HSWF11

• Conducted on

  Date

• Auditor's Name

  Sign

• Auditee's Name

• FSE Code

• 1.1 A completed copy of the HSW Manual including additional blank copies of the hazard / incident report & JSA is carried in the vehicle?

  Yes

  No

  N/A

Services Listed on FMS

• Mow Reg

  Yes

  No

  N/A

• Mow Once

  Yes

  No

  N/A

• Mow Ride On

  Yes

  No

  N/A

• Garden Reg

  Yes

  No

  N/A

• Garden Once

  Yes

  No

  N/A

• Pruning

  Yes

  No

  N/A

• Rubbish Green

  Yes

  No

  N/A

• Rubbish Other

  Yes

  No

  N/A

• Gutters

  Yes

  No

  N/A

• Spray

  Yes

  No

  N/A

• Winz

  Yes

  No

  N/A

• 2.1 All plant / equipment is recorded on the Plant Register?

  Yes

  No

  N/A

• 2.2 All electrical plant is tested / tagged and dates are current?

  Yes

  No

  N/A

• 2.3 Plant / Equipment is maintained as per manufacturer’s requirements?

  Yes

  No

  N/A

• 2.4 There is a system in place to keep records of maintenance? (Logbook, receipts)

  Yes

  No

  N/A

Equipment in Use (check for holes and guards)

• Mower (Hand)

  Pass

  Fail

  N/A

• Mower (Ride On)

  Pass

  Fail

  N/A

• Line Trimmer

  Pass

  Fail

  N/A

• Edger

  Pass

  Fail

  N/A

• Blower

  Pass

  Fail

  N/A

• Hedge Trimmer

  Pass

  Fail

  N/A

• Chainsaw

  Pass

  Fail

  N/A

• Polesaw

  Pass

  Fail

  N/A

• Sprayer

  Pass

  Fail

  N/A

• 3.1 All chemicals are recorded on the Chemical Register?

  Yes

  No

  N/A

• 3.2 All chemicals have a current SDS? I.e. No older than 5 years.

  Yes

  No

  N/A

• 3.3 Chemical containers are clearly labelled?

  Yes

  No

  N/A

• 4.1 First Aid Kit is fully stocked / maintained?

  Yes

  No

  N/A

• 4.2 Fire extinguisher is of the type with a hose and has been tested and tagged in the last 6 months?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Hi Vis Long Sleeve top / pants / hat

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Chemical resistant goggles

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Steel capped boots

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hard Hat with solid visor

  Yes

  No

  N/A

• Safety Harness (tested / tagged)

  Yes

  No

  N/A

• Chaps

  Yes

  No

  N/A

• Respirator

  Yes

  No

  N/A

• Safety signage

  Yes

  No

  N/A

• Safety cones

  Yes

  No

  N/A

• Ladder lock device

  Yes

  No

  N/A

• Spill tray

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• 6.1 There is a system in place to keep records of competencies & training?

  Yes

  No

  N/A

• 6.2 All Workers (including Franchisee) have correct and current licences, certificates of competency and training?

  Select Yes No N/A

  • Yes
  • No
  • N/A

Vehicle Details

• Make

• Model

• Colour

• Rego

• Rego Exp

Trailer Details

• Rego

• Rego exp

• 7.1 Vehicle and trailer are in good working order? I.e. tyres / indicators / brake lights / head & park lights / windscreen

  Yes

  No

  N/A

• 7.2 Drivers licence is current and has not been suspended or cancelled?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 7.3 Vehicle and trailer registration and insurance are current?

  Yes

  No

  N/A

• I hereby declare the above audit, based on the evidence provided by the auditee and my personal observations, to be true and correct.

  Sign