Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Site risk assessment

Site risks

  • PPE for this work

  • Children/animals

  • Exposed electrical items or connections

  • Unfenced drops or voids

  • Confined spaces

  • Other risk, please specify

  • Specific site or client safety requirements

Materials and specification

  • Date and time of first treatment ( if already booked with client and agreed with service manager)

  • Pest spec

  • Initial treatment

  • Follow up

  • Routine visit

  • Number of routines

  • Number of mouse baits

  • Rodenticide bait formulation

  • Litres of insecticide

  • Equipment required

  • Special instructions

Treatment instructions

  • Give detailed treatment instructions and other useful information in this section.

  • Add drawing

  • Add media

  • Add media

  • Add media

Signature of surveyor/manager

  • Add signature

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.