Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
External Areas
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If you were to walk around the outside of Maccabi House, do you find or spot any near misses that needs to raised?
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Did you spot any near misses in the court yard
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Did you spot any near misses in the shared fire evacuation route (outside of Maccabi House)
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Is the pedestian gate operate
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Is the vehicle gate operate
Public Toilets
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Please check the public toilets and assess if reasonably safe to use
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Did you spot any obvious near misses in the Gent toilets?
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Are taps working as they should?
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Did you spot any obvious near misses in the Ladies' toilets?
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Are taps working as they should?
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Did you spot any obvious near misses in the Disabled toilets?
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Are taps working as they should?
Communal Areas
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Please check the communal areas and assess if reasonably safe to access
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Did you spot any near misses at the entrance areas to the flats and offices?
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Did you spot any near misses in the main hall?
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Did you spot any near misses in the back room?
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Did you spot any near misses in the storage room?
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Did you spot any near misses in the IT server room?
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Did you spot any near misses in the 121 room?
Fire Doors
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You are required to visually assessing the fire doors throughout the centre
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Did you find any fire doors left open in the main hall? (please close if this is the case)
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Did you find any fire doors left open in the back room? (please close if this is the case)
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Did you find any fire doors left open in the main storage room? (please close if this is the case)
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Did you find any fire doors left open in the office area? (please close if this is the case)
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Are fire doors restricted in any way? (For example, boxes or items in front of the door, or behind)... where?
IT (Server Room)
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Visually take a look and ensure no obvious risks are visible
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Anything to report?
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Please detail and (take photos)
Lights
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Across the site, please check all lights are operational if not, please report via MaintainX
Kitchen Area
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Did you spot any lights not working?
Main Hall
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Did you spot any lights not working?
Back Room
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Did you spot any lights not working?
Storage Room
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Did you spot any lights not working?
Toilets
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Did you spot any lights not working?
IT Server Room
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Did you spot any lights not working?
External Route
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Did you spot any lights not working? (if applicable)
Fire Extinguishers
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Are all fire extinguisher in their normal place
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Are fire extinguishers in their correct locations (mainly here a fire escape route)?
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Are the blue/green taps in place and untouched?
Fire Panel
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Check the status of the fire panel
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Are there any faults on the display panel?
Air Con Units
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Check if all air con units are operational (if applicable)
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Are units working as per normal?
Slip, Trip or Falls
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Did you spot any slip, trip or falls within the main hall?
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Did you spot any slip, trip or falls within the office area?
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Did you spot any slip, trip or falls within the back office?
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Did you spot any slip, trip or falls within the communal areas?
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Did you spot any slip, trip or falls within the toilet areas?
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Did you spot any slip, trip or falls within the main storage area?
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Did you spot any slip, trip or falls within the court yard?
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Did you spot any slip, trip or falls within the external fire escape routes?
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Take as many photos of possible of any obvious near misses if "answered" yes!
Sign off
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Full Name
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Date