Facility Inspection (Rev 3A)

• Conducted on: 7/5/20

  Date

• Shire Facility

• GPS Location
  Address

• Inspection conducted by

Emergency Exits and Equipment

• 1.1 Are Exit signs installed and operational?

  Select YES - Exit sign(s) installed and operational Exit sign(s) installed but not operational NO - Exit sign(s) not installed and the facility does require them NO - Exit sign(s) not required

  • YES - Exit sign(s) installed and operational
  • Exit sign(s) installed but not operational
  • NO - Exit sign(s) not installed and the facility does require them
  • NO - Exit sign(s) not required

• Provide a photo(s) of exit signage in location

• Yes

  No

  N/A

• Take photo(s) to identify each non-operational exit sign.

• Arrange for the non-operational exit sign(s) to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of exit sign(s) into facility.

• Take photo(s) of location where exit sign(s) need to be installed.

• Make amendments to Evacuation Plan diagram to indicate where new exit sign(s) will be placed.

• No action required

• 1.2 Is the push bar panic exit door installed and operational?

  Select YES - Push bar panic exit door installed and operational Push bar panic exit door installed but not operational NO - Push bar panic exit door not installed and the facility does require them NO - Push bar panic exit door not required

  • YES - Push bar panic exit door installed and operational
  • Push bar panic exit door installed but not operational
  • NO - Push bar panic exit door not installed and the facility does require them
  • NO - Push bar panic exit door not required

• Provide a photo(s) of push bar panic exit door in location

• Take photo(s) to identify each non-operational push bar panic exit door .

• Arrange for the non-operational push bar panic exit door to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of push bar panic exit door(s) into facility.

• Take photo(s) of location where push bar panic exit door(s) need to be installed.

• Make amendments to Evacuation Plan diagram to indicate where new push bar panic exit door(s) will be placed.

• No action required

• 1.3 Are smoke alarms installed and operational?

  Select YES - Smoke alarm(s) are installed and operational Smoke alarm(s) installed but not operational NO - Smoke alarm(s) not installed and the facility does require them NO - Smoke alarm(s) not required

  • YES - Smoke alarm(s) are installed and operational
  • Smoke alarm(s) installed but not operational
  • NO - Smoke alarm(s) not installed and the facility does require them
  • NO - Smoke alarm(s) not required

• Provide a photo(s) of smoke alarm(s) in location

• Provide last service date?

  Date

• Take photo(s) to identify each non-operational smoke alarm(s).

• Arrange for the non-operational smoke alarm(s) to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of smoke alarm(s) into facility.

• Take photo(s) of location where smoke alarm(s) need to be installed.

• No action required

• 1.4 Are First Aid kit(s) present and serviced?

  Select YES - First Aid kit(s) are present and serviced First Aid kit(s) are present but require servicing NO - First Aid kit(s) not present and the facility does require them NO - First Aid kit(s) not required

  • YES - First Aid kit(s) are present and serviced
  • First Aid kit(s) are present but require servicing
  • NO - First Aid kit(s) not present and the facility does require them
  • NO - First Aid kit(s) not required

• Provide photo(s) of First Aid kit(s) in location

• Provide last service date?

  Date

• Take photo(s) to identify each First Aid kit(s) that is out of service.

• Arrange for the out of service First Aid kit(s) to be reviewed in order to be serviced / replaced.

• NOTE: Priority to make arrangements for installation of First Aid kit(s) into facility.

• Take photo(s) of location where First Aid kit(s) need to be installed.

• Make amendments to Evacuation Plan diagram to indicate where new First Aid kit(s) will be placed.

• No action required

• 1.5 Are Fire extinguisher(s) present and serviced?

  Select YES - Fire extinguisher(s) are present and serviced Fire extinguisher(s) are present but require servicing NO - Fire extinguisher(s) not present and the facility does require them NO - Fire extinguisher(s) not required

  • YES - Fire extinguisher(s) are present and serviced
  • Fire extinguisher(s) are present but require servicing
  • NO - Fire extinguisher(s) not present and the facility does require them
  • NO - Fire extinguisher(s) not required

• Provide photo(s) of Fire extinguisher(s) in location

• Provide last service date?

