Audit

JOB SPECIFICS

WORKS ORDER DETAILS

Claim Number

For Hub

Requested By

Purchase Order Number

Works Order Number

The person in control of the job is :

CLIENT DETAILS

Owners Name

Owners Contact Details

Tenants Name

Tenants Contact Details

Access Details (who to call, key given or left etc)

INITIAL INSPECTION

BUILDING TYPE

The Building Is

The Building is on

Is the home in a damp environment?

Floor Area M2

Internal Stud Height M

Comments:

HEALTH ISSUES

Is respiratory distress common?

Are occupants suffering from asthma that has worsened?

Are occupants suffering nose bleeds?

Are occupants suffering headaches?

Do occupants suffer from itchy eyes?

Do occupants suffer from rashes and/or skin lesions?

Do occupants notice an improvement when they leave the home for a period of time?

Comments

PSYCHOMETRIC CONDITIONS

Outdoor Temperature

Ambient Outdoor RH%

Indoor Temperature

Indoor RH%

Sub Floor Temperature

Sub Floor RH%

Equilibrium RH%

Moisture Content is (WME%)

CAUSE OF WATER INTRUSION

Rising Damp

Is there rising damp due to earthquake (explain)

Is rising damp from liquefaction under the floor?

Presence of liquefaction is

Consistency of Liquefaction is:

Is mould present?

Is sewage present?

Is pungent Odour present?

Is there water intrusion to the building envelope due to liquefaction?

Would you recommend removal of liquefaction?

Leaking Water/Drain Pipe

Is Water intrusion due to a leaking pipe?

Has leak been fixed?

Was leak caused by a sudden event?

Where is/was leak?

Photo

Weather Penetration

Is water intrusion due to leak in roof or building envelope?

Has leak been fixed?

Was leak caused by a sudden event?

Where is/was leak?

Photo

MOULD INSIDE

What type of mould exists inside?

Where is the mould located?

Photo

Does mould need to be physically removed?

MOULD IN SUB FLOOR

What type of mould exists under floor?

Where is the mould located?

Photo

Does mould need to be physically removed?

REMEDIATION STRATEGY RECOMENDATIONS

ECC/AIR IMPACT Testing of recommended?

Samples Taken?

Sample taken by:

Pre works 'make safe' subfloor decontamination recommended?
(Basic treatment to ensure the health and safety of tradesmen working in the area)

Pre works 'make safe' internal decontamination recommended?
(Basic treatment to ensure the health and safety of tradesmen working in the area)

Removal of Liquefaction Recomended?
(observations, access etc)

Mechanical drying of underfloor most likely required?
(estimated timeframe if known)

Placement and/or replacement of DPM in subfloor?

Physical removal of mould most likely required?

Mechanical drying inside home most likely required?
(estimated timeframe if known)

Post works FULL subfloor decontamination recommended?
(include notes re drying required etc)

Post works FULL internal decontamination recommended?
(include notes re drying required etc)

CONCLUSION

Recommended PPE Requirements prior to/or without 'make safe' decontamination treatment

Recommended PPE Requirements prior to/or without Full decontamination treatment

Recommended PPE Requirements post 'make safe' decontamination treatment

Recommended PPE requirement post FULL decontamination treatment

Comments

Quote for Recommended Remediation Provided?

SITE SPECIFIC SAFETY PLAN
1. WORKPLACE CONTROL AND HEALTH AND SAFETY MANAGEMENT
The on-site safety representative (SR) for this project is

The person in control of the workplace is :

2. NOTIFIABLE WORKS

We have Notifiable Works associated with our subcontract

DoL will be advised of Notifiable Works upon acceptance of quote

3. HAZARD MANAGEMENT

We will maintain an onside Hazard Register of all existing and new hazards and appropriate controls

We will prepare a written Task Analysis covering all significant hazards associated with our works, in conjunction with employees, and give it to site management before any work involving that hazard commences onsite

Are there hazardous products/processes associated with our subcontract works?

Appropriate Safety Data Sheets have been supplied to the main contractor?

Appropriate Safety Data Sheets have been are available on site?

