in good condition and ready for use.

  Good Condition

  Needs Replacing/Repair

  N/A

• Pool blankets should be covered if kept outdoors. Check that wheels, bumpers, anchor points, drop pins and fabrics are in good condition.

• Pool Blankets used on site are stored correctly, in good condition and ready for use.

  Good Condition

  Needs Replacing/Repair

  N/A

• All other pool equipment, Scoops, Poles, Manual Vacuums, used on site are stored correctly, in good condition and ready for use.

  Good Condition

  Needs Replacing/Repair

  N/A

• LTS Islands used on site are stored correctly, in good condition and are not at risk of breaking under the weight of a patron.

  Good Condition

  Needs Replacing/Repair

  N/A

• All other Learn to Swim or Training Equipment used on site are stored correctly, in good condition and ready for use.

  Good Condition

  Needs Replacing/Repair

  N/A