  Date

• Take photo(s) to identify each Fire extinguisher that is out of service.

• Arrange for the out of service Fire extinguisher(s) to be reviewed in order to be serviced / replaced.

• NOTE: Priority to make arrangements for installation of Fire extinguisher(s) into facility.

• Take photo(s) of location where Fire extinguisher(s) need to be installed.

• Make amendments to Evacuation Plan diagram to indicate where new Fire extinguisher(s) will be placed.

• No action required

• 1.6 Are Fire blanket(s) present and serviced?

  Select YES - PPE is available, stocked and appropriate for use PPE is available but requires stocking up PPE is available but is not appropriate for use e.g. damaged / expired / incorrect for task NO - PPE is not available but is required NO - PPE is not provided and not required

  • YES - PPE is available, stocked and appropriate for use
  • PPE is available but requires stocking up
  • PPE is available but is not appropriate for use e.g. damaged / expired / incorrect for task
  • NO - PPE is not available but is required
  • NO - PPE is not provided and not required

• Provide photo(s) of Fire blanket(s) in location

• Provide last service date?

  Date

• Take photo(s) to identify each Fire blanket that is out of service.

• Arrange for the out of service Fire blanket(s) to be reviewed in order to be serviced / replaced.

• NOTE: Priority to make arrangements for installation of Fire blanket(s) into facility.

• Take photo(s) of location where Fire blanket(s) need to be installed.

• Make amendments to Evacuation Plan diagram to indicate where new Fire blanket(s) will be placed.

• No action required

• 1.7 If there is PPE provided, are there enough items available and are they appropriate for use?

  Select YES - PPE is available, stocked and appropriate for use PPE is available but requires stocking up PPE is available but is not appropriate for use e.g. damaged / expired / incorrect for task NO - PPE is not available but is required NO - PPE is not provided and not required

  • YES - PPE is available, stocked and appropriate for use
  • PPE is available but requires stocking up
  • PPE is available but is not appropriate for use e.g. damaged / expired / incorrect for task
  • NO - PPE is not available but is required
  • NO - PPE is not provided and not required

• Provide photo(s) of PPE in location

• Provide last service date if applicable?

  Date

• Take photo(s) of PPE that requires more stock

• Report the matter to the Supervisor to arrange for the PPE to be ordered and stocked up to the required levels

• NOTE: Priority to make arrangements for the replacement of inappropriate PPE.

• Take photo(s) of any PPE found to be damaged / expired / or unsuitable for task and immediately notify the Supervisor.

• Request the Supervisor order the appropriate PPE required and ask where the inappropriate PPE can be safely disposed of and dispose of identified items.

• Request the Supervisor order the appropriate PPE required.

• No action required

  Yes

  No

  N/A

Electrical

• 2.1 Are Residual Current Devices (RCD's) installed on power and light circuits and operational?

  Select YES - RCD's are installed and operational RCD's are installed but not operational NO - RCD's are not installed and the facility does require them NO - RCD's are not required

  • YES - RCD's are installed and operational
  • RCD's are installed but not operational
  • NO - RCD's are not installed and the facility does require them
  • NO - RCD's are not required

• Provide a photo(s) of RCD's in location

• Take photo(s) to identify each non-operational RCD.

• Arrange for the non-operational RCD's to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of RCD's into facility power and light circuits.

• Take photo(s) of location where RCD's need to be installed.

• No action required

• 2.2 Are Circuit breakers installed and operational?

  Select YES - Circuit breakers are installed and operational Circuit breakers are installed but not operational NO - Circuit breakers are not installed and the facility does require them NO - Circuit breakers are not required

  • YES - Circuit breakers are installed and operational
  • Circuit breakers are installed but not operational
  • NO - Circuit breakers are not installed and the facility does require them
  • NO - Circuit breakers are not required

• Provide a photo(s) of Circuit breakers in location

• Take photo(s) to identify each non-operational Circuit breaker.

