Title Page
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Site conducted
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Conducted on
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Prepared by
Compliance
Fire Safety
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1. Are weekly alarm tests up to date?
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1a. Reason?
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2. Is Fire log Book complete and up to date?
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2a. Reason?
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3. Have all actions from the FRA action plan, if due, been completed?
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3a. Reason?
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4. Has all FLS equipment been serviced and maintained?
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4a. Reason?
Water Hygiene
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5. Are flushing records complete and up to date?
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5a. Reason?
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6. Are WRA action plan items overdue?
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6a. Reason?
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7. Are temperature monitoring records up to date?
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7a. Reason?
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8. Is the Water Log book up to date and to a good standard?
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8a. Reason?
Insurance Inspections
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9. Have all defects from the inspection been rectified?
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9a. Are these booked in?
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9b. Reason?
Fixed Wire Testing
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11. Are there any outstanding C1 or C2 observations from the last test?
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11a. Reason?
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12. Have quotes been obtained to rectify these?
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12b. Reason?
Gas
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13. Is the boiler service in date?
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13a. Is this booked in?
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13b. Reason?
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14. Have defects from last service been rectified? (if no defects were recorded in service then select N/A)
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14a. Are defects booked in for repair?
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14b. Reason?
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15. Are all CP42 Certificates in date?
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15a. Is it booked in?
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15b. Reason?
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16. Gas Soundness Test in date?
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16a. Is this booked in?
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16b. Reason?
PAT Testing
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17. Is PAT testing in date?
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17a. Is this booked in?
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17b. Reason?
Kitchen Extraction
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18. Is the Cleaning certificate in date?
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18a. Is this booked in?
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18b. Reason?
Mansafe System
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19. Is the Mansafe system service in date?
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19a. Is this booked in?
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19b. Reason?
Emergency Lighting
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20. Are weekly emergency light tests up to date?
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20a. Reason?
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21. Is the Emergency lighting service in date?
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21a. Is this booked in?
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21b. Reason?
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22. Are all Defects from the service rectified?
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22a. Is this booked in?
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22b. Reason?
Lightning Protection
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23. Is the Lightning Protection service in date?
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23a. Is it booked in?
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23b. Reason?
Annual Checks
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1. Annual Boundary walk in date?
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1a. Reason?
Weekly Checks
Lifts
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1. Are the weekly lift checks up to date?
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1a. Reason?
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2. If defects have been identified, have these been resolved?
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2a. Reason?
Conclusion
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Summary
Sign
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Signature