Title Page
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Test 13
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Permitted Items Verification Sheet
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Canberra
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Conducted on
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Prepared by
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Location
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Personnel
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Date and Time of Check
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Person Conducting Check
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If a permitted item cannot be found contact your Supervisor immediately.
If a permitted item is observed to be in poor condition contact your Supervisor immediately. -
Is 1 X Bannister Brush soft Green Present ?
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Is 1 X Bannister Brush soft Green in good condition
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Is 1 X Dustpan ergo Green Present ?
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Is 1 X Dustpan ergo Green in good condition ?
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Is 1 X Squeegee Green W/rubber Present ?
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Is 1 X Squeegee Green W/rubber in good condition ?
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Is 1 X Shovel ergo Handle Green Present ?
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Is 1 X Shovel ergo Handle Green in good condition ?
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Is 1 X Scraper Blue Metal Present ?
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Is 1 X Scraper Blue Metal in good condition ?
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Are 3 X Metal Rods with Hooks Present ?
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Are 3 X Metal Rods with Hooks in good condition ?
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Is 1 X Food contact Hook Present ?
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Is 1 X Food contact Hook in good condition ?
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Is 1 X Broom medium Green Present ?
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Is 1 X Broom medium Green in good condition ?
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Is 1 X Brush with Handle Present ?
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Is 1 X Brush with Handle in good condition ?
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Is 1 X Crowbar Present ?
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Is 1 X Crowbar in good condition ?
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Is 1 X Digital Thermometer Present ?
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Is 1 X Digital Thermometer in good condition ?
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Supervisor Verification
