OXLEAS NHS Foundation Trust

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

STATUTORY - Health & Safety Poster

• Health & Safety poster on display in staff areas?

  Yes

  No

  N/A

STATUTORY- LOLER

• LOLER Insurance certificate/ safety certificate in date?

  Yes

  No

  N/A

• Remedial works logged with helpdesk?

  Yes

  No

  N/A

STATUTORY - FGas

• FGas register in date (where applicable)

  Yes

  No

  N/A

STATUTORY - Pressure Vessels

• Insurance Inspection Certificate/Safety Certificate in date?

  Yes

  No

  N/A

• Remedial works logged on helpdesk?

  Yes

  No

  N/A

STATUTORY - Electrical

• PAT Certificate in date?

  Yes

  No

  N/A

• 5 Year Electrical Certificate in date?

  Yes

  No

  N/A

• 5 Yearly Electrical Inspection Remedials logged on helpdesk (C1/C2/C3)

  Yes

  No

  N/A

• Annual Emergency Lighting Certificate in date?

  Yes

  No

  N/A

• Annual Distribution Board Inspection Certificate in date?

  Yes

  No

  N/A

• Annual Lightning Certificate in date?

  Yes

  No

  N/A

• Annual Generator Inspection Certificate in date (where applicable)

  Yes

  No

  N/A

STATUTORY- Water Hygiene

• Legionella Risk Assessment in date?

  Yes

  No

  N/A

• Legionella Risk Assessment Review carried out?

  Yes

  No

  N/A

• Evidence of weekly flushing LUOs?

  Yes

  No

  N/A

• Annual CWS Tank Inspection and Clean carried out?

  Yes

  No

  N/A

• Evidence of tank temperatures taken?

  Yes

  No

  N/A

STATUTORY - Gas Safety

• Gas Safety Inspection in date

  Yes

  No

  N/A

• Gas Tightness Certificate in date

  Yes

  No

  N/A

• Oil Fired Boiler Safety Certificate in date?

  Yes

  No

  N/A

• Calorifiers Carcass Test Certificate in date?

  Yes

  No

  N/A

• LPG Safety Certificate in date (where applicable)?

  Yes

  No

  N/A

STATUTORY - Fire Safety

• Annual Fire Risk Assessment in date?

  Yes

  No

  N/A

• Fire Risk Assessment Review in date?

  Yes

  No

  N/A

• Fire Door Inspection carried out?

  Yes

  No

  N/A

• Annual Fire Alarm Inspection Certificate in date?

  Yes

  No

  N/A

• Annual Fire Extinguisher/Blanket Service Certificate in date?

  Yes

  No

  N/A

• Annual Kitchen Ductwork Clean carried out (where applicable)?

  Yes

  No

  N/A

• Annual Kitchen Fire Hood Inspection Certificate in date (where applicable)?

  Yes

  No

  N/A

• Annual Fire Damper Inspection Certificate in date (where applicable)?

  Yes

  No

  N/A

STATUTORY - DEC

• In-date Energy Certificate on display (where applicable)?

  Yes

  No

  N/A

6M Site PPM and Inspection

• Help desk jobs outstanding?

  Yes

  No

  N/A

• AC Units service in date?

  Yes

  No

  N/A

• AC Units Remedials logged?

  Yes

  No

  N/A

• AHU ventilation checks in date?

  Yes

  No

  N/A

• AHU Remedials logged?

  Yes

  No

  N/A

• Quarterly generator inspection up to date (where applicable)?

  Yes

  No

  N/A

• Generators Remedials logged on helpdesk (where applicable)?

  Yes

  No

  N/A

• BMS fully operational and maintenance up to date?

  Yes

  No

  N/A

• BMS - no uncleared alarms?

  Yes

  No

  N/A

• Permit to Work access system in place?

  Yes

  No

  N/A

• Lift Alarm - check that alarm is in place and received?

  Yes

  No

  N/A

• Correct lift number in lift cab?

  Yes

  No

  N/A

• Lift Quarterly Service in date?

  Yes

  No

  N/A

• Gas quarterly PPM completed?

  Yes

  No

  N/A

• Outstanding Gas Quarterly Remedials logged?

  Yes

  No

  N/A

• Emergency Lighting Testing up to date?

  Yes

  No

  N/A

• Quarterly Fire Alarm inspection in date?

  Yes

  No

  N/A

• Quarterly Panic Alarm inspection in date (where applicable)?

  Yes

  No

  N/A

• Quarterly intruder alarm inspection in date (where applicable)?

  Yes

  No

  N/A

• Window Restrictors in place (where applicable)?

  Yes

  No

  N/A

• Window Restrictors Inspection in date (where applicable)?

  Yes

  No

  N/A

• Quartlerly Maintenance of TMV's complete?

  Yes

  No

  N/A

Site Inspection

Internal Inspection

• Decoration - Paintwork should be bright, co-ordinated and in good condition

  Yes

  No

  N/A

• Internal Fixtures and Fittings- should be free from scuffs/scratches/gouges/tears and stains should be easily removed by cleaning?

  Yes

  No

  N/A

• Any item that has an action ( automatic doors/taps/lights/etc) should be working correctly?

  Yes

  No

  N/A

• Toilets and bathrooms should have working locks?

  Yes

  No

  N/A

• Ceiling tiles should be in place and in good condition?

  Yes

  No

  N/A

• Floors should be free from tears/splits/excessive wear/tape/raised or lifting areas?

  Yes

  No

  N/A

• Flooring in dementia areas should be matt,non reflective, non patterned and noise absorbent?

  Yes

  No

  N/A

• Lighting where artificial should simulate natural light and provide enough light to make areas bright. Lamps should be working at all times.

  Yes

  No

  N/A

• Kitchen equipment should be at Condition B?

  Yes

  No

  N/A

• Toilets and bathroom - fixed equipment and flooring should be Condition B?

  Yes

  No

  N/A

External Area Inspection

• External brickwork should look clean and well maintained?

  Yes

  No

  N/A

• Gutters, down pipes and hoppers should be free from obstructions and vegetation?

  Yes

  No

  N/A

• Drainage pipe work should be secured?

  Yes

  No

  N/A

• Windows and frames should be clean and free from damage. Frames should be in good condition.

  Yes

  No

  N/A

• Grounds, roads and walkways should be well maintained, free from potholes and no uneven/loose paving slabs. Road markings should be clear. Where appropriate, kerbs should be adapted to facilitate wheelchair access.

  Yes

  No

  N/A

• Pedestrian areas should be well lit.

  Yes

  No

  N/A

• Roofs should be free from damage?

  Yes

  No

  N/A

FM Comments