• Arrange for the non-operational Circuit breakers to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of Circuit breakers.

• Take photo(s) of location where Circuit breakers need to be installed.

• No action required

• 2.3 Are Light(s) operational and check their general condition?

  Select YES - Lights are operational and in good condition Light(s) not operational and appear to be in good condition Light(s) not operational and appear to be in bad condition Insufficient lighting. More lights are required Lights are not required

  • YES - Lights are operational and in good condition
  • Light(s) not operational and appear to be in good condition
  • Light(s) not operational and appear to be in bad condition
  • Insufficient lighting. More lights are required
  • Lights are not required

• Provide a photo of operational lights in location.

• Take photo(s) to identify each non-operational light.

• Arrange for the non-operational lights to be reviewed in order to be repaired / replaced.

• Take photo(s) to identify each non-operational light that is in bad condition.

• Arrange for the non-operational lights in bad condition to be reviewed in order to be repaired / replaced.

• NOTE: Priority to make arrangements for installation of more lighting.

• Take photo(s) of approximate location of where extra light(s) should be installed.

• No action required.

• 2.4 Are General Power Outlets (GPO's) operational and check their general condition?

  Select YES - GPO's are operational and in good condition GPO's are not operational and appear to be in good condition GPO's are not operational and appear to be in bad condition Insufficient GPO's available. More GPO's are required GPO's are not required

  • YES - GPO's are operational and in good condition
  • GPO's are not operational and appear to be in good condition
  • GPO's are not operational and appear to be in bad condition
  • Insufficient GPO's available. More GPO's are required
  • GPO's are not required

• Provide a photo of operational GPO's in location.

• Take photo(s) to identify each non-operational GPO in location.

• Arrange for the non-operational GPO(s) to be reviewed in order to be repaired / replaced.

• Take photo(s) to identify each non-operational GPO that is in bad condition.

• Arrange for the non-operational GPO(s) in bad condition to be reviewed in order to be repaired / replaced.

• Make arrangements for installation of more GPO's.

• Take photo(s) of approximate location of where extra GPO(s) should be installed.

• No action required.

  Yes

  No

  N/A

• 2.5 Are Air conditioner(s) operational and check service date?

  Select YES - Air conditioner(s) are operational and in within service schedule Air conditioner(s) are operational and due for service Air conditioner(s) are not operational Insufficient Air conditioner(s) available. More Air conditioner(s) are required. Air conditioner(s) are not required

  • YES - Air conditioner(s) are operational and in within service schedule
  • Air conditioner(s) are operational and due for service
  • Air conditioner(s) are not operational
  • Insufficient Air conditioner(s) available. More Air conditioner(s) are required.
  • Air conditioner(s) are not required

• Provide a photo of operational Air conditioner(s) in location.

• Make a Note of last date serviced.

  Date

• Take photo(s) to identify each Air conditioner that requires servicing.

• Arrange for the Air conditioner(s) to be reviewed in order to be serviced.

• Take photo(s) to identify each non-operational Air conditioner.

• Arrange for the non-operational Air conditioner(s) to be reviewed in order to be repaired / replaced.

• Make arrangements for installation of Air conditioner(s).

• Take photo(s) of approximate location of where Air conditioner(s) should be installed.

• No action required.

Water Facilities

• 3.1 Are water taps / outlets operational and not leaking?

  Select YES - Water taps / outlets are operational, in good repair and not leaking Water taps / outlets are operational and are leaking / require repair Water taps / outlets are not operational Water taps / outlets are not required

  • YES - Water taps / outlets are operational, in good repair and not leaking
  • Water taps / outlets are operational and are leaking / require repair
  • Water taps / outlets are not operational
  • Water taps / outlets are not required

• Provide a photo of operational Water taps / outlets in location.

• Take photo(s) to identify each Water taps / outlet that is leaking.

• Arrange for the Water taps / outlets to be reviewed in order to be repaired.

