Information
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Document No.
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Conducted on
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Name of Security Officer
Electrical/Lighting Failures
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Are there any electrical/lighting failures to report?
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If yes, provide details, including the exact location of the fault.
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Photo of location of electrical/lighting failure
Power Failure
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Are there any power failures to report?
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If yes, provide details, including the exact location of the failure.
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Photo of location of power failure
Flood/Water Leaks
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Are there any flood/water leaks to report?
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If yes, provide details, including the exact location of the leak/flood,
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Photo of location of flood/water leak
Damages/Health and Safety Hazards
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Is there any damage to report which could pose a health and safety hazard?
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If yes, provide details, including the exact location of the damage/hazard.
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Photo of location of damage/hazard
Fire Extinguisher Damages
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Are there any fire extinguisher damages to report?
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If yes, provide details, including the exact location of the fire extinguisher damage.
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Photo of location of damaged fire extinguisher
Door Faults
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Are there any door faults to report?
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If yes, provide details, including the exact location of the door fault.
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Photo of location of door fault
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Officer Signature