Department 1

Department:

Miscellaneous Items

Equipment

Other

Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.

What category of equipment?

Provide brand and model no:

Add photos

In what year was this equipment purchased?

Have any items been reported as showing environmental stress cracking?
N/A (no damage reported)
Low (Damage reported every 8 - 12 months)
Minor (Damage reported every 6 - 8 months)
Medium (Damage reported every 3 - 6months)
High (Damage reported every 1- 3 months)

Provide additional details

What is the principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently are the high touch items cleaned?

Provide details including dilution.

How frequently are the high touch items cleaned?

Provide additional details, type, where the technology is used and frequency of use?

How frequently are the high touch items cleaned?

Has the cleaning regime changed recently for this category of equipment? (> 12 months)

What was the previous principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently was this category of equipment previously cleaned?

Provide details including dilution.

How frequently was this category of equipment previously cleaned?

Provide additional details, type, where the technology was used and frequency of use?

How frequently were the high touch items cleaned?

Provide any additional details as required?

Has the cleaning regime change, resulted in revised staff training procedures?

Please provide details of training provided including competency and the craft groups that received the new training?

Have there been a change in cleaning services within the previous 12 months.
In-house service to external contracted service
external service to in-house service
change in external provider.

Please provide additional details?

ESC
1 – Minor (1 or 2 small cracks)
2 – Major (multiple cracking)
3 – Severe (extensive cracking and resulting material loss and damage

Department 2

Department:

Miscellaneous Items

Equipment

Other

Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.

What category of equipment?

Provide brand and model no:

Add photos

In what year was this equipment purchased?

Have any items been reported as showing environmental stress cracking?
N/A (no damage reported)
Low (Damage reported every 8 - 12 months)
Minor (Damage reported every 6 - 8 months)
Medium (Damage reported every 3 - 6months)
High (Damage reported every 1- 3 months)

Provide additional details

What is the principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently are the high touch items cleaned?

Provide details including dilution.

How frequently are the high touch items cleaned?

Provide additional details, type, where the technology is used and frequency of use?

How frequently are the high touch items cleaned?

Has the cleaning regime changed recently for this category of equipment? (> 12 months)

What was the previous principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently was this category of equipment previously cleaned?

Provide details including dilution.

How frequently was this category of equipment previously cleaned?

Provide additional details, type, where the technology was used and frequency of use?

How frequently were the high touch items cleaned?

Provide any additional details as required?

Has the cleaning regime change, resulted in revised staff training procedures?

Please provide details of training provided including competency and the craft groups that received the new training?

Have there been a change in cleaning services within the previous 12 months.
In-house service to external contracted service
external service to in-house service
change in external provider.

Please provide additional details?

ESC
1 – Minor (1 or 2 small cracks)
2 – Major (multiple cracking)
3 – Severe (extensive cracking and resulting material loss and damage

Department 3

Department:

Miscellaneous Items

Equipment

Other

Environmental Stress Cracking
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.

What category of equipment?

Provide brand and model no:

Add photos

In what year was this equipment purchased?

Have any items been reported as showing environmental stress cracking?
N/A (no damage reported)
Low (Damage reported every 8 - 12 months)
Minor (Damage reported every 6 - 8 months)
Medium (Damage reported every 3 - 6months)
High (Damage reported every 1- 3 months)

Provide additional details

What is the principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently are the high touch items cleaned?

Provide details including dilution.

How frequently are the high touch items cleaned?

Provide additional details, type, where the technology is used and frequency of use?

How frequently are the high touch items cleaned?

Has the cleaning regime changed recently for this category of equipment? (> 12 months)

What was the previous principal cleaning / disinfectant used?

Provide brand

Provide additional details

How frequently was this category of equipment previously cleaned?

Provide details including dilution.

How frequently was this category of equipment previously cleaned?

Provide additional details, type, where the technology was used and frequency of use?

How frequently were the high touch items cleaned?

Provide any additional details as required?

Has the cleaning regime change, resulted in revised staff training procedures?

Please provide details of training provided including competency and the craft groups that received the new training?

Have there been a change in cleaning services within the previous 12 months.
In-house service to external contracted service
external service to in-house service
change in external provider.

Please provide additional details?

ESC
1 – Minor (1 or 2 small cracks)
2 – Major (multiple cracking)
3 – Severe (extensive cracking and resulting material loss and damage

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.