• Take photo(s) to identify each non-operational Water tap / outlet.

• Arrange for the non-operational Water tap / outlet to be reviewed in order to be repaired / replaced.

• No action required.

• 3.2 Are bathroom and toilets (WC's) and urinals operational and not leaking?

  Select YES - WC's and urinals are operational, in good repair and not leaking WC's and urinals are operational and are leaking / require repair WC's and urinals are not operational WC's and urinals are not required

  • YES - WC's and urinals are operational, in good repair and not leaking
  • WC's and urinals are operational and are leaking / require repair
  • WC's and urinals are not operational
  • WC's and urinals are not required

• Provide a photo of operational WC's and urinals in location.

• Take photo(s) to identify each WC and / or urinal that is leaking.

• Arrange for the WC and / or urinal to be reviewed in order to be repaired.

• Take photo(s) to identify each non-operational WC and / or urinal.

• Arrange for the non-operational WC and / or urinal to be reviewed in order to be repaired / replaced.

• No action required.

• 3.3 Are drains internal / external operational and not leaking or blocked?

  Select YES - Drains are operational, not leaking or blocked Drains are operational and are leaking or blocked Drains are not operational Drains are not required

  • YES - Drains are operational, not leaking or blocked
  • Drains are operational and are leaking or blocked
  • Drains are not operational
  • Drains are not required

• Provide a photo(s) of operational drains in location.

• Take photo(s) to identify each drain that is leaking or blocked.

• Arrange for the drain to be reviewed in order to be repaired / unblocked.

• Take photo(s) to identify each non-operational drain.

• Arrange for the non-operational drain to be reviewed in order to be repaired / replaced.

• No action required.

• 3.4 Are gutters and down pipes operational and not leaking or blocked?

  Select YES - Gutters and down pipes are operational, not leaking or blocked Gutters and down pipes are leaking or blocked Gutters and down pipes are not operational Gutters and down pipes are not required

  • YES - Gutters and down pipes are operational, not leaking or blocked
  • Gutters and down pipes are leaking or blocked
  • Gutters and down pipes are not operational
  • Gutters and down pipes are not required

• Provide a photo(s) of operational gutters and down pipes in location.*

• Take photo(s) to identify each gutter or down pipe that is leaking or blocked.

• Arrange for the gutter or down pipe to be reviewed in order to be repaired / unblocked.

• Take photo(s) to identify each non-operational gutter or down pipe.

• Arrange for the non-operational gutter or down pipe to be reviewed in order to be repaired / replaced.

• No action required.

• 3.5 Are their any signs of water ingress through the roof or from the ground into the facility?

  Select There are NO signs of water ingress through the roof There are NO signs of water ingress from the ground YES - There are signs of water ingress through the roof YES - There are signs of water ingress from the ground

  • There are NO signs of water ingress through the roof
  • There are NO signs of water ingress from the ground
  • YES - There are signs of water ingress through the roof
  • YES - There are signs of water ingress from the ground

• No action required

• No action required

• Take photo(s) to identify each sign of water ingress through the roof.

• Arrange for the areas that have signs of water ingress through the roof to be reviewed in order to be repaired / replaced.

• Take photo(s) to identify each sign of water ingress from the ground.

• Arrange for the areas that have signs of water ingress from the ground to be reviewed in order to be repaired / replaced.

4. General Facility Items

• 4.1 Are windows, doors and screens operational and in good repair?

  Select YES - Windows, doors and screens are operational and in good repair Windows, doors and screens are operational but require repair NO - Windows, doors or screens are not operational Other Windows, doors or screens are not required

  • YES - Windows, doors and screens are operational and in good repair
  • Windows, doors and screens are operational but require repair
  • NO - Windows, doors or screens are not operational
  • Other Windows, doors or screens are not required

• Provide a photo(s) of windows, doors and screens in location

• Take photo(s) to identify each window, door or screen that requires repair.

• Arrange for any damaged windows, doors and screens to be reviewed in order to be repaired.

