KVisit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre-visit store preparation

• Agreed actions from previous visit reviewed (if applicable)

  Yes

  No

  N/A

• Store specific communications prepared before visit (if applicable)

  Yes

  No

  N/A

• Safety statistics reviewed, e.g. safety score card, LTI's, TRI's

  Yes

  No

  N/A

• Is this store on the Safety Improvement Program

  Not applicable

  Green

  Amber

  Red

• Comments for discussion with Store Manager

Service desk / sign in

• Visitors sign in register in place

  Yes

  No

  N/A

• Register being used appropriately, all pages completed correctly

  Yes

  No

  N/A

• Site details page up to date with correct information (check date)<br>

  Yes

  No

  N/A

• Hazard update form in place and completed where required

  Yes

  No

  N/A

• Emergency grab folder in place with current information

  Yes

  No

  N/A

• We're you offered a site orientation?

  Yes

  No

  N/A

• Rate team members understanding of the sign in process (1 = Unsatisfactory, 2= Satisfactory, 3 = Excellent)

• All visitors being signed in by Service Desk Team Member

  Yes

  No

  N/A

Selling area

• Floor clear of spills (including dog food, kitty litter and silica gel) and empty hangers (e.g. Coat hangers, footwear hangers)

  Safe

  At Risk

  N/A

• Black decks appropriately filled/stacked with merchandise

  Safe

  At Risk

  N/A

• H cages on selling floor being used as per Safe Work Practice

  Safe

  At Risk

  N/A

• Chlorine separation occurring as per required standards minimum 3m separation between granular and liquid chlorine)

  Yes

  No

  N/A

• Slip resistance of flooring in automotive area (Score of 6 or lower 'at risk', 7 and above 'safe')

• Walkways free of hazards, such as electrical cords.

  Yes

  No

  N/A

• Free weights fixture stable and stocked appropriately

  Yes

  No

  N/A

• Ball display unit(s) stable and secured to nearby fixture (where possible)

  Yes

  No

  N/A

Stockroom

• Boom gates on back dock in down position if not being used

  Yes

  No

  N/A

• Keys are removed from motorised plant if not in use (motorized plant may include walkie stackers, waves, electric pallet jacks and forklifts)

  Yes

  No

  N/A

• List of current approved operators attached to motorised plant

  Yes

  No

  N/A

• Pre-operational checks completed daily for all motorised plant

  Yes

  No

  N/A

• H-cages being used as per required Safe Work Practice

  Safe

  At Risk

  N/A

• Pallets stored in racking above ground level are shrinkwrapped

  Yes

  No

  N/A

• Pallet racking not damaged and locking pins in place

  Yes

  No

  N/A

• Plant room locked restricting access

  Yes

  No

  N/A

• Fire exits and fire equipment clear of obstruction

  Yes

  No

  N/A

• Clear walkways observed throughout entire stockroom

  Yes

  No

  N/A

• Flooring free of slip/trip risks (e.g. Mezzanine floor is level without any raised sections that could catch a persons foot)

  Yes

  No

  N/A

• Cardboard pallets not stored on racking

  Yes

  No

  N/A

Cleaners room

• Current safety data sheets available (current - dated within 5 years)

  Yes

  No

  N/A

• Spare gas bottles secured

  Yes

  No

  N/A

• All containers labelled appropraitely

  Yes

  No

  N/A

Office

Noticeboards / safety boards

• Safety notice board is up to date and displaying correct information

  Yes

  No

  N/A

• Safety board is displaying the correct months results

  Yes

  No

  N/A

• Current (if required) hazard alert displayed

  Yes

  No

  N/A

Operational site safety plan

• Reviewed previous quarter safety plan including outstanding actions, completed checklists and documents

  Yes

  No

  N/A

• If a SIP store, review SIP action plan ensuring actions have been carried over into quarter plan

  Yes

  No

  N/A

• Reviewed page 3 safety score for completion and trend performance (located in quarter plan sheet 'Measures, targets and performance)

  Yes

  No

  N/A

Safety cabinet

• Correct tabs in place

  Yes

  No

  N/A

• Documentation filed and in order

  Yes

  No

  N/A

• Previously issued hazard alerts actioned appropriately

  Yes

  No

  N/A

End of visit

• Comments

  Yes

  No

  N/A

• Findings discussed with Store Manager / Store Administration Manager

  Yes

  No

  N/A

• Signature of Safety Services Manager

  Sign

• Signature of Management Representative

  Sign

Actions required following completion of checklist:

• 1. SM to review action required items identified within the checklist with management team

• 2. Transfer action required items to your current months store specific actions page within your current quarter safety plan

• 3. Discuss the findings of the checklist during your next safety committee meeting

• 4. Close out action required items via the quarterly site safety plan

• 5. Review close out items with SOM/ZM when next visiting store

• Reference media item #1

  Media

• Reference sketch / drawing #1

  Drawing