Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Is there a site person with responsibility for ensuring that the Life Saving Equipment is being inspected, tested and maintained?
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Is there a Life Saving Equipment site plan detailing the specific location of the equipment around the site?
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Have you performed a Life Saving Equipment tour?
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Is Life Saving Equipment specifically placed around the site in the correct location in accordance with the information detailed on the Life Saving Equipment site plan?
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Does Life Saving Equipment specifically placed around the site have unrestricted access making it immediately accessible for use?
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Is Life Saving Equipment specifically placed around the site available for operational use?
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Does Life Saving Equipment have the required securing stands/fixing points?
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Does the equipment have the correct identification labelling?
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Is the equipment present in the required quantity in accordance with the information detailed on the site plan?
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Does the equipment have a valid and current inspection/examination date?
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Are any equipment that has been found to have defects or found to be faulty appropriately and clearly identified/labelled, quarantined (as is practicable) and removed from service as to prevent unintended use?
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Record details of any other issues/concerns regarding Life Saving Equipment revealed as a result of the self-verification review
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Signature
