Information

  • Document No.

  • Location (including Store Number, if applicable)
  • Date and time of assessment

  • Name and role of assessor

  • Name and role of assessee

Van Inspection

Van Inspection

  • Does the assessee have a van?

  • Vehicle Registration Number

  • What is the condition of the tyres?

  • Take a clear picture of the tyres.

  • Are the tyres wearing evenly?

  • Take a clear picture of the tyres.

  • Use this image as a guide, if any of the tyres on the van resemble one of these images

    tyre_wear_full.jpg
  • Use this image as a guide.

    tyresafety_vans_02.jpg
  • Is there any damage on the vehicle?

  • Provide information on this.

  • Provide photographs on this.

  • Has the vehicle's weight been checked in the last 6 months?

  • Enter the vehicle's weight during this check.

  • Was the weight within the vehicle's weight limit?

  • Is the exterior of the vehicle clean?

  • Provide photograph of the vehicle.

  • Are all lights on the van (including brake lights, fog lights and hazard lights) working?

  • What lights are not working?

  • Is the interior of the vehicle tidy?

  • Provide photograph of the vehicle.

Fit For Service

Tools & Equipment

  • Does the colleague have any power tools?

  • Pick a random power tool held by the colleague. Type what the item is, and its make and model.

  • Is the power tool on the approved tools list?

  • Is the PAT in date?

  • What is the condition of the power tool?

  • Enter date of test.

  • State how the power tool was stored.

  • Follow this link to locate the approved tools list.
    http://arcusfs01/sites/qms/hs/hssa/Documents/Forms/AllItems.aspx

  • Does the colleague have a Harness, Lanyard and Transfastener?

  • Are the Harness, Lanyard and Transfastener on the approved PPE list?

  • Are the Harness, Lanyard and Transfastener labelled?

  • Is the inspection for the Harness, Lanyard and Transfastener in date?

  • Please enter the date of the inspection

  • Is the certificate for the Harness, Lanyard and Transfastener present and in-date?

  • Please enter the expiry date on the certificate

  • What is the condition of the Harness, Lanyard and Transfastener?

  • Please provide information for why it is unsatisfactory.

  • Does the colleague have a ladder?

  • Is the ladder on the approved equipment list?

  • Is the ladder labelled?

  • Is the inspection for the ladder in date?

  • Please enter the date of the inspection

  • What is the condition of the ladder?

  • Please provide information for why it is unsatisfactory.

  • Include a photograph if applicable.

  • Does the colleague have a set of barriers?

  • What is the condition of the barriers?

  • Please provide information for why it is unsatisfactory.

  • Include a photograph if applicable.

  • Does the colleague have a lock off kit?

  • What is the condition of the lock off kit?

  • Please provide information for why it is unsatisfactory.

  • Include a photograph if applicable.

  • Does the colleague have a haz crate?

  • Is there any hazardous waste inside the crate?

  • Approximately how long has the hazardous waste been inside for?

  • Does the colleague have a spill kit?

  • What is the condition of the spill kit?

  • Please provide a photograph of the spill kit.

PPE

  • Refer to the Approved PPE List and Select 3 Random Items from the List (unless previously advised which 3 to sample by the HSQE team)
    http://arcusfs01/sites/qms/hs/hssa/Documents/Forms/AllItems.aspx

  • Enter item 1, including Make and Model

  • Enter item 2, including Make and Model

  • Enter item 3, including Make and Model

  • Are all three selected items present?

  • State what items were missing and reason why,

  • What is the condition of the items?

  • Provide a photograph showing the reason it is unsatisfactory.

  • Consider if it will serve the purpose it is intended in its current condition and whether it's free from defect.

COSHH

  • Select 3 random COSHH items from the van.

  • Enter item 1

  • Enter item 2

  • Enter item 3

  • Check they are listed on the COSHH approved list (follow the link for this list).
    http://arcusfs01/sites/qms/hs/coshh/Documents/Forms/AllItems.aspx

  • Are all three selected items present on the approved COSHH list?

  • State what items weren't on the list and reason why.

  • Include a photograph of the item.

  • Are COSHH items in their original container with a label, lids secure and stored in a safe manner?

  • Are there any refrigerant cylinders stored on the van?

  • How many cylinders are there?

  • What is the capacity of the cylinders?

  • Are they stored safely?

  • Include a photograph of how they are stored.

  • Is the colleague wearing full uniform, including ID badge?

  • Has the colleague signed in and made themselves aware to client management?

Process

  • Colleague should carry out a work order as normal, accompanied by the assessor.

  • Is a work order available at the store to be completed?

Pre-Task Checklist

  • What is the work order number for the task to be completed?

  • Is a permit required for the task?

  • Has the correct permit been obtained and completed by the colleague?

