HS-013 Site Audit Form Template

• Date

  Date

• Name of auditor

• Site conducted

  Select

• Operative( s)

• Location
  Address

Operative (s)

• Uniform

  Select Full Deltron Lifts (DL) Uniform Not wearing DL top Not wearing appropriate trousers Acceptable No Uniform N/A Damaged-not acceptable

  • Full Deltron Lifts (DL) Uniform
  • Not wearing DL top
  • Not wearing appropriate trousers
  • Acceptable
  • No Uniform
  • N/A
  • Damaged-not acceptable

• Tidy & professional

  Acceptable

  Not acceptable

• ID badge

  Select Worn & visable Damaged & illegible Available on request Not presented Out of date Lost

  • Worn & visable
  • Damaged & illegible
  • Available on request
  • Not presented
  • Out of date
  • Lost

• Signed in to site

  Signed into client system

  Signed in Deltron CDM system

  Signed in (other)

  Not signed in

  N/A

• Health and welfare of operative

  Select All good Disclosed mental health concerns Disclosed physical health concerns Auditor concerned re health

  • All good
  • Disclosed mental health concerns
  • Disclosed physical health concerns
  • Auditor concerned re health

• CSCS card

  Valid

  Expired

  Inappropriate to works

  No card

  N/A

Site

• Site specific risk assessment

  Select Up to date and can show auditor where located Can't show auditor where located Checked but not available

  • Up to date and can show auditor where located
  • Can't show auditor where located
  • Checked but not available

• Operative can demo access to google drive for RAMS, etc

  Select Has access and can demonstrate use Has access but can not demonstrate proper use No access Not required- CPP on site inc RAMS & induction recorded Not required -CPP on site inc RAMs but no record of induction

  • Has access and can demonstrate use
  • Has access but can not demonstrate proper use
  • No access
  • Not required- CPP on site inc RAMS & induction recorded
  • Not required -CPP on site inc RAMs but no record of induction

• Fire precautions

  Select Available, ext in date, signs posted Avail but not indate/sufficient *pls state None/ inadeqate *pls state N/A

  • Available, ext in date, signs posted
  • Avail but not indate/sufficient *pls state
  • None/ inadeqate *pls state
  • N/A

• Health hazards

  Select None present Asbestos-identified Asbestos-suspected Phone masts Water in pit Needles Dust-inc silca Water towers/ air conditioning units Bodily fluids Excrement -bat/pigeon, etc. * Pls state Mulitple *pls state Other *pls state

  • None present
  • Asbestos-identified
  • Asbestos-suspected
  • Phone masts
  • Water in pit
  • Needles
  • Dust-inc silca
  • Water towers/ air conditioning units
  • Bodily fluids
  • Excrement -bat/pigeon, etc. * Pls state
  • Mulitple *pls state
  • Other *pls state

• General house keeping

  Select Clean & Tidy Unacceptable -Deltron Lift issues Unaccertable- caused by others

  • Clean & Tidy
  • Unacceptable -Deltron Lift issues
  • Unaccertable- caused by others

• Access/Egress

  Safe

  Unsafe *pls state why

• Welfare facilities

  Select Available, suitable & clean Available but unsuitable/unclean Off site None available

  • Available, suitable & clean
  • Available but unsuitable/unclean
  • Off site
  • None available

• Hoardings/ Safety barriers - Note:safety barriers should be fixed into position

  Select Barrier acceptable and in proper use Damaged/ incomplete *pls state Acceptable barrier but not fixed in position Acceptable hoarding but not locked Not required

  • Barrier acceptable and in proper use
  • Damaged/ incomplete *pls state
  • Acceptable barrier but not fixed in position
  • Acceptable hoarding but not locked
  • Not required

PPE

• PPE suitable stored

  Safely Stored

  Not suitable

• Safety footwear

  Worn & suitable

  Damaged

  Not being worn

  N/A

• Hi-Vis Vest (where applic)

  Select Acceptable Damaged Dirty Not available Not suitable N/A

  • Acceptable
  • Damaged
  • Dirty
  • Not available
  • Not suitable
  • N/A

• Hard hat (<3 yrs)

  Suitable & In date

  Out of date (3+ yrs)

  Damaged/ dirty

  N/a

• Bump cap

  Suitable & In date

  Out of date (3+ yrs)

  Damaged/ dirty

  N/a

• Suitable gloves

  Acceptable

  Damaged

  Not available

  Not suitable for the task

• Googles, safety glasses

  Select Acceptable Damaged Not available Available but not with tools on site N/A

  • Acceptable
  • Damaged
  • Not available
  • Available but not with tools on site
  • N/A

