HSE SITE INSPECTION

• Site conducted

  Select

• Site Name

• Conducted on

  Date

• Inspector Name

• Location
  Address

Site Safety Inspection

Worker Induction

• Are records available that all workers are appropriately inducted on the site ?

  Yes

  No

  N/A

Site Documentation

• Do workers have access to relevant XL Retail and client forms including incident and hazard reports ?

  Yes

  No

  N/A

Chemical Management

• Are all MSDS current (less than 5 years from date of issue) and available for all chemicals that are used ?<br>Check the Site MSDS Register entry against actual.

  Yes

  No

  N/A

• Are all chemical containers capped and labelled with clean, legible labels ?

  Yes

  No

  N/A

• Is there appropriate PPE available for use as outlined in MSDS ?

  Yes

  No

  N/A

• Only chemicals permitted for use at the site are in use/store in the cleaner's room?

  Yes

  No

  N/A

Storage and Work Area

• Is the cleaner's storage area maintained in a neat and tidy state ?

  Yes

  No

  N/A

• Are the walkways clear of obstructions and trip hazards ?

  Yes

  No

  N/A

Electrical Safety

• Do all portable electrical equipment have current test tags as per the requirements of AS3760 ?<br>Check the Site Register against actual.

  Yes

  No

  N/A

Equipment Management

• Equipment is in good working order and maintained in a clean state ?

  Yes

  No

  N/A

• Damaged equipment is isolated and tagged ?

  Yes

  No

  N/A

Emergency Response

• Are there adequate first aid facilities on site ?<br>Locate the first aid kit and look for records of maintenance

  Yes

  No

  N/A

• Are the site emergency procedures current and maintained in a clean state ?

  Yes

  No

  N/A

• Are all emergency exits and firefighting equipment clear of obstructions and with signs in place ?

  Yes

  No

  N/A

• Do workers know how to respond to a spill ? Is there a spill kit available ?

  Yes

  No

  N/A

• Is there an emergency call list ? <br>Interview a worker on how to respond to an emergency situation.

  Yes

  No

  N/A

Infection Control

• Is colour coded equipment (e.g., cleaning cloths, mops, buckets) used on site ?

  Yes

  No

  N/A

• Do workers present in a professional and hygienic manner including wearing an XL Retail uniform ?

  Yes

  No

  N/A

• Did you witness workers using correct cleaning techniques for controlling infection/cross contamination ?

  Yes

  No

  N/A

Worker Safety (observe worker/s)

• Name of worker/s being observed

• Location worker/s are being observed

• Are workers working to XL Retail and/or client procedures ?

  Yes

  No

  N/A

• Do workers have access to appropriate PPE including disposable gloves and safety glasses ?

  Yes

  No

  N/A

• Is appropriate PPE being worn, maintained and stored correctly ?

  Yes

  No

  N/A

• Are workers using correct manual handling techniques ?

  Yes

  No

  N/A

• Are the correct cleaning signage requirements in place ?

  Yes

  No

  N/A

Hazards

• Do workers know how to report a hazard ?

  Yes

  No

  N/A

• If yes, what is the proposed corrective action for reducing the risk of this hazard ?

• Did workers inform you of any hazards during this inspection ?<br>Note down hazards identified

  Yes

  No

  N/A

General Comments

• Any further comments or recommendations arising from this inspection?

• Add any additional relevant photos

  Media

• Have all required corrective actions been added as Actions to this inspection?

  Yes

  No

  N/A

• Please add any corrective actions to the appropriate questions above before completing this report

Sign Off

• Name & Signature of Inspector

  Sign

• Name & Signature of Site Supervisor / Manager

  Sign