Title Page

  • Audit Title

  • Enter "Monthly Safety Review" and month eg, June above

  • Client / Site

  • Enter "Plas Derwen, Llangollen" above

  • Location
  • Geolocation

  • Conducted on

  • Prepared by

  • Previous audit checked for follow up actions ?

Car Park

  • Main car park area free from obstructions or debris

  • Fire log up to date (weekly testing)

  • Picture of fire log

  • Fire doors operating correctly ?

  • Fire door intumescent strip intact ?

  • Fire door gaps no larger than 3mm

  • Fire signage exit route signage adequate

  • Fire door signage adequate

  • Fire doors locked

  • Identify lighting by adjacency to parking bay or block and cupboard use

  • General Lighting Operational

  • Emergency lighting operational ?

  • Fire extinguishers in place ?

  • Any other issues identified ?


  • Block

  • Emergency lighting test duration (3 hour tests should be completed sequentially on rotation, check last audit for block due)

  • Stairwell lighting is numbered from the top floor down, floor lighting (behind fire doors is numbered left to right)

  • Emergency lights indicated are not working

  • General lighting indicated is not working

  • Communal areas free from combustible material

  • Lift operation OK

  • Floor number
  • Floor number

  • Fire doors operating correctly and gaps of appropriate size

  • Fire doors should close without assistance and gap around edges should be no more than 4mm intumescent seal should be intact

  • Smoke vent operating ?

  • The following lights are not working
    Lighting to each floor is numbered clockwise from doorway

  • Emergency Lighting

  • Lighting

  • Service cupboards free from rubbish

Sign off

  • All information contained was correct at the time of inspection

  • Add signature


  • Emergency Lighting
    All lighting is numbered from top floor down

    Block A
    2 (emergency only), 3, 5, first floor foyer 1, 7, 9, ground floor foyer 1, 11, 13, 14 (emergency only)

    Block B
    3, second floor foyer, 5, 7, first floor foyer 1, 8, 9, 10, 11, ground floor foyer 1, ground floor foyer 3, 13, 15, 16, 17

    Block C
    All fittings are numbered, emergency lights are:- 4, 6, first floor foyer, 8, 10, ground floor foyer 1, ground floor foyer 3, 12, 14, 15.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.