KJ & LM Burns HSSE Rep Checklist

• Document No.

• Monthly HSSE Checklist

• Client / Site

• Conducted on

  Date

• Prepared by

Red Book, Flip Chart and Robbery Kit

• Was the Red Book signed off by all staff and all action required completed?

  Yes

  No

  N/A

• Site specific Document control form from Risk Register has discussed?

  Yes

  No

  N/A

• Is Flip Chart up-to-date and present at the right place?

  Yes

  No

  N/A

• Robbery Kit Available and present at the right place?

  Yes

  No

  N/A

Monthly HSSE & SRA Checklist Completed?

• Did you complete this and send it to office ?

  Yes

  No

  N/A

OST PACK

• Was this discussed with all staff ?

  Yes

  No

  N/A

Site's counter and panic alarms

• Was the alarms tested min 3 times this month ? If so, add date please.

  Date:

First Aid, Spill Kits and Evacuation Bag checked ?

• Were these checked ? Did you put in an order if any stock was needed ?

HSSE & Bulk Incident Reports

• Did you at least do 5 reports for the month and Bulk incident every week? If no, please use note to explain.

  Yes

  No

  N/A

$200 till limits in tills

• Did you do some random checks on tills ?

  Yes

  No

  N/A

• Were all staff members compliant to $200 till limits ? If not, use note and explain.

  Yes

  No

  N/A

Any outstanding HSSE issues at your site.

• Are all HSSE issues at your site been sorted ? If no, please use note and explain.

  Yes

  No

  N/A

Panic pendants

• Do your site have 3 panic pendants ? If no, please explain.

  Yes

  No

  N/A

Site ZORM Folder

• Is all documentation in place?

  Yes

  No

  N/A

Meeting Notes

• KJ & LM Burns Meeting notes completed?

  Yes

  No

  N/A

• Is all Monthly meeting notes sent to Rupali and Mel:<br>1. photo of completed and signed red book (all pages for that month)<br>2, Photo of HSSE checklist sheet.<br>3.Photo of the completed Spill check sheet for that Month.<br>4. Photo of Site Specific Document control from risk register (this should show what section you reviewed at the meeting)<br>5. Excel compliance Spreadsheet needs completed and returned to me. Make sure you indicate that you have all 3 pendant alarms and that have been tested.<br>we would like your meetings to be held within the 1st 3 weeks of the month.

  Yes

  No

  N/A

HSNO Board & Certification.

• HSNO Board's all documentation in place?<br>1. Valid Test Certificate for 91, 95, Diesel and LPG.<br>2. Valid Approved Handler Certificate.<br>3. Valid Approved Handler Call Tree<br>4. Valid Electrical Certificate.<br>5. All Site Plan

  Yes

  No

  N/A

• Current Building WOF Certificate available on site and Displayed?

  Yes

  No

  N/A

• Current Site Food Exemption Certificate and Annual Certificate on Display?

  Yes

  No

  N/A

PPE Check

• Panic Alarm, Safety Shoes, Correct Gloves, Hi-Vest, Name Badge, Safety Glasses.