Information

  • Document No.

  • Engineers name

  • Conducted on

  • Prepared by

  • Location

Engineer

Engineer

  • Engineers head/ full body shot

  • Driving license (photo card)

  • Driving license (paper version)

  • Number of points

  • The engineer's licence is at risk (note the offence and date from paper licence)

  • Note details here

  • Do you have a Westway ID card?

  • Gas safe card in date?<br>For engineers who work with natural gas. E.g. Boilers

  • CSCS card in date (Construction Skills Certification Scheme)

  • Human Focus card in date <br>Used specifically for Cushman & Wakefield sites. The card is chip and pin and will hold H&S training.

  • IPAF card in date (international powered access federation)<br>Only if engineer is using a mobile platform.

  • ACRIB card in date (air conditioning and refrigeration industry board)<br>Only for engineers that work with F gas. E.g. AC or refrigeration

  • PASMA card in date (Prefabricated Access Suppliers and Manufacturers Association)<br>Only for engineers who use mobile scaffold towers.

  • Other card

  • Card
  • Card details

Uniform

Uniform

  • Is the engineer presentable?

  • Is uniform clean and tidy

  • How many polo shirts?

  • How many sweat shirts?

  • How many shirts?

  • How many overalls?

  • Any other uniform items?

PPE

PPE

  • PPE bag present

  • Gloves

  • Safety glasses

  • Goggles

  • Ear defender

  • Harness

  • Safety boots/shoes

  • Hi-Viz

  • Safety helmet

  • Bump cap

  • Other PPE item

Vehicle

Vehicle

  • Vehicle type

  • Registration number

  • Tax disc expiry date

  • Odometer reading (mileage reading)

  • Vehicle service booklet (take picture of stamped pages)

  • Vehicle clean (external)

  • Glass condition 1=front 2=off side 3=rear 4=near side (note damage)

  • Body work condition 1=Front, 2=Off side, 3=Rear, 4=Near side (note damage)

  • Wheels condition 1=Off side front, 2=Off side, 3=Rear, 4=Near side 5=Spare tyre (note damage)

  • Light cluster 1=Off side front, 2=Off side rear, 3=Near side rear 4=Near side front, 5=Number plate

  • Vehicle clean (internal)

  • Storage (organised and accessible safely)

  • First aid kit (check dates, condition, supplies)

  • Fire extinguisher (check dates, condition)

Paper work

Paper work

  • Do you have a copy of the H&S policy

  • Acknowledge receipt off H&S policy

  • COSHH (Chemicals Or Substances Hazardous to Health) found

  • COSHH data sheets

Hand Tools

Hand tools

  • Tool box/bag clean

  • Tool box/bag safe and secure

  • Hand tools clean

  • Hand tools safe and fit for purpose

  • Steps

  • Ladders

Power Tools

Power tools

  • Tool box/bag clean

  • Tool box/bag safe and secure

  • Power tools clean

  • Power tools safe and fit for purpose

  • Extension lead

  • Have all of your power tools been PAT tested? (If NO, list which tools have not)

  • 110V transformer (does the engineer have one and has it been PAT tested)

  • 110V Power tool

  • Mobile phone charger (mains)

  • Mobile phone

  • Battery charger

  • Battery powered tool

  • Refrigerant recovery machine

  • Vacuum pump

Site work

Site work

  • How were you instructed to come to this site?

  • How were you advised?

  • Does the engineer have any feedback or requests. for making their work more safe?

Sign off

Sign off

  • Auditor signature

  • Engineer signature

Follow Up

Follow Up

  • Outstanding observations in need of a follow up

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.