Title Page

  • Site address

  • Date conducted

  • Prepared by

  • Signature

  • Have you confirmed that all building occupants are not currently suffering from COVID-19, nor do they have COVID-19 symptoms (potentially positive but undiagnosed), nor have they recently been deemed a close person contact of someone who is suffering from COVID-19?

  • Have you reviewed Ecomad's COVID Safe Plan recently?

  • Are you wearing a face mask?

  • Has the resident (home owner) signed and understood Moonee Valley City Council’s Participation Form?

  • Does the resident have any pets? If so, are you comfortable with their presence or are they appropriately restrained?

  • Have you discussed any potential for interactions with wildlife e.g. snakes and spiders with the resident?

  • Have you discussed any known (or potential) slip, trip or fall hazards with the resident – particularly if it has been raining

  • Have you ensured there is a safe location to inspect ceiling insulation? Have building occupants been informed to keep a safe distance during this part of the Scorecard Assessment, especially if ceiling access is near a doorway or a point of thoroughfare? Note: the inspection will not involve physically climbing into the ceiling space and/or moving around the ceiling space

  • Does the ladder being used come with an "industrial" rating?

  • Have you discussed the cleanliness of the chimney cavity with the resident, if there is one, to assess whether a dust mask is required for inspection

  • Have you discussed and identified the best way(s) to exit in the event of an emergency with the resident

  • Have you ensured that the location of the vehicle used to travel to the residential address is parked in an appropriate location; ask the resident that it is secure and unlikely to obstruct other motorists

  • Signature of Scorecard Assessor upon completion

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.