Information
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Document No.
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Site Name
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Organisation Name
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Conducted on
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Prepared by
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Site Address
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Personnel in attendance
General
Emergency Systems
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Emergency procedures in place
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Emergency names and numbers displayed / available
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Emergency procedures training provided
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Emergency access and egress clear and unobstructed
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Fire alarm system functioning correctly
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Photo
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Actions Required
Safety Systems
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Client policy and procedures in place
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Client site induction training provided
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Client indent identified hazards information provided
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Photo
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Actions Required
Security Systems
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Personal and duress alarm system available and operable
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CCTV fitted and operable
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Communication systems available operable (telephone / portable radio)
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Security fences erected and in good condition
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Photo
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Actions Required
Electrical and Lighting
Electrical
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Plugs, sockets and switches in good condition
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Testing and tagging current
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No exposed electrical wire
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Electrical switchboards / rooms are safe and secure
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Actions
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Photo
General Lighting
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Adequate illumination
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All light fittings operable
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Emergency lighting operable
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Actions
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Photo
Amenities
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Cool, clean palatable drinking water available
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Rest area available (clean and tidy)
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Car parking available
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Seating available (eg static guarding)
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Photo
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Actions
First aid and site specific PPE
First Aid
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Cabinets and contents clean and orderly
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Easy access to cabinets
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Employees aware of location of first aid cabinet
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Emergency names / first aiders names and numbers displayed
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Photo
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Actions
Site Specific PPE
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Suitable for task
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Information, instruction and training provided
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Photo
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Actions
Noise
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Noisy areas identified
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Controls in place to minimise exposure to noise
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Photo
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Actions
Outdoors
Site Grounds
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Lighting adequate
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Safe surface, no dangerous excavations, cracks or holes
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Hazard areas secured and safety signage erected and visible
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Unobstructed vision at intersection, stairs /ramps
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Photo
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Action
Car Parks
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Lighting adequate
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Safe surface, no dangerous excavations, cracks or holes
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Pedestrian walkways available
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Photo
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Action
Walkways
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Lighting adequate
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Safe surface, no dangerous undulations, cracks or holes
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Elevated walkways are in good condition and have handrails fitted
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Stairways are fitted with handrails and without slip / trip hazards
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Steps and split level areas are clearly marked or illuminated
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Photo
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Action
Additional Hazards
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Hazard
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Photo
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Action
Employee Acknowledgement
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Name
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Signature
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Name
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Signature
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Name
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Signature
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Name
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Signature
Additional Employee
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Name
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Signature
