Energy Audits for Businesses (Energy Advice and Cost Saving Technical Assessments) | On-Site Risk Checklist

• Business name

• Conducted on

  Date

• Prepared by

• Address
  Address

• Confirmed that none of the staff currently on-site are suffering from COVID-19

  Yes

  No

  N/A

• Please terminate the assessment immediately.

• Confirmed that none of the staff currently on-site have been recently deemed a close personal contact of someone who is currently suffering from COVID-19

  Yes

  No

  N/A

• Please terminate the assessment immediately.

• Have you recently reviewed (within the last week) Conserva's Safe Work Method Statement (SWMS) which was reviewed and edited by Moonee Valley City Council? (SWMS No 22/102365 and dated 19/04/2022)

  Yes

  No

  N/A

• Please review Conserva's SWMS (No 22/102365 and dated 19/04/2022) before entering the premises

• Please upload the Participation Form (take a photo) - signed by the business owner/representative

  Media

• Ask the business owner/representative about any potential hazards on-site. Use the following examples as a prompt: (1) are there any tripping or bumping hazards, (2) is there a possibility of interacting with wildlife, (3) is there any moving machinery? Did the business owner/representative identify anything?

  Yes

  No

  N/A

• What was identified/brought to your attention?

• As agreed with Moonee Valley City Council, a ladder will not be used during any of the assessments

• Do not enter areas which require "Working At Heights" training

• As agreed with Moonee Valley City Council, confined spaces will not be entered during any of the assessments

• If and when inspecting electrical switchboards, ensure that all warning signs are observed (and abided by) and DO NOT open if door is sealed (e.g. with screws)

• Does the site have a "plant room"?

  Yes

  No

  N/A

• Comprehensively review Conserva's SWMS (No 22/102365 and dated 19/04/2022) before entering and request that the business representative/owner accompanies you with appropriate PPE (if necessary)

• Does the site have a "commercial kitchen"?

  Yes

  No

  N/A

• (1) Maintain a safe distance from cooking activities (especially flames) at all times. (2) Do not touch stoves or ovens for any reason. (3) Never touch steam pipework or equipment. (4) Be wary of fast movements and consider rebooking the assessment time for when the kitchen will not be in use. (5) Ask to be accompanied by the business owner/representative.

• Did you identify any other hazards throughout the course of your assessment?

  Yes

  No

  N/A

• What were they?

Contractor Sign Off

• Print Name:

• Signature

  Drawing