Information
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Audit Title
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Document No.
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Client / Site
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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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PROJECT DETAILS:
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Project Name:
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Project Code:
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Project Address:
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Project Manager:
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Project Contact Number:
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DETAILS OF PERSON CONDUCTING THE INSPECTION:
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Select date
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SLIPS, TRIPS, HAZARDS & FALLS:
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Are There Any Hazards That Could Cause A Slip, Trip Or Fall?
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Are there any trailing leads supplying computers, printers fax machines, etc?
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Are there any areas of loose carpets or mats?
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Are there any access routes blocked by debris, waste bins, etc?
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Please detail any other slips, trips and fall hazards identified:
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FALLING OBJECT HAZARDS:
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Are There Any Objects That Could Fall On People?
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Please detail any other falling object hazards identified:
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SUBSTANCE RELATED HAZARDS:
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Are there any substances used that could cause harm from contact or inhalation:
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Has any staff member complained of any persistent or increasing allergic reactions: running nose or eyes, coughing, sneezing, itching skin, etc?
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Are adequate COSHH risk assessment conducted for all substances hazardous to health on site?
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Please detail any areas of concern:
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VENTILATION HAZARDS:
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Are all areas adequately ventilated?
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Have air condition units (where installed) been serviced this month by a competent contractor?
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Please detail any areas of concern:
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LIGHTING:
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Are all light diffusers clean and securely fixed?
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Are all light working and free from defect?
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Are there any areas of which are poorly lit and cause concern?
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Please detail any areas of concern:
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HYGIENE HAZARDS:
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Are sanitary provisions sufficient to reduce the risk of infection or contamination:
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Please detail any areas of concern:
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SIGNAGE:
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Is signage suitable and sufficient?
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Please detail any areas where further signage is required:
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MAINTANANCE:
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Is there any requirement for maintenance or repair on the premises or equipment?
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Please list identified maintenance or repair requirements:
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SECURITY:
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Has an entry control procedure and safe system of work been developed and adopted by the project?
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Are all door release systems operational?
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Is CCTV in working order:
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Has a safe system of work for response to panic alarm been developed and adopted by the project?
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Are an appropriate number of Intruder Alarm Key Holders nominated?
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Please detail any areas of concern:
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PASSENGER & STAIR LIFT (Where Installed)
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Has scheduled maintenance been carried out this month?
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Have any faults been reported within the past month?
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Please detail any areas of concern:
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ELECTRICAL SAFETY:
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Has a hard wire test been conducted by a competent contractor this month? (Tests are required at 5 year intervals)
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Has PAT testing been conducted by a competent contractor this month? (Test are required annually only)
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Has a visual inspection been conducted this month?
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Are there any extension leads or multi socket adaptors on site which pose a risk?
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Findings of visual inspection:
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GAS SAFETY:
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Has a gas safety check been undertaken by a competent contractor this month? (Checks are required annually only)
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Are Carbon Monoxide Detectors (Patch or Alarm) installed by any boiler present on site?
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Has the Carbon Monoxide Detector been checked this month?
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Has a visual inspection been undertaken this month?
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Please detail any areas of concern or findings of visual inspection:
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LEGIONELLA CONTROL:
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Has a Legionella Risk Assessment been undertaken on the premises?
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Is a preventative water cleaning schedule in place?
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Have monthly water temperature checks been undertaken and recorded in the Water Hygiene Log Book?
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Please detail any areas of concern or findings of water temperature checks identified as a risk:
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ASBESTOS MANAGEMENT:
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Has an Asbestos Risk Assessment been carried out for the premises by a competent person?
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Has an Asbestos Management Schedule been introduced to the premises?
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Are staff, volunteers, peer mentors and peer advocates aware of any asbestos present on site?
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Has a visual check been undertaken on any areas of known asbestos:
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Please detail any areas of concern or findings of asbestos check:
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SUMMARY OF ACTIONS FROM PREMISES INSPECTIONS:
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PLEASE REFER TO PREVIOUS MONTHS PREMISES INSPECTION FORM AND ENSURE ALL ACTIONS HAVE BEEN COMPLETED AND SIGNED OFF
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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ACTIONS IN ORDER OF PRIORITY:
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Select date
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Add signature
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The Assessor and Project Manager should sign below to show that the assessment is a correct and reasonable reflection of the hazards and of the control measures and actions required:
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Assessors Name:
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Add signature
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Select date
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Line Managers Name:
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Add signature
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Select date
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The completed form should be kept within the Premises Inspection Toolkit Section of the H&S Manual. A copy must be forwarded to the Health and Safety Co-ordinator in March and September
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SUBMISSION OF PREMISES INSPECTION FORM IN JANUARY & JULY:
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Maintenance Log Attached:
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Received By Health & Safety Co-Ordinator:
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Select date
