OneStaff Christchurch PPE Checklist

• Document No.

• Conducted on

  Date

Client details

• Company Name

• Location
  Address

• Supervisor on Site

Employee details

• Employee Name

Auditor Details

• Checklist completed by

  Select Nick Body Justine Ward Darryl Blockley Kristan Jellyman David Norgate Mandy McNaughton Murray Roeske

  • Nick Body
  • Justine Ward
  • Darryl Blockley
  • Kristan Jellyman
  • David Norgate
  • Mandy McNaughton
  • Murray Roeske

Personal Protective Equipment - worn and in useable condition

• Hard Hat

  Yes

  No

  N/A

• Hard hat issue date

  Date

• Hearing Protection

  Yes

  No

  N/A

• Ear Muffs

• Ear Plugs

• Eye Protection

  Yes

  No

  N/A

• Safety Glasses

• Goggles

• Safety Footwear

  Yes

  No

  N/A

• Hi Vis Vest

  Yes

  No

  N/A

• Other PPE

  Off

  On

• Face Shield

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Long Sleeves & Trousers

  Yes

  No

  N/A

• Overalls

  Yes

  No

  N/A

• Respirator / Dust Mask

  Yes

  No

  N/A

• Welding Helmet

  Yes

  No

  N/A

• Wet Weather Gear

  Yes

  No

  N/A

• PPE replaced / issued

  Off

  On

• Details of equip replaced / issued

Training & Competency

• Is the employee conducting tasks, operating machinery, equipment that requires specific training, competencies?

  Yes

  No

  N/A

• Has the client completed an on the job competency assessment?

  Yes

  No

  N/A

• Has the client provided training specific to these tasks?

  Yes

  No

  N/A

• Is the client providing adequate supervision for these tasks?

  Yes

  No

  N/A

Employee Participation

• Has an onsite induction been completed?

  Yes

  No

  N/A

• Is adequate supervision being provided?

  Yes

  No

  N/A

• Is the employee being included in Health and Safety activities on site?

  Yes

  No

  N/A

• Are the hazards observed on site controlled adequately?

  Yes

  No

  N/A

• Has the employee been involved in any incidents / injuries / near misses?

  Yes

  No

  N/A

• Incident Details / Has this been report and to whom?

• Additional Notes / Safety Observations / Disussions

Signatures

• Employee to sign

  Sign

• Auditor to sign

  Sign