Information
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Conducted on
Monthly Fire Safety Checks
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Date & Time Completed
Fire Safety Checks
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What to check on the Fire Exits, Fire Doors & Fire Extinguishers
Ground Floor
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(FD1) School Entrance Door (Fire Door)
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(FD2) Public Entrance (Fire Door)
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Corridor - 1x 6L H2O (Extinguisher 104)
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(FD3) Male Changing Rooms Entrance (Fire Door)
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(FD2) Female Changing Rooms Entrance (Fire Door)
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(FD4) Male Changing Rooms Pool Door (Fire Door)
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(FD5) Female Changing Rooms Pool Door (Fire Door)
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Office - 1x 2Kg CO2 (Extinguisher 102)
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Office - 1x 6L H2O (Extinguisher 103)
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(FE1) Poolside (Fire Exit Door)
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(FD6) Plant Room (Fire Door)
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Plant Room - 1x 2Kg CO2 (Extinguisher 105)
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(FD7) Boiler Room (Fire Door)
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Boiler Room - 1x (Extinguisher ###)
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Any Action Point / Further Comments / Information
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Write Name & Signature Of Person Completing Check
Monthly Evac+Chair Check
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Date & Time Completed
Evac+Chair Safety Check
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Chair is located in correct location
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Signage to the designated place of relative safety is in place
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Signage is located above the evac chair
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Ensure that the straps and buckles are not damaged
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Check the belts are intact and no signs of damage
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Check all 4 wheels and the brakes on the smaller 2 wheels
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Check there is no sign of damage to the fabric of the seating area
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Any Action Point / Further Comments / Information
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Write Name & Signature Of Person Completing Check
Monthly First Aid Stock Check
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Date & Time Completed
First Aid Stock Check
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Ensure All Expiry Dates Are Checked
First Aid Box Stock
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Accident Forms & Head Injury Forms Are Saved Onto The System
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HSE Sterile Dressings (Large 18cm) (Min 3)
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Order Is Required
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HSE Sterile Dressings (Medium 12cm) (Min 3)
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Order Is Required
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Sterile Triangular Bandages (Min 2)
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Order Is Required
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Eye Pads (Min 2)
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Order Is Required
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Medi Wipes (Box) (Min Packs 1)
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Order Is Required
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Face Shields (Min 2)
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Order Is Required
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Safety Pins (Packs) (Min 1 Pack Of 6)
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Order Is Required
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Fabric Strapping (Individual Rolls) (Min 3)
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Order Is Required
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Eye Wash (Individual Sachets) (Min 5)
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Order Is Required
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Selection Of Plasters (1 Box)
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Order Is Required
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Heat Retaining Blankets (Min 2)
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Order Is Required
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Gloves (Box) (Min 1 Box)
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Order Is Required
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Ice Packs (Min 1 Box)
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Order Is Required
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First Aid Box Seals (Pack) (Min 1 Pack)
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Order Is Required
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Face Mask (Min 1)
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Order Is Required
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Spare AED Pads - Check & Record Expiry Dates (Min 1)
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Order Is Required
Burns Kit Stock
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Burnshield Hydrogel (Min 1)
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Order Is Required
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Burnshield Burn Blott (Min 2)
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Order Is Required
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Blue Detectable Waterproof Tape (Min 1)
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Order Is Required
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Tuff Kutt Scissors (Min 1)
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Order Is Required
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Limb Dressings (Min 2)
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Order Is Required
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Conforming Bandages (Min 1)
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Order Is Required
Bio-Hazard Kit Stock
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Bio Hazard Bags (Pk 25) (Min 1 Pack)
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Order Is Required
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Absorbent Granules (Min 1 Tube)
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Order Is Required
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One Use Body Fluid Kit (Min 2)
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Order Is Required
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Response Sharps Refill Kit (Min 2 Packs)
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Order Is Required
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Disinfectant Spray (Min 2)
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Order Is Required
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Write Name & Signature Of Person Completing Check
Monthly PPE Check
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Date & Time Completed
General Manager - Lewis Freeman
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
Deputy General Manager - Chris Corcoran
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
Deputy General Manager - Dan Flippance
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
Deputy General Manager - Milena Eblowska
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
Deputy General Manager - Tracey Blair
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
Senior Membership Advisor - Dan Worth
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Facemask Record Cartridge Expiry Date and confirm type (ABEK P3)<br>Is it clean and free from chemical residues?<br>Is it in good condition and free from cracks, splits?<br>Are they head strap and clips in good condition?
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Gloves<br>Are they clean and free from chemical residues?<br>Are they in good condition, free from holes or tears?<br>Are they stored in an individual plastic bag?
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Wellington Boots <br>Are They Present, Clean & Serviceable?
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Overall's<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Apron<br>Are they clean and free from chemical residues?<br>Are they free from rips and tears?
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Safety Goggles / Face Shield<br>Are they stored in an individual plastic bag?<br>Are they clean and free from chemical residues?
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Write Name & Signature Of Person Completing Check
Monthly Pool Inspection
Pool
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Check Completed By:-
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Observations
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Attach Any Photos Here
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If Any Defects Identified, Inform The Duty Manager / Operations Manager
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Write Name & Signature Of Person Completing Check
Monthly Work Equipment
Henry Hoover (Cleaning Cupboard)
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Are the casing and cables in good condition?
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Is the item clean? (check filters and blockages)
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Check operation
Henry Hoover (Gym Office)
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Are the casing and cables in good condition?
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Is the item clean? (check filters and blockages)
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Check operation
Handheld Hoover (Gym Office)
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Are the casing and cables in good condition?
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Is the item clean? (check filters and blockages)
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Check operation
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Does the unit charge when plugged into the base?
Steam Cleaner (Cleaning Cupboard)
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Check all cables and wires for damage
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Check frame for cracks and broken parts
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Check handle is secure and not worn
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Check the machine runs and in good working order
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Check lance / hose not worn or damaged
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Check machine is clean
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Write Name & Signature Of Person Completing Check
