Title Page

  • Site conducted

  • Conducted on

  • Prepared by

Compliance

Fire Safety

  • 1. Are weekly alarm tests up to date?

  • 1a. Reason?

  • 2. Is Fire log Book complete and up to date?

  • 2a. Reason?

  • 3. Have all actions from the FRA action plan, if due, been completed?

  • 3a. Reason?

  • 4. Has all FLS equipment been serviced and maintained?

  • 4a. Reason?

Water Hygiene

  • 5. Are flushing records complete and up to date?

  • 5a. Reason?

  • 6. Are WRA action plan items overdue?

  • 6a. Reason?

  • 7. Are temperature monitoring records up to date?

  • 7a. Reason?

  • 8. Is the Water Log book up to date and to a good standard?

  • 8a. Reason?

Insurance Inspections

  • 9. Have all defects from the inspection been rectified?

  • 9a. Are these booked in?

  • 9b. Reason?

Fixed Wire Testing

  • 11. Are there any outstanding C1 or C2 observations from the last test?

  • 11a. Reason?

  • 12. Have quotes been obtained to rectify these?

  • 12b. Reason?

Gas

  • 13. Is the boiler service in date?

  • 13a. Is this booked in?

  • 13b. Reason?

  • 14. Have defects from last service been rectified? (if no defects were recorded in service then select N/A)

  • 14a. Are defects booked in for repair?

  • 14b. Reason?

  • 15. Are all CP42 Certificates in date?

  • 15a. Is it booked in?

  • 15b. Reason?

  • 16. Gas Soundness Test in date?

  • 16a. Is this booked in?

  • 16b. Reason?

PAT Testing

  • 17. Is PAT testing in date?

  • 17a. Is this booked in?

  • 17b. Reason?

Kitchen Extraction

  • 18. Is the Cleaning certificate in date?

  • 18a. Is this booked in?

  • 18b. Reason?

Mansafe System

  • 19. Is the Mansafe system service in date?

  • 19a. Is this booked in?

  • 19b. Reason?

Emergency Lighting

  • 20. Are weekly emergency light tests up to date?

  • 20a. Reason?

  • 21. Is the Emergency lighting service in date?

  • 21a. Is this booked in?

  • 21b. Reason?

  • 22. Are all Defects from the service rectified?

  • 22a. Is this booked in?

  • 22b. Reason?

Lightning Protection

  • 23. Is the Lightning Protection service in date?

  • 23a. Is it booked in?

  • 23b. Reason?

Annual Checks

  • 1. Annual Boundary walk in date?

  • 1a. Reason?

Weekly Checks

Lifts

  • 1. Are the weekly lift checks up to date?

  • 1a. Reason?

  • 2. If defects have been identified, have these been resolved?

  • 2a. Reason?

Conclusion

  • Summary

Sign

  • Signature

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