HEALTH, SAFETY & ENVIRONMENT SITE – POND INSPECTION FORM

• Site conducted

  Select
• Location
  Address

• Area Inspected

• Pond Risk Level

  Safe

  At Risk

  N/A

• Prepared by

• Inspection date

  Date

External Inspection

• Boundaries

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Circulation Routes (roads, paths etc.)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Public Safety

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• General Housekeeping

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Slips, Trips & Falls (all areas)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Vegetation Hazards (Trees etc.)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

Internal Inspection

• Signage (clear, clean, visible)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Access & Egress

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Services (culverts etc.)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Life Saving Equipment

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Other hazards (specify)

  Select No Defects found Maintenance Defect requiring specified time scale for action Safety Defect requiring category 1 action Not applicable to this site

  • No Defects found
  • Maintenance Defect requiring specified time scale for action
  • Safety Defect requiring category 1 action
  • Not applicable to this site

• Category

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• Catagory

  Select Category 1 – Safety defect within 48 hours Category 2 - Maintenance defect within 7 days Category 3 - Maintenance defect within 28 days Category 4 – Specified time scale

  • Category 1 – Safety defect within 48 hours
  • Category 2 - Maintenance defect within 7 days
  • Category 3 - Maintenance defect within 28 days
  • Category 4 – Specified time scale

• Description of Defect

• Comments/ Actions

• I declare that following the inspection, no other defects were found other than those specified above.

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