Title Page

  • Site/Building Name

  • Site Address
  • Site Number

  • Have any other sites been included within this checklist?

  • List the building names and Asset Numbers

  • Conducted on

  • Prepared by

  • Time of Arrival

  • Time of Departure

  • Photo of Building

Site Details

    Site Details

1.0 Site Contact

  • <br>1.10 Sign in/out book available? Attach image of signed book if yes

  • 1.11 Attach image of sign in book

  • 1.20 Is there any other workers OR Personal On-site?

  • 1.21 Number of workers/personal on-site:

  • 1.22 Names of all Personal onsite within the immediate vicinity of the works.(if facility is in use verify other occupants Visitor log out book)

2.0 Social Distancing

  • 2.1 Whilst Conducting this Inspection have you ensured that all persons, including employees, customers, and vendors remain at least 1.5m apart to the greatest extent possible, both inside and outside workplaces

  • 2.2 Are the work zones isolated from the public and building users?

  • 2.3 Have protocols been established to ensure that trades can practice adequate social distancing?

  • 2.4 Required face coverings or masks for all trades are being used

  • 2.5 Implemented additional procedures. (Please describe them on the note)

3.0 Hygiene Protocols

  • 3.1 Are handwashing facilities throughout the workplace

  • 3.2 Are bathrooms are well stocked with hand wash and paper towels OR Hand dryer?

  • 3.3 Provided regular sanitization of high touch areas, such as workstations, equipment, screens, doorknobs, restrooms throughout work site

  • 3.4 Implemented additional procedures. (Please describe them on the note)

4.0 Building External Inspection

  • 4.1 Is there a build-up of rubbish, dumped items around the external of the Building?

  • 4.11 List the location

  • 4.12 Attach a Photo

  • 4.2 Is there any Graffiti?

  • 4.21 List the location

  • 4.22 Attach a Photo

  • 4.23 Is the Graffiti over 2m High?

  • 4.3 General cleanliness: noting any specialised cleaning e.g high ceiling, windows, major cobwebs, very dirty requiring specialist cleaning

  • 4.31 List Cleaning Items

  • 4.32 Attach Photos

  • 4.4 Inspecting from the groud, Are there any visibly broken skylights or roof tiles or loose/damaged roof sheets?

  • 4.41 List the Items

  • 4.42 Attach Photos

  • 4.5 General exterior building checks (gutters ok, downpipes connected, no trees down, lawn mowing, stormwater damaged?

  • 4.51 List the issues

  • 4.52 Attach Photos

5.0 Building Internal Inspection

  •  5.1 Are there any lights on or is there any HVAC running (generally these items should not be on/running in an unoccupied building – please ignore any lights that you have activated due to your motion being detected)This will enable us to identify if there are any programming, timer, sensor or other issues we need to investigate.

  • 5.12 List the lights that are found on

  • 5.2 Is there any Visible roof or Plumbing Leaks?

  • 5.21 List the location

  • 5.22 Attach photos

  • 5.3 Does the Room Smell Damp?

  • 5.31 List the Rooms

  • 5.32 Attach Photos

  • 5.4 Visible Mould on any surfaces? – detail what areas and material the mould is on e.g carpet, plaster, soft and hard furnishings etc

  • 5.41 Provide Details of the affected area

  • 5.42 Attach Photos

  • 5.5 Is The Power On?

  • 5.51 List the areas that do not have power

  • 5.52 Have you checked the Switchboard?

  • 5.53 Was Power able to be restored?

  • 5.54 Is an electrician required?

  • 5.6 Are the Lights Working?

  • 5.61 Are All lights affected or is the problem localized?

  • 5.62 Is mains pressure water available at each tap? and are all toilets flushing

  • 5.63 List the affected taps or toilets

  • 5.7 Is there evidence of blocked toilets or sewers?

  • 5.71 List the location of the problem/s

  • 5.72 Attach a photo

  • 5.8 is the Air conditioning or heating operational?

  • 5.81 List the Affected area

  • 5.82 Take a photo of the room or unit/s

  • 5.9 General cleanliness: noting any specialized cleaning e.g high ceiling, windows, Major Cobwebs, very dirty requiring specialist cleaning

  • 5.91 List cleaning Items

  • 5.92 Attach Photos

  • 5.10 Is Gas Natural OR LPG on-site?

  • 5.11 is the Gas supply available

  • 5.12 Is a plumber required to attend the site?

6.0 Building Security

  • 6.1 Is there evidence of a break-in or Attempt?

  • 6.11 List the Areas

  • 6.12 Attach a photo

  • 6.2 Is the building secure?

  • 6.21 Contract Campeyn Group Office Arrange Repairs

  • 6.3 Is there any unauthorized access currently - is anyone squatting?

  • 6.31 List details of the situation on site

7.0 Urgent Works - Do any of the defects meet the Parameters Below?

  • 7.1 Any water continually running, flooding, blocked toilets & sewer blockages- within Council Facilities and boundaries.

  • 7.2 Any Electrical or Gas safety hazard – including internal / external security lighting, faulty power points, faulty cooking appliances, power supply interruption caused by damaged private powerlines. lighting creating a significant safety issue.

  • 7.3 Any Break in response/security issues/door issues, including Broken glass, doors or windows that cannot be locked, repairs to alarm systems and security cameras, doors that cannot be opened including internal doors?

  • 7.4 Any Structural collapse? – including internal ceilings, walls etc

  • 7.5 Any Roof leaks found- all?

  • 7.6Any Mechanical plant malfunction , heating and cooling, including items relating to pool function?

  • 7.7 Any there any Damaged Asbestos Containing Material?

  • 7.8 Any Mould found?

  • 7.9 If yes to any of the above supply details

  • 7.10 If Yes to the above attach Photos

  • 7.11 Is the site safe to reopen in its current state?

  • 7.12 State why

Summary

  • Final Notes

  • You may contact the following person with any questions or comments about this plan.

  • Name

  • Contact Number

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.