  • Are safe isolation procedures required?

  • Have safe isolation procedures been carried out?

  • Are the works intrusive / accessing an area rarely accessed?

  • Has the asbestos register been checked?

  • Is a dynamic risk assessment required?

  • Can the colleague show you the dynamic risk assessment?

  • Show the colleague the relevant risk assessment and how to complete it.

  • Can the colleague show you the risk assessment for the task being performed?

  • Show the colleague the relevant risk assessment and how to access it.

  • Can the colleague tell you what PPE is required for the job?

  • List the PPE the colleague stated.

Task Process

  • Is the colleague wearing the appropriate PPE?

  • State the reason for 'No'.

  • Is the colleague following the correct work order management procedures?

  • Is the colleague following a safe system of work?

  • Can the colleague state the specific hazards related to this location?

  • List the hazards the colleague stated that relate to this location.

  • Include photographs of the location.

  • Has the colleague put physical barriers in place to prevent harm to others?

  • Are the barriers fit for purpose?

  • Include photograph of barriers in place.

  • Does the colleague require any lifting aids for the task? i.e. Trollies, mechanical aids or hoists.

  • Are they being used when working with heavy items / loads?

  • State reason for 'No'.

  • Is the colleague aware of any slip, trip or fall hazards in the working location?

  • State what they are and how they've been controlled.

  • Include photograph if applicable.

  • Does the colleague require use of any chemicals?

  • State what these chemicals are.

  • Are these chemicals on the COSHH approved list?

  • The link to COSHH approved list is here.
    http://arcusfs01/sites/qms/hs/coshh/Documents/Forms/AllItems.aspx

  • Does the colleague require use of any tools to carry out the task?

  • List what tools the colleague states are required.

  • Are these the correct tools to be using?

Post-Task Completion

  • Has the colleague confirmed with the client management that the task has been completed satisfactorily?

Training & Awareness

Training

  • Does the colleague have any training cards on their person?

  • List the cards that are on their person, and the expiry dates.

Awareness

  • Is the colleague aware of the asbestos process?

  • Can the colleague state what to do if asbestos is exposed or they have become aware of asbestos that has been illegally removed?

  • Is the colleague aware of the process for Hazards Spots / Near Misses and Accidents?

  • Can the colleague state how to report Hazard Spots / Near Misses and Accidents?

  • Is the colleague aware that they need to inform the store if anything happens on site.

  • Has the colleague had any near misses, hazard spots or accidents recently?

  • Is the colleague aware of the process for lone working?

  • Can the colleague advise of the process for lone working?

  • Is the colleague aware of how to dispose of non-hazardous waste?

  • Can the colleague advise of the process for disposing non-hazardous waste?

  • Is the colleague aware of how to dispose hazardous waste?

  • Can the colleague advise of the process for disposing hazardous waste?

  • Is the colleague aware of who their environmental champion is?

Container

  • Is there a container on site?

Containers

  • Is there any waste in or around the container?

  • Is it hazardous waste?

  • Is it stored appropriately?

  • Include a photograph of the waste.

  • Is there lighting in the container?

  • Is the lighting sufficient within the container?

  • Are there any tools or equipment in the container?

  • Select 3 random items from the container (unless previously advised which 3 to sample by the HSQE team).

  • Enter item 1, including Make and Model

  • Enter item 2, including Make and Model

  • Enter item 3, including Make and Model

  • Check they are listed on the Tools and Equipment approved list (follow the link for this list).
    http://arcusfs01/sites/qms/hs/hssa/Documents/Forms/AllItems.aspx

  • Are all three selected items present on the approved Tools and Equipment list?

  • State what items weren't on the list, and reason why (if known).

  • Include a photograph of the item.

  • Do the selected tools and equipment need inspecting and / or testing?

  • Enter the date of the last inspection for item 1 (if applicable).

  • Enter the date of the last inspection for item 2 (if applicable).

  • Enter the date of the last inspection for item 3 (if applicable).

  • Is there a COSHH cabinet for the storage of substances?

  • Select 3 random items from the COSHH cabinet (unless previously advised which 3 to sample by the HSQE team).

  • Enter item 1

  • Enter item 2

  • Enter item 3

  • Check they are listed on the COSHH approved list (follow the link for this list).
    http://arcusfs01/sites/qms/hs/coshh/Documents/Forms/AllItems.aspx

  • Are all three selected items present on the approved COSHH list?

  • State what items weren't on the list, and reason why (if known).

  • Include a photograph of the item.

  • Is racking present?

  • Is it bolted to the floor?

  • Is it stable?

  • Is it loaded appropriately?

  • Include a photograph of the racking.

  • Is the container in a secure area (free from unauthorised access)?

Close

  • Signature of Assessor

  • Signature of Assessee

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.