Routine Worksite Report - Version 3

• Document No.

• Audit Title

• Contractor

• Conducted on

  Date

• Prepared by

• Author - D Gilchrist Authorised by - D Gilchrist Date - 27-10-15 Version - 3 Review Date - November 2016

Reporting Requirements - ( answer yes if ok)

• Accident, Near Miss or Safety Incident

  Yes

  No

  N/A

• Environmental Incidents

  Yes

  No

  N/A

Task to be carried out

• Litter Collection

  Yes

  No

• Amenity Grass Cut

  Yes

  No

• Strimmed Edges

  Yes

  No

• Rough Grass Cut

  Yes

  No

• Wildflower Grass Cut

  Yes

  No

• Shrub Beds Weeded - NB - If weeding carried out FEPA form required.

  Yes

  No

• Young Woodland / Hedges Weeded - NB - If weeding carried out FEPA form required

  Yes

  No

• Shrubs Pruned

  Yes

  No

• Hard Surfaces Blow Vac'd

  Yes

  No

• Tree Ties Adjusted

  Yes

  No

• Dead Trees Removed

  Yes

  No

• Report any issues here

• Add images of reported issues here

  Media

Fence Management

• Weed control

  Yes

  No

• Damaged

  Yes

  No

• Report any issues here

• Add images of reported issues here

  Media

Customer Care - Report

• Provide details of Customer Care Number and Details of Findings

• Photos to be attached if applicable

  Media

Contractor Report

• Provide details of issues or defects

• Photos to be attached if applicable

  Media

Inspection Completion

• Signature of Contractor/Safety Co-ordinator

  Sign