Information
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Client / Site
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Conducted on
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Prepared by
Previous inspection
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Are there any outstanding items from the last inspection.
Work area inspected.
Items requiring attention
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What are the Hazard/s?
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Add media
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Who might be harmed and how?
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What is already being done to address the Hazard?
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Add media
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What further Action is Required
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Add media
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How will the controls be implemented?
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Add media
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Person/s responsible for implementing the controls?
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Add media
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Date by when the Controls need to be implemented?
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What Actions are required post implementation?
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Has this eliminated the Hazard - if not why not?
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Add media
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What subsequent action is required?
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Add media
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Using the Hierarchy of Control what control/s have been used to reduce or eliminate the Hazard?
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Add media
Comments
Sign off - Audit Content
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Auditor
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Department Manager
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Select date
Sign off- Action Plan Completed
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Auditor
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Department Manager
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Select date
