Pacifica Appliance Services - Field Safety Overview

• Conducted on

  Date

• Inspector

• Location
  Address

Resident Inspection Authorisation & COVID 19 Questions

• Operative Name

• [Pacifica Group Customer Declaration – Including COVID-19 Measures & Sign off]: [The Resident], confirm I authorised Pacifica to carry out an Audit / Inspection and gave my GDPR / Privacy consent to photos being taken during the visit I acknowledge which will be retained as evidences of the work done within the property. [Pacifica Group COVID-19 Statement]: I can also confirm that during the time of the Pacifica visit no-one in the household is showing any symptoms of Coronavirus. Pacifica carried out a Dynamic Risk Assessment prior to accessing my property. The appointment was screened to confirm no resident had symptoms of COVID-19 which was confirmed again prior to Pacifica staff entering the property. Pacifica staff informed me that they have had enhanced Covid-19 training, in line with their Health & Safety Policy which includes the most up to date Government Advice. This ensured that all within the property maintained safe distances and used Covid-safe working practices at all times. To ensure safety for all, I agreed to maintain Social Distancing measures by adopting the required distancing and by staying in a separate room while Pacifica staff were present. Pacifica staff used PPE during the visit which included; Anti-Bacterial Wipes, Surgical Face Masks, Disposable Gloves, Hand Sanitizer and Full Face Visors were available for use. The hand-held was wiped before and after I added my signature to minimise any Covid-19 cross contamination. Copyright © Pacifica Group 2020 | Pacifica Group Limited company number 05541667, Pacifica Home Services Limited company number 04966472, Pacifica Appliance Services Limited company number 05288361, UK Warranty Limited company number 07728040 and Oakes Energy Services Limited company number 06434382 are Registered in England and Wales, Registered Office address Pacifica House, Venter Building, 3 Mandarin Road, Rainton Bridge Business Park, Houghton Le Spring, County Durham, DH4 5RA

  Sign

• Does the Operative have COVID RAMS, present, signed and in-date?

  Yes

  No

• Can the Operative clearly outline the procedure to prevent the spread of COVID?

  Yes

  No

• Is the Operative aware of the COVID symptoms?

  Yes

  No

• Does the Operative have all COVID PPE available as supplied by the Company (Sanitizer, wipes, disposable gloves, face visor, masks)?

  Yes

  No

• Select weather conditions at time of inspection..

  Select Clear Sky Cloudy Raining Windy Hazy Snow/Hail Sunny

  • Clear Sky
  • Cloudy
  • Raining
  • Windy
  • Hazy
  • Snow/Hail
  • Sunny

Site Safety and Customer Service

• Do Operatives carry valid ID Cards [I.E Company ID, Gas Safe, OFTEC, NICEIC]

  Yes

  No

  N/A

• Is the works vehicle parked safely?

  Yes

  No

  N/A

• Is the works vehicle tidy?

  Yes

  No

  N/A

• Does the Operative have access to current RAMS, COSHH and Method Statements?

  Yes

  No

  N/A

• Evidence Site Safety Set-Up: Have Operatives set up the work area in an orderly fashion, keeping access/ egress routes free from obstruction?

  Yes

  No

  N/A

• Are the Operatives using the correct floor coverings? (Dust sheets/ Roll and stroll/ Rubber matting)

  Yes

  No

  N/A

• Have provisions been made to protect the existing furnishings?

  Yes

  No

  N/A

• Has the customer been suitably advised on the repair process and potential hazards associated, including the safe zone and work zone locations?

  Yes

  No

  N/A

Electrical Equipment Checklist

• Earth Loop Impedance Meter / Tester Condition

  Good

  Fair

  Poor

  N/A

• Any equipment in poor condition - arrange replacement

• Insulation Resistance & Continuity Test Meters Condition

  Good

  Fair

  Poor

  N/A

• Any equipment in poor condition - arrange replacement

• RCD Response Time Test Meter (BG Only)

  Good

  Fair

  Poor

  N/A

• Any equipment in poor condition - arrange replacement

• 2-Pole Indicator Condition

  Good

  Fair

  Poor

  N/A

• Any equipment in poor condition - arrange replacement

• Any Other Meters

• Any / All Lock Off Equipment & Devices Condition

  Good

  Fair

  Poor

  N/A

• Any equipment in poor condition - arrange replacement

Electrical - Safe Isolation Process

• REQUIRED - Engineer MUST Demonstrate Safe Electrical Isolation Process

• Can the Operative make correct use of the non-contact Volt Detector (Volt Stick)?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

