Jim’s Mowing NZ

• Conducted on

  Date

• Prepared by

• Location
  Address

• FSE Name

• FSE Code

• Make

• Model

• Colour

• Registration

• Vehicle Rego expires

• Trailer Registration

• Trailer Rego expires

• 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 (single)

  Yes

  No

  N/A

• Spray

  Yes

  No

  N/A

• Winz

  Yes

  No

  N/A

• First Aid Kit

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• Safety Cones

  Yes

  No

  N/A

• OHS Manual

  Yes

  No

  N/A

• Completed SWMS for listed services

  Yes

  No

  N/A

• Blank SWMS

  Yes

  No

  N/A

• Blank Accident / Injury forms

  Yes

  No

  N/A

• Awareness Signs

  Yes

  No

  N/A

• Sun Screen

  Yes

  No

  N/A

• Insect Repellant

  Yes

  No

  N/A

• Hand Sanitiser

  Yes

  No

  N/A

• Face Masks

  Yes

  No

  N/A

• Disposable Gloves

  Yes

  No

  N/A

• Green Long Pants

  Yes

  No

  N/A

• Green / Hi-Vis Long Sleeved Shirt or Polo

  Yes

  No

  N/A

• Jumper or Windcheater

  Yes

  No

  N/A

• Hat

  Yes

  No

  N/A

• Sturdy Gloves (eg leather rigger type or gardening gloves)

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Steel Capped Boots

  Yes

  No

  N/A

• Hard Hat with Visor

  Yes

  No

  N/A

• Chaps

  Yes

  No

  N/A

• Chemical Resistant Gloves

  Yes

  No

  N/A

• Respirator

  Yes

  No

  N/A

• Industrial Rated Ladder

  Yes

  No

  N/A

• Ladder lock device

  Yes

  No

  N/A

• Harness (Qualification & check exp date)

  Yes

  No

  N/A

• 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 (check for training certs)

  Pass

  Fail

  N/A

• PoleSaw

  Pass

  Fail

  N/A

• Sprayer (check for training certs)

  Pass

  Fail

  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.

• Franchisee Signature

  Sign

• Franchisor Signature

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