4. COMMUNICATION/EMPLOYEE PARTICIPATION

The methods we use to communicate safety information to our employees are:

Daily Toolbox Talks - including covering site hazards and emergency/evacuation procedures

Monthly Health and Safety Meetings - covering use of equipment, hazards encountered

Pre-task Planning Meetings - Done first Visit to site post quote approval

Other

Urgent Safety Updates are e-mailed and/or TXT to all staff and put on the router for the next Health and Safety Meeting

5. EMERGENCIES

Emergency Kit One (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

Emergency Kit Two (First Aid Kit, Confined space emergency kit, Fire Extinguisher) is located

We have trained First Aid personnel and procedures in place on site to render assistance in the event of an accident/emergency

Our Designated Warden/First Aid person is

In the event of a site emergency or evacuation our personnel will report to our safety representative and assemble at the evacuation area shown on the Emergency Evacuation Plan

We have an Emergency Plan for all hazardous products and processes referred to in section 3 above

EMERGENCY PLAN AND PROCEDURES FOR HAZARDOUS WORK

Emergency Procedure: Evacuate to meeting point specified below, Role call, Dial 111 Emergency Services and/or administer First Aid if required

Evacuation Plan for all Emergency Situations: Alarm Evacuation, Unsound Building, Earthquake, Fire, Tsunami, Other

Evacuation Plan 3: Other

6. ACCIDENT/INCIDENT: REPORTING/INVESTIGATION/RECORDING

We have an accident/incident reporting/investigation system in place and keep an Accident/Incident Register

We will immediately notify all serious harm accidents to site management and follow up within 7 days with a completed copy of the Accident and Incident Investigation Report

7. SAFETY INSPECTIONS AND SAFETY REVIEWS

We agree to undertake safety inspections and reviews at the intervals required by the Safety Activity Monitoring Register Wall Chart

A sample of documentation of our safety inspections has been sent to the main contractor

8. TRAINING/INDUCTION

All persons under our control hold current passports or induction pass cards as required

All persons under our control on site are given a site specific safety induction

All persons under our control on site are appropriately qualified, competent or fully supervised

9. SUBCONTRACTORS

Will we have subcontractors working for you on this project

Subcontractors to provide SSSP

Subcontractors to provide Task Analysis

SIGNATURE
Signature of Technician Compiling SSSP
Time and date Task Analysis Complete

TASK ANALYSIS

GENERAL STEPS

Step 1: Assess property for external hazards

Step 2: Familiarise customer with process and requirements

Step 3: Erect signs and barricades and/or check existing signs and barricades

Potential Hazard:

Control Methods:

Step 4: Don PPE according to task requirements as below

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Step 5: As per task below

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Step 6: Remove PPE

Potential Hazard:

Control Methods

Step 7: Ensure any signage being left onside is secure and visible

Step 8: Remove signage not being left onsite

Step 9: Check site and leave

ECC AND/OR AIR SAMPLING

A) Follow steps 1-4 of general

B) Load in equipment

Potential Hazard:

Control Methods:

C) Record observations including clients comments

D) Take samples as required

Potential Hazard:

Control Methods:

E) Follow steps 6-9 of general

DECONTAMINATION OF CRAWL SPACE

A) Follow steps 1-4 of general

B) Ensure all occupants and pets are out of the area to be decontaminated

Potential Hazard:

Control Methods:

C) Block all foundation vents

D) Load in equipment

Potential Hazard:

Control Methods:

E) Load in disinfectants and ensure they are safely stored and mixed

Potential Hazard

Control Methods

F) Treat Subfloor

Potential Hazard:

Control Methods:

G) Follow steps 6-9 of general

DECONTAMINATION OF INTERNAL ENVELOPE OF PROPERTY

A) Follow steps 1-4 of general

B) Load in equipment

Potential Hazard:

Control Methods:

C) Load in disinfectants and ensure they are safely stored and mixed

Potential Hazard

Control Methods

D) Take pre-air samples

Potential Hazard:

Control Methods:

E) Ensure all occupants and pets are out of the area to be decontaminated

Potential Hazard:

Control Methods:

F) Apply surface treatments

G) Set VHP and close up home

H) Follow steps 6-9 of general

POST TREATMENT SAMPLING

A) Follow steps 1-4 of general

B) Upon Re-entry, test VHP levels. Only re-enter if safe to do so

Potential Hazard:

Control Methods:

C) Take Post Samples

Potential Hazard:

Control Methods:

Signature of Technician Compiling Task Analysis
Time and date Task Analysis Complete
CHECKLIST

Initial inspection report complete?

SSSP Complete?

Task analysis complete?

Quote complete

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.