Title Page
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Document No.001
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Self Audit Inspection
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Venue - name
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Operational Group (select from drop down)
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Date of inspection / audit conducted
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Prepared by (Name of person conducting)
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Location Address
Audit / Inspection type (please select from drop down list)
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Select type of inspection / audit
- Office
- Warehouse
- Refit Refurb
- Building Health Check
- Contractor Review
- Vehicle
- Equipment check (includes PPE)
- Tech room
- Retail outlet
- Race venue
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Current BWoF displayed
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BWoF is current
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There is a visitor register at reception
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Visitor register shows evidence of use
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Frontage of building is clean and tidy in appearance
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Well presented I.e signage correct, paint in good condition
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Free of rubbish and waste
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Doors
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Seated correctly
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Doors lock correctly
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Free of damage
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Reception area
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Clean and tidy
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Appropriate signage displayed
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Furnishings in good condition
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Fire doors
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Shut when inspected as per legal requirements under fire regulations
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Correctly labelled
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Correctly seated
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Able to be opened easily in an emergency
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Fire exits are clear of potential blockages and obstructions I.e nothing with 1 square metre of the dorrway
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Appropriate fire suppression equipment present
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Access ways are clear of obstructions
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Lighting
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All lights appear to be working correctly
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Light fittings are securei
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Appropriate lighting present 350 lux for lighting in office or at work bench spaces
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Air quality
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Air condition if present is set to a minimum of 10% air exchange rate
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Is free of unusual odours
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Is free of obvious dust particles
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Thermal comfort
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Office workspace temperature is 20 degrees
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Warehouse open space for manual work is 16 degrees minimum
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Humidity in air conditioned environs is between 20-38 %
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Is free of drafts etc.
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Toilets
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Clearly labelled
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Plumbing works
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Tap water temperature is ok? I.e. Less than 50 but greater than 40 degrees celcius
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Kitch area
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Is tidy
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Waste is removed or waste bins provided
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Plumbing works properly ( check for leaks)
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Taps work correctly
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Free of cracks in floors or walls
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There is both hot and cold water
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Furnishings
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Chairs are in good condition
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Work desks are in good condition
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Other furnishings
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Ceilings
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Free of leaks or stains
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Secure
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Walls interior
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In good condition free of cracks or markings (more than general wear and tear)
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Emergency procedures
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Are posted and displayed
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Are current ( check version against those on line)
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Choose specific warehouse location
- 30 Teviot Street Dunedin
- 5 Moule Street, Addington, Christchurch
- 106-110 Jackson Street, Petone, Lower Hutt
- 690 treating Avenue, Palmerston North
- 394 Te Rapa Road, Te Rapa, Hamilton
- 64 Stanley Street, PANMURE, Auckland
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The warehouse is tidy and free of rubbish?
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Fire exit doors free of obstructions?<br>
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Rubbish has been removed or is in proper waste storage bins?
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Sufficient lighting an lighting is in working order? Please note any lights which may require replacement or repair.
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Access ways for safe pedestrian access clearly marked?
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Heavy items on shelves are secured and stable?
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Shelving is load rated and marked to show max loads possible?
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There is a forklift on location?
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Seat belt fitted and working?
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Stowed with forks on the ground?
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Reversing beacon works (sounds when reversing)?
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Holds current test or inspection certificate?
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Appropriate safety signage displayed on the forklift?<br>1 - authorised operators only.<br>2 - seat belt must be worn when in use?<br>3 - maximum loading signage displayed?<br>
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Current F-Endorsement held by operator?
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Free of leaks on hydraulic lines or fuel source?
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Tyres in good condition? I.e. Sufficient tread depth (minimum 1.5 mm deth, or passes the 20 cent coin test depth).
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Select type of equipment being inspected
You have selected Personal Protective Equipment please complete the following checks and net your observations.
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Safety foot wear is free of damage (I.e. No exposed steel cars, upper sole in good condition, sole is not worn, laces are in good condition)? Slip on boots are not permitted.
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Harness - full body is in good condition?
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Webbing in good condition I.e free of feathering, tears, cuts, and abrasions?
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Equipment certificate of fitness is current?
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Quick release units work correctly - I.e. Free release, and lock properly when engaged?
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No paint or solvent marks on the webbing?
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nano lock or PFAS system attached?
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Nano lock system works I.e. Retracts properly when released?
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D-links or carabeeners load rated to a minimum of 15kN and working? I.e. Twist gate double action secures and works as required.
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Double action scaff-it hooks work when tested and close and open smoothly?
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Hung properly for safe storage?
