INSPECTION RECORD

PLEASE ENSURE TO ADD PHOTO OF ITEM AND ANY ACTIONS ON THE 'EQUIPMENT/PPE/KITS DESCRIPTION' QUESTION:

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Please select Inspection Required:

Operator PPE Inspection:

PLEASE ENSURE THE FOLLOWING RULES ARE UNDERTAKEN WHEN INSPECTING PPE:

1. Take a photo of PPE

3. set action if needing replacement/cleaning

a. Assign to 'Operator'
b. Note comments - Start with Operators Name
c. Images to clarify requirements

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Select PPE to be inspected:

PLEASE ENSURE PPE COMPLIES WITH THE BELOW:

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SAFETY HELMET – CONFORMING TO EN 397

EYE PROTECTION – EITHER A MESH VISOR COMPLYING WITH EN 1731 OR SAFETY GLASSES CONFORMING TO EN 166

HEARING PROTECTION – CONFORMING TO EN 352

LEG PROTECTION – CONFORMING TO EN 381-5

PROTECTIVE BOOTS – CONFORMING TO EN 345-2

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SAFETY HELMET – CONFORMING TO EN 397

HIGH VISIBILITY CLOTHING – CONFORMING TO EN471

SAFETY FOOTWEAR – CONFORMING TO EN345-1

PLEASE ENSURE THE FOLLOWING RULES ARE UNDERTAKEN WHEN INSPECTING COSHH CONTROLS:

1. Take a photo of COSHH CONTROL

3. set action if needing replacement/cleaning

a. Assign to 'CONTRACTOR'
b. Note comments
c. Images to clarify requirements

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COSHH Controls Inspection:

COSHH Control to be inspected:

SPILL KIT:

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Spill Pads (Minimum of 12 Pads)

Socks (Minimum of 2)

1 Disposable bag

1 Zip Tie

not contaminated?

adequate gloves

goggles

not contaminated?

PLEASE ENSURE THE FOLLOWING RULES ARE UNDERTAKEN WHEN INSPECTING FIRST AID KITS:

1. Take a photo of FIRST AID KITS

3. set action if needing replacement

a. Assign to 'CONTRACTOR'
b. Note comments
c. Images to clarify requirements

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First Aid Kit Inspections:

First Aid Kit Type:

EQUIPMENT Item:

Machine / Operation:

Equipment Description:

Name:

Assessment:

DO NOT USE EQUIPMENT - Please Mark up and inform operators not to be used in operations

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Please note reason for Failure:

Equipment Description:

Name of item:

Assessment:

DO NOT USE EQUIPMENT - Please Mark up and inform operators not to be used in operations

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Please note reason for Failure:

Equipment Description:

Name:

Assessment:

DO NOT USE EQUIPMENT - Please Mark up and inform operators not to be used in operations

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Please note reason for Failure:

APPROVAL

Inspections added and completed to the requirements:

Signature of designated person:
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.