Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Please choose only one of the following statements
> if either statment 1 or 2 are relevant please simply sign and date the bottom of this document
> if statment 3 is relevant then please complete audit -
1: I declare that there are no significant risks arising from hazards associated with the conduct of this business (within my control) to which anybody would be exposed
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2: I undertake to prohibit employees / customers from undertaking any task that would expose them to significant risk
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3: I have conducted a risk assesment on identified hazards arising from the activities of this organisation to that employees/ customers may be exposed, the significant findings are listed below
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Name of Auditor
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Auditor signature
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tasks to be under taken
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Potential hazard
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Details of risk
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Control measure
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tasks to be under taken
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Potential hazard
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Details of risk
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Control measure
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tasks to be under taken
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Potential hazard
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Details of risk
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Control measure
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tasks to be under taken
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Potential hazard
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Details of risk
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Control measure
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Name of person completing the audit
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Auditor signature