• NOTE: Priority to make arrangements for non-operational windows, doors and screens to be replaced.

• Take photo(s) of location windows, doors or screens need to be replaced.

• No action required

• 4.2 Are window treatments installed, operational and in good condition?

  Select YES - Window treatments are installed, operational and in good condition Window treatments are installed, operational and are NOT in good condition Window treatments are installed but NOT operational Window treatments are not installed but are required Window treatments are not installed and are NOT required

  • YES - Window treatments are installed, operational and in good condition
  • Window treatments are installed, operational and are NOT in good condition
  • Window treatments are installed but NOT operational
  • Window treatments are not installed but are required
  • Window treatments are not installed and are NOT required

• Provide a photo(s) of window treatments in location

• Take photo(s) to identify window treatments that are not in good condition and require cleaning / repair / replacement.

• Arrange for any window treatments that are not in a good condition to be reviewed in order to be rectified.

• Take photo(s) to identify window treatments that are not operational.

• Arrange for any window treatments that are not operational to be reviewed in order to be repaired / replaced.

• Take photo(s) to identify where window treatments need to be installed.

• Arrange for any required window treatments to be reviewed in order to be ordered / installed.

• No action required

• 4.3 Are floor coverings installed and in good condition?

  Select YES - Floor coverings are installed and in good condition Floor coverings are installed and are NOT in good condition Floor coverings are not installed but are required Floor coverings are not installed and are NOT required

  • YES - Floor coverings are installed and in good condition
  • Floor coverings are installed and are NOT in good condition
  • Floor coverings are not installed but are required
  • Floor coverings are not installed and are NOT required

• Provide a photo(s) of floor coverings in location

• Take photo(s) to identify floor coverings that are not in good condition and require cleaning / replacement.

• Arrange for any floor coverings that are not in a good condition to be reviewed in order to be rectified.

• Make arrangements for floor coverings to be installed.

• Take photo(s) of location floor coverings need to be installed.

• No action required

• 4.4 Are disabled access / ramps / doors / thresholds installed, operational and in good condition?

  Select YES - Disabled access / ramps / doors / threshold are installed, operational and in good condition Disabled access / ramps / doors / threshold are installed, operational and are NOT in good condition Disabled access / ramps / doors / threshold are installed and NOT operational Disabled access / ramps / doors / threshold are NOT installed but are required Disabled access / ramps / doors / threshold are NOT installed and are NOT required

  • YES - Disabled access / ramps / doors / threshold are installed, operational and in good condition
  • Disabled access / ramps / doors / threshold are installed, operational and are NOT in good condition
  • Disabled access / ramps / doors / threshold are installed and NOT operational
  • Disabled access / ramps / doors / threshold are NOT installed but are required
  • Disabled access / ramps / doors / threshold are NOT installed and are NOT required

• Provide a photo(s) of disabled access / ramp / door / threshold in location

• Take photo(s) to identify disabled access / ramp / door / threshold that are not in good condition and require repair / replacement.

• Arrange for disabled access / ramp / door / threshold that are not in a good condition to be reviewed in order to be rectified.

• Make arrangements for non-operational disabled access / ramp / door / threshold to be repaired / replaced.

• Take photo(s) of location of non-operational disabled access / ramp / door / threshold.

• Make arrangements for disabled access / ramps / doors / thresholds to be installed as appropriate.

• Take photo(s) of location of where disabled access / ramps / doors / thresholds need to be installed.

• No action required

• 4.5 Is the facility generally clean and in good condition internally?

  Select YES - The facility internally is generally clean and in good condition The facility internally is generally clean but NOT in good condition The facility internally is NOT generally clean but is in good condition The facility internally is NOT generally clean and NOT in good condition

  • YES - The facility internally is generally clean and in good condition
  • The facility internally is generally clean but NOT in good condition
  • The facility internally is NOT generally clean but is in good condition
  • The facility internally is NOT generally clean and NOT in good condition

• Provide photo(s) of general condition of the facility on day of inspection.

• Take photo(s) to identify why you have determined the facility is NOT in good condition and make Notes on each photo.