• Ear protection/ RPE

  Select Acceptable Damaged Not available Available but not with tools on site N/A Not suitable for task

  • Acceptable
  • Damaged
  • Not available
  • Available but not with tools on site
  • N/A
  • Not suitable for task

Equipment

• Shorting kit

  Select Available and complete Available but items missing Not available. (Check if issued)

  • Available and complete
  • Available but items missing
  • Not available. (Check if issued)

• Lock off/ tag out kit

  Available and complete

  Available but items missing

  Not available

  Required

• Door stopper

  Acceptable

  Not acceptable

• Ladder – tagged & checked

  Damaged - not useable

  N/a

  Not tagged

  Tagged not checked

  Tagged & checked

• Electrical equipment

  Select Not suitable- 240V mains powered Suitable, PAT tested and in date Suitable, PAT tested but out of date Suitable but not PAT tested N/A

  • Not suitable- 240V mains powered
  • Suitable, PAT tested and in date
  • Suitable, PAT tested but out of date
  • Suitable but not PAT tested
  • N/A

• Hand tools

  All acceptable

  Suitable for use but damaged

  Unsuitable

• First aid kit

  Select Available and complete Available but items missing Not available. (Check if issued)

  • Available and complete
  • Available but items missing
  • Not available. (Check if issued)

• Hygiene kit

  Select Complete Item requires replenising *pls state Kit required N/a

  • Complete
  • Item requires replenising *pls state
  • Kit required
  • N/a

• Lifting equipment -slings, etc

  Select Good condition Not required/ not applicable Good condition but no certs on site Damaged-quarantine. Replacement needed

  • Good condition
  • Not required/ not applicable
  • Good condition but no certs on site
  • Damaged-quarantine. Replacement needed

• Harnesses - only where used on sites by trained personnel

  Select Good condition Not required/ not applicable Good condition but no certs on site Damaged-quarantine. Replacement needed

  • Good condition
  • Not required/ not applicable
  • Good condition but no certs on site
  • Damaged-quarantine. Replacement needed

Vehicle

• Registration

• Mileage

• Vehicle exterior

  Select Clean Acceptable level of dirt Needs cleaning Dirty - number plate not visible

  • Clean
  • Acceptable level of dirt
  • Needs cleaning
  • Dirty - number plate not visible

• Damage to vehicle

  No damaged

  Wear & tear

  Damaged

  Damaged - repair required

• Number plates

  All ok - no damage and visible

  Damaged

• Horn, mirrors & tyres

  Select All acceptable Damaged tyre(s) *pls state Worn tyre(s) *pls state Horn not working Mirror(s) damaged Mirror (s) not present

  • All acceptable
  • Damaged tyre(s) *pls state
  • Worn tyre(s) *pls state
  • Horn not working
  • Mirror(s) damaged
  • Mirror (s) not present

• Clean interior

  Select Clean Acceptable level of dirt Needs cleaning Dirty - number plate not visible

  • Clean
  • Acceptable level of dirt
  • Needs cleaning
  • Dirty - number plate not visible

• Doors lockable

  Yes

  No-requires repair

• Lights inc check hazard lights

  All working

  Not working *pls state

  Damaged *pls state which

  Hazards not working

• Seat belts secure

  Yes

  No-requires repair

• Wipers & windows

  All acceptable

  Wipers need replacing

  Windscreen damaged

  Other damage *pls state

• No smoking signs

  Not present

  Present

  Issued during check

• Hazardous substances

  Select Presented in date copy when asked Not available. Issue/ give access during audit Non DLL company: Remind legal duty

  • Presented in date copy when asked
  • Not available. Issue/ give access during audit
  • Non DLL company: Remind legal duty

• Batteries correctly stores ( terminals shld be taped over)

  Select Batteries present and terminals covered over Batteries present but terminals exposed No batteries present N/A

  • Batteries present and terminals covered over
  • Batteries present but terminals exposed
  • No batteries present
  • N/A

• Equipment

  Suitably stored

  Not suitably stored

• Waste Carriers Licence

  Select Presented in date copy when asked Not available. Issue/ give access during audit Non DLL company: Remind legal duty

  • Presented in date copy when asked
  • Not available. Issue/ give access during audit
  • Non DLL company: Remind legal duty

Other

• Any other items noted

Sign Off

• Auditor (Name, Signature & Sign Date)

  Sign