Lazaro Site Inspection Form - duplicate

• Document No.

• PURPOSE OF VISIT: Planned/Random/Complaint follow up /Client visit/Other

• Indicate if the inspection is: Daily/weekly/monthly

  Daily

  Weekly

  Monthly

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

LAZARO P L SITE INSPECTION REPORT FORM

ITEM 1 OFFICE AREAS

• Tables,chairs

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Shelves,ledges

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Bins

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Walls, doors

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Partition Glass

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of issue

  Media

ITEM 2 FLOOR & FLOOR COVERINGS

• Carpets

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Hard surface floors, vinyl floors

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Edges, kick boards, corners

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Removal of stains & spillage

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of issue

  Media

ITEM 3 FOOD PREPARATION AREAS/KITCHENS

• Tables, chairs

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Cupboards, doors, benchtops

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Fridges, microwave, pie heaters

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Walls,sinks

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Floor coverings

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of any issues

  Media

ITEM 4 TOILETS/SHOWERS/CHANGE ROOM

• Floors, walls, mirrors, doors

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Toilet bowls, seats, lids, urinals

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Showers, screens, soap holders

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Basins, sinks, vanities, fittings, bins

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Refill of toilet requisites

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of any issue

  Media

ITEM 5 CONCRETE/PAVING & EXTERNAL AREAS

• Loose rubbish,bins

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Internal/external stairways,entries

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Railings

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• External cobwebs

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• External Windows, Passage ways

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of any issues

  Media

ITEM 6 HAZARD IDENTIFICATION

• Cleaners cupboard tidy and clean?

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• MSDS ( material safety data sheets) available and in date

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Machinery tagged,clean,in safe condition

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Correct uniform and PPE used

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Manual handling risk

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Safe work method statements followed

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Chemicals labelled, lids on, stored securely

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photos of any issues

  Media

ITEM 7 ENVIRONMENTAL ASPECTS & IMPACTS

• Equipment has noise control measures

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Waste disposal records maintained

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Flora and fauna not disturbed during cleaning activities

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Spill kits available for use

  Not applicable

  Poor

  Needs Improvement

  Good

  Excellent

• Is there any:<br>FEEDBACK,HAZARDS,RISKS IDENTIFIED?

  Yes

  No

  N/A

• Take photo of issue

  Media

• Lazaro representative name and signature

  Sign

• Customer name and signature

  Sign