• Arrange for any items that are not in a good condition to be reviewed in order to be rectified.

• Take photo(s) to identify why you have determined the facility is NOT clean and make Notes on each photo.

• Arrange for any items that are not clean to be reviewed in order to be rectified.

• Take photo(s) to identify why you have determined the facility is NOT clean and NOT in good condition and make Notes on each photo.

• Arrange for any items that are not clean and not in good condition to be reviewed in order to be rectified.

• 4.6 Is the facility generally clean and in good condition externally?

  Select YES - The facility externally is generally clean and in good condition The facility externally is generally clean but NOT in good condition The facility externally is NOT generally clean but is in good condition The facility externally is NOT generally clean and NOT in good condition

  • YES - The facility externally is generally clean and in good condition
  • The facility externally is generally clean but NOT in good condition
  • The facility externally is NOT generally clean but is in good condition
  • The facility externally is NOT generally clean and NOT in good condition

• Provide photo(s) of general external condition of the facility on day of inspection.

• Take photo(s) to identify why you have determined the facility is NOT in good condition and make Notes on each photo.

• Arrange for any items that are not in a good condition to be reviewed in order to be rectified.

• Take photo(s) to identify why you have determined the facility is NOT clean and make Notes on each photo.

• Arrange for any items that are not clean to be reviewed in order to be rectified.

• Take photo(s) to identify why you have determined the facility is NOT clean and NOT in good condition and make Notes on each photo.

• Arrange for any items that are not clean and not in good condition to be reviewed in order to be rectified.

• 4.7 Are there any signs of termite activity?

  Select There are NO signs of termite activity. YES - There are signs of current termite activity. YES - There are signs of previous termite activity.

  • There are NO signs of termite activity.
  • YES - There are signs of current termite activity.
  • YES - There are signs of previous termite activity.

• Make a note of the date of the last annual termite inspection.

  Date

• Take photo(s) of where you have identified current termite activity.

• NOTE: Arrange for any areas identified as having current termite activity to be reviewed in order to be rectified promptly.

• Take photo(s) of where you have identified previous termite activity.

• Arrange for any areas identified with previous termite activity to be reviewed to ensure they have not returned. Make a Note to verify no current / recurring termite activity detected.

• 4.8 Is there any asbestos present internally / externally and if so, what is its condition?

  Select There is NO known asbestos present internally or externally. YES - There is asbestos present internally and it is in a safe condition. YES - There is asbestos present internally and it is NOT in a safe condition. YES - There is asbestos present externally and it is in a safe condition. YES - There is asbestos present externally and it is NOT in a safe condition.

  • There is NO known asbestos present internally or externally.
  • YES - There is asbestos present internally and it is in a safe condition.
  • YES - There is asbestos present internally and it is NOT in a safe condition.
  • YES - There is asbestos present externally and it is in a safe condition.
  • YES - There is asbestos present externally and it is NOT in a safe condition.

• Check that this facility does not appear on the Shire asbestos register.

• Take photo(s) of where you have identified asbestos in a safe condition inside the facility.

• Check that this facility appears on the Shire asbestos register.

• Take photo(s) of where you have identified asbestos in an UNSAFE condition inside the facility.

• NOTE: Arrange for any areas identified with asbestos in an UNSAFE condition inside the facility to be reviewed in order to be rectified promptly.

• Check that this facility appears on the Shire asbestos register.

• Take photo(s) of where you have identified asbestos in a safe condition outside the facility.

• Check that this facility appears on the Shire asbestos register.

• Take photo(s) of where you have identified asbestos in an UNSAFE condition outside the facility.

• NOTE: Arrange for any areas identified with asbestos in an UNSAFE condition outside the facility to be reviewed in order to be rectified promptly.

• Check that this facility appears on the Shire asbestos register.

Additional findings

• e.g. Note: Leak in gutter at join / Take photo / Action: Requires silicone.

  Additional findings

  N/A

Acknowledgements

• Add signature

  Sign