Title Page
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Site conducted
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Business unit
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Conducted on
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Prepared by
Emergency Checklist
Emergency Reponse Team
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If you do not have adequate trained emergency response teams- answer None and report to the line manager
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Who are the First Aiders available for this shift?
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Who are Fire Wardens available for this shift?
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W/H Who are the trained spill response available for this shift?
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Who are the trained Drugs and Alcohol testers for this shift?
Safety Issues in last 24 hours
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Have any safety issues been raised in the previous 24 hours
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What is the safety issue?
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Have any quality issues been raised in the previous 24 hours
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What is the quality issue?
Staff
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Are staffing levels at the required amount to perform all tasks safely?
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Escalate to manager. Raise a POTential Action
Sign off
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Name and signature