Information
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Document No.
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Engineers name
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Conducted on
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Prepared by
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Location
Engineer
Engineer
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Engineers head/ full body shot
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Driving license (photo card)
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Driving license (paper version)
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The engineer's licence is at risk (note the offence and date from paper licence)
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Note details here
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Do you have a Westway ID card?
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Gas safe card in date?<br>For engineers who work with natural gas. E.g. Boilers
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CSCS card in date (Construction Skills Certification Scheme)
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Human Focus card in date <br>Used specifically for Cushman & Wakefield sites. The card is chip and pin and will hold H&S training.
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IPAF card in date (international powered access federation)<br>Only if engineer is using a mobile platform.
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ACRIB card in date (air conditioning and refrigeration industry board)<br>Only for engineers that work with F gas. E.g. AC or refrigeration
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PASMA card in date (Prefabricated Access Suppliers and Manufacturers Association)<br>Only for engineers who use mobile scaffold towers.
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Other card
Card
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Card details
Uniform
Uniform
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Is the engineer presentable?
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Is uniform clean and tidy
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Any other uniform items?
PPE
PPE
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PPE bag present
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Gloves
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Safety glasses
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Goggles
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Ear defender
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Harness
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Safety boots/shoes
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Hi-Viz
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Safety helmet
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Bump cap
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Other PPE item
Vehicle
Vehicle
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Vehicle type
- Car
- Small van
- Large van
- Truck
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Registration number
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Tax disc expiry date
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Odometer reading (mileage reading)
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Vehicle service booklet (take picture of stamped pages)
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Vehicle clean (external)
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Glass condition 1=front 2=off side 3=rear 4=near side (note damage)
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Body work condition 1=Front, 2=Off side, 3=Rear, 4=Near side (note damage)
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Wheels condition 1=Off side front, 2=Off side, 3=Rear, 4=Near side 5=Spare tyre (note damage)
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Light cluster 1=Off side front, 2=Off side rear, 3=Near side rear 4=Near side front, 5=Number plate
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Vehicle clean (internal)
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Storage (organised and accessible safely)
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First aid kit (check dates, condition, supplies)
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Fire extinguisher (check dates, condition)
Paper work
Paper work
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Do you have a copy of the H&S policy
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Acknowledge receipt off H&S policy
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COSHH (Chemicals Or Substances Hazardous to Health) found
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COSHH data sheets
Hand Tools
Hand tools
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Tool box/bag clean
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Tool box/bag safe and secure
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Hand tools clean
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Hand tools safe and fit for purpose
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Steps
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Ladders
Power Tools
Power tools
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Tool box/bag clean
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Tool box/bag safe and secure
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Power tools clean
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Power tools safe and fit for purpose
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Extension lead
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Have all of your power tools been PAT tested? (If NO, list which tools have not)
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110V transformer (does the engineer have one and has it been PAT tested)
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110V Power tool
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Mobile phone charger (mains)
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Mobile phone
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Battery charger
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Battery powered tool
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Refrigerant recovery machine
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Vacuum pump
Site work
Site work
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How were you instructed to come to this site?
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How were you advised?
- Text
- Phone call
- Continuation
- Just turned up
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Does the engineer have any feedback or requests. for making their work more safe?
Sign off
Sign off
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Auditor signature
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Engineer signature
Follow Up
Follow Up
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Outstanding observations in need of a follow up