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Climbing hard hat
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Current to within 5 years of issue or manufacture
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Chin strap connectors work properly
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Free of damage to shell
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Free of paint marks or marker pen labelling or unapproved stickers / labels
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Gloves
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Gloves are fit for purpose free of holes and heavy wear
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Gloves are suitable type or as approved by NZRB
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General notes
You have selected electrical equipment inspection please complete the following checks and note your observations
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Current electrical test and tag? (Check the tag is attached to the main power lead and is within date)
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The item is free of damage? I.e. Squashed cabling, crimping, broken outer sheath, exposed colour coded wires (inner sheath) or exposed wires, or general damage such as cracked outer casings.<br>
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The cable leading to the main unit is connected to a mains outlet or commercial rated power multi box?
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The plug cable is not exposed to general foot or equipment traffic? I.e. Has a coverage or is stowed safely out of the way of such.
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Select sub category of the venue item being inspected
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Access ways clear and free of obstructions
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Plug outlets in good condition, no exposed wiring and working
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Work area is free of waste and rubbish including animal waste
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Seating is in good condition and safe
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Lighting is good
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General notes
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Select type of tower
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Ladder appears to be in good condition I.e free from corrosion bending, warping, or fatigue?<br>
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Tower appears to be in good condition by appearance?
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Access to the tower is restricted?<br>
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Trap door / door to tower closes and opens freely without difficulty?
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Tower interior is clean and hygienic?
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There is an anchor point available within the tower?
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Name of the tower? I.e. Back straight number 3 etc.
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Safe access to the tower I.e ground condition is safe and not inhibitive.<br>
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Tower structure is free of obvious rot
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Platform location
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Platform is safe and stable
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Platform has safe access?
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You have good field of view for the camera
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If the last form is above 1 metre there is a fall prevention rail in place?
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Area is free of rubbish and waste?
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General notes
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Choose type of vehicle unit being inspected from drop down list
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Vehicle rego.
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Trailer has maximum load rating displayed
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Tyre tread depth is good I.e. 1.5mm or greater
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Tow hitch coupling is free of any damage or defect
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Tow hitch grease point is freshly greased
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Storage unit compartment free of damage and closes securely
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Current registration
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Current trailer warrant of fitness displayed
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Pin connector free of defects or exposed wiring
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Trailer stop lights working
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Jockey wheel functions correctly and free of defects
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Trailer indicators working correctly as do hazards
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Coupling works correctly and seats correctly on tow bar of vehicle
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Brake unit hydraulic reservoir topped up with fresh (dark green) fluid
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When closed the hydraulic brakes work properly
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Trailer unit is free of damage
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The trailer has a current registration
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Vehicle rego.
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Trailer has a current warrant of fitness
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The trailer has a maximum load rating displayed
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The trailer structure appears in good condition
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The trailer stop lights function correctly
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The trailer indicator lights function correctly
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The trailer coupling is free of defects
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The trailer unit draw bar chain is in good condition
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The trailer Pin Connector is in good condition and free of exposed wires
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Current registration
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Vehicle rego
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Current warrant of fitness
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Tyres have good tread depth 1.5mm or greater
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Spare tyre is in good condition
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Stop lights work properly
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Indicators work properly
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Coupling seats correctly and securely
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Wiring pin connector in good condition I.e. Connects properly and free of exposed wiring
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Trailer chain present and in good condition
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Record mileage
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Vehicle rego.
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Current registration
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Current vehicle warrant of fitness
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If diesel the vehicle has current RUC (road user charges)
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Indicators working correctly
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Stop lights work correctly
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Vehicle windscreen free of damage
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Vehicle interior and exterior are clean and tidy
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Vehicle is free of damage
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Current first aid kit
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Current fire extinguisher (ABE Dry Powder 1.5 kg minimum)
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Record current mileage
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Vehicle rego.
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The vehicle has a current certificate of fitness
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The vehicle mileage is within the RUC displayed
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Seatbelts function and retract as designed.
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Interior is clean and tidy
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Exterior is free of damage
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Tyres are in good condition I.e. A minimum of 1.5mm tread depth uniform ally across the tyres on all tyres.
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There is a spare tyre fitted?
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Tyre is inflated to the correct PSi and has a good tread
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The tare changing equipment is present and able to be accessed easily
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Head lights work both low beam and high beam.
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Indicators work
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Stop lights work
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Reversing beacon operates when revering gear engaged
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Water (windscreen) topped up
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Window wipers work and function properly I.e. No streams on working
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Oil is correctly topped
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Vehicle has a first aid kit
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Vehicle has a fire extinguisher fitted (minimum of ABE Dry powder 1.5kg)
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Vehicle is fitted with a hydraulic ramp?
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Grease nibs have been greased for hydraulic pins with fresh MP Grease
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Correct safety signage is displayed on the outside of the ramp I.e. Max loading and distance for following vehicles and parking vehicles
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Vehicle is OB (Broadcasting Truck)?
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Ram pins properly engage on retractable steps
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Manual pins properly engage when retractable steps stowed
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Door latches operate properly and able to be secured for transit
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Electrics tagged and tested within last 12 months
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Appropriate safety signage is displayed
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Summary notes and general observations
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Signature and name of person submitting audit / inspection