Information
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Document No.
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Location (including Store Number, if applicable)
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Date and time of assessment
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Name and role of assessor
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Name and role of assessee
Van Inspection
Van Inspection
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Does the assessee have a van?
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Vehicle Registration Number
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What is the condition of the tyres?
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Take a clear picture of the tyres.
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Are the tyres wearing evenly?
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Take a clear picture of the tyres.
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Use this image as a guide, if any of the tyres on the van resemble one of these images
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Use this image as a guide.
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Is there any damage on the vehicle?
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Provide information on this.
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Provide photographs on this.
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Has the vehicle's weight been checked in the last 6 months?
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Enter the vehicle's weight during this check.
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Was the weight within the vehicle's weight limit?
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Is the exterior of the vehicle clean?
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Provide photograph of the vehicle.
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Are all lights on the van (including brake lights, fog lights and hazard lights) working?
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What lights are not working?
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Is the interior of the vehicle tidy?
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Provide photograph of the vehicle.
Fit For Service
Tools & Equipment
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Does the colleague have any power tools?
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Pick a random power tool held by the colleague. Type what the item is, and its make and model.
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Is the power tool on the approved tools list?
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Is the PAT in date?
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What is the condition of the power tool?
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Enter date of test.
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State how the power tool was stored.
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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?
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Are the Harness, Lanyard and Transfastener on the approved PPE list?
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Are the Harness, Lanyard and Transfastener labelled?
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Is the inspection for the Harness, Lanyard and Transfastener in date?
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Please enter the date of the inspection
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Is the certificate for the Harness, Lanyard and Transfastener present and in-date?
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Please enter the expiry date on the certificate
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What is the condition of the Harness, Lanyard and Transfastener?
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Please provide information for why it is unsatisfactory.
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Does the colleague have a ladder?
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Is the ladder on the approved equipment list?
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Is the ladder labelled?
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Is the inspection for the ladder in date?
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Please enter the date of the inspection
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What is the condition of the ladder?
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Please provide information for why it is unsatisfactory.
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Include a photograph if applicable.
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Does the colleague have a set of barriers?
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What is the condition of the barriers?
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Please provide information for why it is unsatisfactory.
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Include a photograph if applicable.
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Does the colleague have a lock off kit?
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What is the condition of the lock off kit?
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Please provide information for why it is unsatisfactory.
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Include a photograph if applicable.
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Does the colleague have a haz crate?
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Is there any hazardous waste inside the crate?
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Approximately how long has the hazardous waste been inside for?
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Does the colleague have a spill kit?
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What is the condition of the spill kit?
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Please provide a photograph of the spill kit.
PPE
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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
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Enter item 2, including Make and Model
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Enter item 3, including Make and Model
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Are all three selected items present?
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State what items were missing and reason why,
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What is the condition of the items?
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Provide a photograph showing the reason it is unsatisfactory.
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Consider if it will serve the purpose it is intended in its current condition and whether it's free from defect.
COSHH
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Select 3 random COSHH items from the van.
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Enter item 1
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Enter item 2
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Enter item 3
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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?
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State what items weren't on the list and reason why.
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Include a photograph of the item.
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Are COSHH items in their original container with a label, lids secure and stored in a safe manner?
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Are there any refrigerant cylinders stored on the van?
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How many cylinders are there?
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What is the capacity of the cylinders?
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Are they stored safely?
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Include a photograph of how they are stored.
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Is the colleague wearing full uniform, including ID badge?
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Has the colleague signed in and made themselves aware to client management?
Process
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Colleague should carry out a work order as normal, accompanied by the assessor.
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Is a work order available at the store to be completed?
Pre-Task Checklist
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What is the work order number for the task to be completed?
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Is a permit required for the task?
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Has the correct permit been obtained and completed by the colleague?
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Are safe isolation procedures required?
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Have safe isolation procedures been carried out?
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Are the works intrusive / accessing an area rarely accessed?
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Has the asbestos register been checked?
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Is a dynamic risk assessment required?
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Can the colleague show you the dynamic risk assessment?
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Show the colleague the relevant risk assessment and how to complete it.
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Can the colleague show you the risk assessment for the task being performed?
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Show the colleague the relevant risk assessment and how to access it.
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Can the colleague tell you what PPE is required for the job?
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List the PPE the colleague stated.
Task Process
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Is the colleague wearing the appropriate PPE?
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State the reason for 'No'.
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Is the colleague following the correct work order management procedures?
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Is the colleague following a safe system of work?
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Can the colleague state the specific hazards related to this location?
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List the hazards the colleague stated that relate to this location.
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Include photographs of the location.
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Has the colleague put physical barriers in place to prevent harm to others?
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Are the barriers fit for purpose?
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Include photograph of barriers in place.
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Does the colleague require any lifting aids for the task? i.e. Trollies, mechanical aids or hoists.
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Are they being used when working with heavy items / loads?
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State reason for 'No'.
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Is the colleague aware of any slip, trip or fall hazards in the working location?
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State what they are and how they've been controlled.
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Include photograph if applicable.
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Does the colleague require use of any chemicals?
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State what these chemicals are.
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Are these chemicals on the COSHH approved list?
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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?
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List what tools the colleague states are required.
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Are these the correct tools to be using?
Post-Task Completion
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Has the colleague confirmed with the client management that the task has been completed satisfactorily?
Training & Awareness
Training
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Does the colleague have any training cards on their person?
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List the cards that are on their person, and the expiry dates.
Awareness
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Is the colleague aware of the asbestos process?
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Can the colleague state what to do if asbestos is exposed or they have become aware of asbestos that has been illegally removed?
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Is the colleague aware of the process for Hazards Spots / Near Misses and Accidents?
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Can the colleague state how to report Hazard Spots / Near Misses and Accidents?
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Is the colleague aware that they need to inform the store if anything happens on site.
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Has the colleague had any near misses, hazard spots or accidents recently?
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Is the colleague aware of the process for lone working?
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Can the colleague advise of the process for lone working?
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Is the colleague aware of how to dispose of non-hazardous waste?
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Can the colleague advise of the process for disposing non-hazardous waste?
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Is the colleague aware of how to dispose hazardous waste?
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Can the colleague advise of the process for disposing hazardous waste?
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Is the colleague aware of who their environmental champion is?
Container
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Is there a container on site?
Containers
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Is there any waste in or around the container?
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Is it hazardous waste?
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Is it stored appropriately?
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Include a photograph of the waste.
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Is there lighting in the container?
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Is the lighting sufficient within the container?
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Are there any tools or equipment in the container?
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Select 3 random items from the container (unless previously advised which 3 to sample by the HSQE team).
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Enter item 1, including Make and Model
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Enter item 2, including Make and Model
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Enter item 3, including Make and Model
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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?
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State what items weren't on the list, and reason why (if known).
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Include a photograph of the item.
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Do the selected tools and equipment need inspecting and / or testing?
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Enter the date of the last inspection for item 1 (if applicable).
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Enter the date of the last inspection for item 2 (if applicable).
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Enter the date of the last inspection for item 3 (if applicable).
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Is there a COSHH cabinet for the storage of substances?
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Select 3 random items from the COSHH cabinet (unless previously advised which 3 to sample by the HSQE team).
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Enter item 1
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Enter item 2
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Enter item 3
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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?
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State what items weren't on the list, and reason why (if known).
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Include a photograph of the item.
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Is racking present?
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Is it bolted to the floor?
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Is it stable?
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Is it loaded appropriately?
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Include a photograph of the racking.
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Is the container in a secure area (free from unauthorised access)?
Close
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Signature of Assessor
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Signature of Assessee