Monthly Audit - OPTUM - Dublin

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Office Space / Meeting Room

• Floor

• Furniture including pedestals & chairs

  Yes

  No

  N/A

• Soft floors

  Yes

  No

  N/A

• Walls including vision panels, window sills & skirting

  Yes

  No

  N/A

• Coat Storage units

  Yes

  No

  N/A

• Bins

  Yes

  No

  N/A

• Printers and drinking water stations

  Yes

  No

  N/A

• Signage, Photo frames etc

  Yes

  No

  N/A

• Other

Bathrooms/Shower Rooms

• Check Sheets are completed, location displayed, checks within 90 mins

  Yes

  No

  N/A

• Sanitary ware including shower is clean

  Yes

  No

  N/A

• Cubicle panels and frames

  Yes

  No

  N/A

• Flooring

  Yes

  No

  N/A

• Mirrors and dispensers

  Yes

  No

  N/A

• Signage in place and in good appearance

  Yes

  No

  N/A

• Vertical surfaces, skirting, window sills and radiators

  Yes

  No

  N/A

• Bins

  Yes

  No

  N/A

• Other

Corridors / stairs / entrances / lifts

• Signage and all other framing

  Yes

  No

  N/A

• Handrails, skirting and window sills

  Yes

  No

  N/A

• Soft flooring including stair nosing

  Yes

  No

  N/A

• Vertical surfaces including walls, doors and vision panels

  Yes

  No

  N/A

• Other

Dining areas / Tea Station /Work Cafe/Canteen Area

• Fridge (clean with no out of date foods)

  Yes

  No

  N/A

• Microwaves are clean inside

  Yes

  No

  N/A

• Furniture is clean

  Yes

  No

  N/A

• Work surfaces

  Yes

  No

  N/A

• Cupboards

  Yes

  No

  N/A

• Bins

  Yes

  No

  N/A

• Flooring

  Yes

  No

  N/A

• Walls, skirting and window sills

  Yes

  No

  N/A

• Dishwasher

  Yes

  No

  N/A

• Dispensers

  Yes

  No

  N/A

• Other

Reception

• Furniture

  Yes

  No

  N/A

• Front door and glazing surround

  Yes

  No

  N/A

• Flooring

  Yes

  No

  N/A

• Walls, skirting and window sills

  Yes

  No

  N/A

• Signage and Frames

  Yes

  No

  N/A

• Other

First Aid Rooms/Mother's Room/Cleaner's Room

• Furniture including fridge

  Yes

  No

  N/A

• Flooring and walls

  Yes

  No

  N/A

• Chemicals stores correctly and CoSSH info reviewed

  Yes

  No

  N/A

• Equipment

  Yes

  No

  N/A

• Other

COSHH Compliance

• Have you spot checked the building in known risk areas for the storage of chemicals?

  Yes

  No

  N/A

• Are all chemicals stored in approved chemical bottles?

  Yes

  No

  N/A

• Are all chemical bottles labeled correctly?

  Yes

  No

  N/A

• Is colour coding in place & adhered to for cloths, mops and equipment

  Yes

  No

  N/A

• Is there evidence that all equipment is cleaned & disinfected between uses?

  Yes

  No

  N/A

• Is all equipment in good working order & stored correctly?

  Yes

  No

  N/A

• Does all electrical equipment have an up to date PAT Test?

  Yes

  No

  N/A

• Is there a COSSH\ MSDS folder on site?

  Yes

  No

  N/A

• Have you complete a spot check on this folder to confirm that there is a valid SDS for each Chemical approved for this site?

  Yes

  No

  N/A

• Are all the Chemicals on this site from the Approved list - if no what are they and please attach a picture for each one.

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Authorisation signatures

• Client signature

  Sign

• Manager Signature

  Sign

• Date & Time of Audit

  Date

ATP Checks

• Surface 1

  Yes

  No

  N/A

• Surface 2

  Yes

  No

  N/A

• Surface 3

  Yes

  No

  N/A

• Surface 4

  Yes

  No

  N/A

• Surface 5

  Yes

  No

  N/A

• Surface 6

  Yes

  No

  N/A

• Surface 7

  Yes

  No

  N/A

• Surface 8

  Yes

  No

  N/A

• Surface 9

  Yes

  No

  N/A

• Surface 10

  Yes

  No

  N/A