Inspection Record - Mall / Footpath Flushing & High Pressure Cleaning

• Conducted on

  Date

• CC Worker/s Name

• Prepared by

• Map Location
  Address

• Location

• Task Being Undertaken

  Hosing / Flushing

  Pressure Cleaning

  Litter / Gum Removal

• Procedures / Risk Assessments Followed

  Yes

  No

  N/A

• Has Work Been Completed To Required Standards

  Yes

  No

  N/A

• Driver Following Work Instructions

  Yes

  No

  N/A

• Has Location Been Completed Fully

  Yes

  No

  N/A

• Security In Place

  Yes

  No

  N/A

• Correct Break Times

  Yes

  No

  N/A

• Comments

Photos

• Insert all related photos

  Media

Cleaners signature

• Sign below

  Sign