SD37 - 4-Stage Clearance Site Audit Sheet - Issue 3 - April 2013

• SD37 - 4-Stage Clearance Site Audit Sheet - Issue 3 - April 2013

• Document No:

• Site:

• Date:

  Date

• Prepared by:

Job Details

• Job Number:

• Client:

• Date:

  Date

• Site Address:

• Purpose of Audit:

  Select Initial Audit On-going Competence Result of a Failure in Procedures Re-Authorisation Other

  • Initial Audit
  • On-going Competence
  • Result of a Failure in Procedures
  • Re-Authorisation
  • Other

• Auditee's Name & Signature:

  Sign

• Auditor's Name & Signature:

  Sign

Audit Summary:

• Equipment:

  Satisfactory

  Unsatisfactory

  N/A

• Procedures:

  Satisfactory

  Unsatisfactory

  N/A

• Documentation:

  Satisfactory

  Unsatisfactory

  N/A

• Paperwork:

  Satisfactory

  Unsatisfactory

  N/A

• Comments:

Health & Safety:

• Is the analyst clean shaven?

  Yes

  No

  N/A

• Is a shave kit available on site?

  Yes

  No

  N/A

• Is RPE available?

  Yes

  No

  N/A

• Is RPE clean and labelled?

  Yes

  No

  N/A

• Does the analyst have tyveks available?

  Yes

  No

  N/A

• Does the analyst have cover shoes available?

  Yes

  No

  N/A

• Does the analyst have safety boots available?

  Yes

  No

  N/A

• Does the analyst have a hi-viz jacket/vest available?

  Yes

  No

  N/A

• Does the analyst have a hard hat and/or bump cap available?

  Yes

  No

  N/A

• Does the analyst have gloves available?

  Yes

  No

  N/A

• Does the analyst have ear defenders available?

  Yes

  No

  N/A

• Does the analyst have safety glasses/goggles available?

  Yes

  No

  N/A

• Does the analyst have knee pads available?

  Yes

  No

  N/A

• Does the analyst have a first aid kit available?

  Yes

  No

  N/A

Equipment:

• Flowmeter numbers (long and short tubes):

• Are the flowmeters within calibration date and correctly labelled?

  Yes

  No

  N/A

• Stage micrometer number:

• Is the stage micrometer within calibration date and correctly labelled?

  Yes

  No

  N/A

• NPL test slide number:

• Is the NPL within calibration date and correctly labelled?

  Yes

  No

  N/A

• Timer number:

• Is the timer within calibration date and correctly labelled?

  Yes

  No

  N/A

• Air sampler numbers (including personal pump):

• Do all air samplers have current service records and are they correctly labelled?

  Yes

  No

  N/A

• Microscope number:

• Does the microscope have a current service record and is it correctly labelled?

  Yes

  No

  N/A

• Detail the cosmetic condition of the equipment and whether it is functioning correctly - identify any potential faults or actions required if the equipment is not labelled or calibrated:

• Take the microscope out of phase and ask the analyst to set it up. Describe performance and detail any guidance required:

Documentation:

• Does the analyst have a copy of HSG248 available?

  Yes

  No

  N/A

• Does the analyst have a copy of TP03 available?

  Yes

  No

  N/A

• Comments/Action Required?

Certificate of Reoccupation Procedures:

• Job details:

Stage 1:

• Has the analyst verified the generic risk assessments?

  Yes

  No

  N/A

• Has the analyst completed the document verification process satisfactorily?

  Yes

  No

  N/A

• Has the analyst conducted a satisfactory initial inspection of the exterior of the enclosure and adjacent areas?

  Yes

  No

  N/A

• Has the analyst conducted a satisfactory initial inspection of the hygiene facility and transit route?

  Yes

  No

  N/A

• Has the analyst conducted a satisfactory initial inspection of the waste route and waste storage area?

  Yes

  No

  N/A

• Further Comments and observations:

Stage 2:

• Is the analyst's entry/exit procedure to/from the enclosure satisfactory?

  Yes

  No

  N/A

• Is the standard of the visual inspection satisfactory?

  Yes

  No

  N/A

• Has the analyst had to use any ladders/scaffold towers within the area? If so was this done correctly?

  Yes

  No

  N/A

• Further comments and observations:

Stage 3:

• Has the analyst used an appropriate sampling strategy?

  Yes

  No

  N/A

• Did the analyst carry out the dust disturbance procedure correctly?

  Yes

  No

  N/A

• Further comments and observations:

Stage 4:

• Has the analyst carried out a satisfactory inspection of the former enclosure area?

  Yes

  No

  N/A

• Has the analyst carried out a satisfactory inspection of the former work areas and the transit/waste route?

  Yes

  No

  N/A

• Further comments and observations:

Site Documentation:

• Have the contractor signatures been collected as required?

  Yes

  No

  N/A

• Has the summary of works been completed adequately?

  Yes

  No

  N/A

• Further comments and observations:

Audit Summary:

• Audit outcome:

  Satisfactory

  Unsatisfactory

  N/A

Staff Feedback:

• Is there anything that could make the analyst's job easier? (Please get the analyst to fill in Staff Feedback Form SD59 to be filed with Action Form SD06)

Required Actions:

• Is any action required? Please note the action numbers (DD/MM/YYYY/01 etc - Please also fill in separate action forms SD06 for each action and complete the Action Log SD99)

  Yes

  No

  N/A

• Comments: