Metserve Ltd Personal Protective Equipment on site assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equipment

• Gloves trafi red

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Gloves trafi yellow

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Gloves trafi green

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Gloves -hard wearing

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Gloves gauntlet

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Gloves latex

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Eye protection goggles

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter details

• Over glasses

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Ear defenders

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Safety shoes

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Shoe covers

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Dust mask

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Coveralls white

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Hard hat under 5 years old

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Bump cap

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• High visibility vest

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• First aid kit

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Ladder labelled and in date

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Steps labelled and in date

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Safety signs

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Socket and see tester

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Volt stick

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• 3 Pin socket tester

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• R.C.D

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Continuity bonds

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Cable locator

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Crawling boards

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

• Non-Slip Mat

  Select Seen Yes Seen No Good Condition Poor Condition Evidence of use yes Evidence of use No Not applicable

  • Seen Yes
  • Seen No
  • Good Condition
  • Poor Condition
  • Evidence of use yes
  • Evidence of use No
  • Not applicable

• Enter comments

PAT. Electrical tools / equipment

• Drill charger

  Yes compliant

  Non Compliant

• Jig Saw charger

  Yes compliant

  Non Compliant

• 240 volt drill

  Yes compliant

  Non Compliant

• Hoover

  Yes compliant

  Non Compliant

• Overall comments

• Name of engineer and signature

  Sign

• Assessors name and signature

  Sign