• Following training given, I "The Operative" can confirm I have read, received and will adhere to all information provided

  Sign

• Can the Operative perform an Earth Loop Impedance Test (ELI)?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

• Following training given, I "The Operative" can confirm I have read, received and will adhere to all information provided

  Sign

• Can the Operative perform an RCD Response Time Test (BG Only)?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

• Can the Operative perform an Earth Continuity Test?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

• Can the Operative perform an Insulation Resistance Test?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

• Can the Operative make use of the 2-Pole Indicator to prove dead?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Inspector - refer to attached Electrical Safety Training Presentation & Provide Training

PPE & Work Equipment

• Picture of full PPE / Equipment Bag [Empty Contents and Check Equipment Stock Levels]

  Media

• Does the Operative have the correct PPE /Work Equipment in order to undertake the work safely? [Including COVID PPE]

  Yes

  No

  N/A

• Does the Operative have a fully stocked, in date First Aid Kit including eyewash?

  Yes

  No

  N/A

• Any items missing from First Aid Kit - arrange replenishment

• PPE / Equipment Checklist

  Select Test Socket Adaptor FFP3 Face Masks Socket & See [Earth Loop Tester] Voltage Detector / Volt Pen Surface Protection Mats RCD PPE Storage Kit Bag Electrical Lock Off Equipment Cable Ties Padlocks Safety Glasses Bump Cap First Aid Kit Including Eyewash Dustsheets / Floor Protection Cut 3 Gloves Cut 5 Gloves Non-slip Overshoe Hi-Viz Safety Footwear Socket and See (RCD Tester) Kevlar Sleeves PPE / Equipment Storage Bag

  • Test Socket Adaptor
  • FFP3 Face Masks
  • Socket & See [Earth Loop Tester]
  • Voltage Detector / Volt Pen
  • Surface Protection Mats
  • RCD
  • PPE Storage Kit Bag
  • Electrical Lock Off Equipment
  • Cable Ties
  • Padlocks
  • Safety Glasses
  • Bump Cap
  • First Aid Kit Including Eyewash
  • Dustsheets / Floor Protection
  • Cut 3 Gloves
  • Cut 5 Gloves
  • Non-slip Overshoe
  • Hi-Viz
  • Safety Footwear
  • Socket and See (RCD Tester)
  • Kevlar Sleeves
  • PPE / Equipment Storage Bag

• Any equipment damaged or missing - arrange replacement

• Work being carried out in a safe manner using appropriate, serviceable PPE?

  Pass

  Low Risk Defect

  High Risk Defect

  Severe Risk Defect

• Operatives Gloves & Work Clothing

  Media

• Socket & See Available (RCD and PDL)

  Yes

  No

  N/A

• Volt Pen Available [VOLT PEN]

  Yes

  No

  N/A

• Is all hand tools / field equipment free from damage?<br>(if at risk, remove from use immediately and replace)

  Safe

  At Risk

  N/A

• Has the defective equipment been immediately removed from site?

  Yes

  No

  N/A

• RCD available **where applicable

  Yes

  No

  N/A

• Does the Operative have X1 1KG Powder Fire Extinguisher Available? [Fully Pressurised and Maintained]

  Yes

  No

  N/A

• Extinguisher and Condition

  Media

• Is a stocked first aid kit available complete with eye wash, (in date)?

  Yes

  No

  N/A

• Is safety footwear in good condition and of the correct type?

  Yes

  No

  N/A

• Are staff aware of the correct PPE for the tasks they are trained to perform?

  Yes

  No

  N/A

• Is there a system/ register in place for access and lifting equipment for inspections? (Van file)

  Yes

  No

  N/A

• List system / register missing for replenishment

• Access Equipment / Lifting Equipment in good condition and free from any defects? (Check feet, platforms and rungs **where applicable)

  Yes

  No

  N/A

• Remove from use immediately and arrange replacements

• 3 Tier Ladder

  Safe

  At Risk

  N/A

• CAT Ladder

  Safe

  At Risk

  N/A

• Telescopic Ladder / Steps

  Safe

  At Risk

  N/A

• Hop-Up

  Safe

  At Risk

  N/A

• Does the Operative have adequate continuity clamps?

  Yes

  No

  N/A

• Does the Operative have correct paperwork [Warning Labels, Electrical and Gas]

  Yes

  No

  N/A

Sign Off

• Auditor Feedback

• Auditor Sign

  Sign

• Operative Sign

  Sign