Self Inspection Template V2.0

• Division and team

• Room number and building

• Select date

  Date

• Names of all the people present for the audit

• Name of the person completing the audit

• Position of the person completing the audit

• Supervisor/Line Manager in charge of the area

• 1. Please complete ALL of the questions.
  2. Yes - means that a particular activity is carried out in the area you are auditing
  3. No - means that a particular activity is not carried out in the area you are auditing.
  4. N/A means that a particular activity is not carried out because it is not relevant to the area you are auditing
  5. If you leave any fields blank it will affect the overall score of your audit. Blank fields give a negative scoring but N/A does not give a negative score.
  

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Yes

  No

  N/A

• 1.2 - Have all actions been completed?

  Yes

  No

  N/A

2.0 - Fire Prevention For some of the fire related questions you may need to go out of your immediate area and look at the area collectively. For example fire notices and extinguishers may not be in the immediate space you are auditing, but they may be located somewhere else on your floor.

• 2.1 - Is the Evacuation plan displayed? If this is not displayed in the room you are auditing it may be displayed on your corridor.

  Yes

  No

  N/A

• 2.2 - Are fire notices displayed? If this is not displayed in the room you are auditing it may be displayed on your corridor.

  Yes

  No

  N/A

• 2.4 - Are extinguishers in place and clearly marked for type of fire? Fire extinguishers may be located in the corridor or along your exit route.

  Yes

  No

  N/A

• 2.5 - Do extinguishers display the date they were last serviced?

  Yes

  No

  N/A

• 2.6 - Is the service label in date?

  Yes

  No

  N/A

• 2.7 - Are extinguishers clear of obstructions? Nothing around them that would make it difficult to reach them in an emergency.

  Yes

  No

  N/A

• 2.8 - Can exit doors be easily opened from the inside?

  Yes

  No

  N/A

• 2.9 - Are exit routes clear of obstructions?

  Yes

  No

  N/A

• 2.10 - Is the fire alarm tested weekly? Ask someone who is based in the area.

  Yes

  No

  N/A

• 2.11 - Is the area clear of excessive amounts of combustible material?

  Yes

  No

  N/A

3.0 - Lighting

• 3.1 - Is there good natural lighting?

  Yes

  No

  N/A

• 3.2 - Is the area free from reflected light from walls & ceilings that may cause glare?

  Yes

  No

  N/A

• 3.3 - Are light fittings clean and in good condition?

  Yes

  No

  N/A

4.0 - Building Safety

• 4.1 - Are floor surfaces even and uncluttered?

  Yes

  No

  N/A

• 4.2 - Are walkways kept clear?

  Yes

  No

  N/A

• 4.3 - Are liquid spills removed quickly?

  Yes

  No

  N/A

• 4.4 - Are railings in good condition?

  Yes

  No

  N/A

5.0 - Waste

• 5.1 - Are bins located at suitable points around the area?

  Yes

  No

  N/A

• 5.2 - Are bins emptied regularly?

  Yes

  No

  N/A

6.0 - Storage Design and Use

• 6.1 - Are items stored in cupboards and on shelves wherever possible?

  Yes

  No

  N/A

• 6.2 - Is storage designed to minimise lifting problems? ie heavy items lower down.

  Yes

  No

  N/A

• 6.3 - Are floors around shelving clear of rubbish/obstruction?

  Yes

  No

  N/A

• 6.4 - Is shelving in good condition?

  Yes

  No

  N/A

7.0 - Electrical Safety

• 7.1 - Is there a sufficient number of plug sockets? ie no overloading of extension cables or daisy-chaining of extension cables (where one extension cable is plugged into another)

  Yes

  No

  N/A

• 7.2 - Is equipment PAT tested and labelled?

  Yes

  No

  N/A

• Who holds the PAT records?

  Yes

  No

  N/A

• 7.3 - Is the area clear of items that have failed a PAT test?

  Yes

  No

  N/A

• 7.4 - Is the area free from broken plugs, sockets or switches?

  Yes

  No

  N/A

• 7.5 - Is the area clear of trailing cables?

  Yes

  No

  N/A

• 7.6 - Is the area free from any damaged leads?

  Yes

  No

  N/A

• 7.7 - Is the area free from any strained leads?

  Yes

  No

  N/A

• 7.8 - Is the area warm enough without supplementary heating?

  Yes

  No

  N/A

• 7.9 - If supplementary heaters are in use list type of heater and location:

• 7.10 - Is equipment correctly located and regularly maintained?

  Yes

  No

  N/A

• Who holds the records for inspection and servicing?

  Yes

  No

  N/A

• 7.11 - Are all users trained in correct use of the equipment?

  Yes

  No

  N/A

8.0 Ladders and Kickstools If you do not use ladders or Kickstools in your area you can answer N/A to questions that are not relevant, but do NOT leave the questions blank. If you do use ladders or Kickstools in your area but they are not located in the area at the time you are carrying out the audit, you will need to locate them in order to answer the following questions.

• 8.1 - Are all ladders Industrial strength? (Non Household rated, check label.)

  Yes

  No

  N/A

• 8.2 - Are ladders in good condition?

  Yes

  No

  N/A

• 8.3 - Is training provided in the safe use of ladders?

  Yes

  No

  N/A

• 8.4 - Are kickstools in good condition?

  Yes

  No

  N/A

9.0 First Aid Facilities The first aid facilities that you have access to may not be located in the area that you are auditing. You will need to locate your nearest provision to answer the following questions.

• 9.1 - Do you know where your nearest first aid box is?

  Yes

  No

  N/A

• 9.2 - Do you know how to get the help of a first aider?

  Yes

  No

  N/A

• 9.3 - Are first aid boxes and contents clean and orderly?

  Yes

  No

  N/A

• 9.4 - Are contents regularly checked? (arrangements are outlined in your Health and Safety Policy)

  Yes

  No

  N/A

• 9.5 - Are all items within their expiry date?

  Yes

  No

  N/A

• 9.6 - Are first aid notices displayed? These may not be displayed in the location you are auditing, but they should be displayed in a nearby location eg. On the corridor or in the building entrance.

  Yes

  No

  N/A

• 9.7 - Do you know how to find out where the AEDs (Automated External Defibrillators) are located across the site?

  Yes

  No

  N/A

10.0 - Office Hazards

• 10.1 - Do filing cabinets have anti-tilt mechanism? (If you can open more than one door at once the cabinet does not have an anti-tilt mechanism)

  Yes

  No

  N/A

• 10.2 - Are chairs ( with five star bases) in good condition?

  Yes

  No

  N/A

• 10.3 - Are desks in good condition with no damage?

  Yes

  No

  N/A

• 10.4 - Are Display Screen Equipment self-assessments carried out for each user? Your local assessor is named in your Health and Safety Policy.

  Yes

  No

  N/A

• 10.5 - Are photocopiers and printers with heavy useage positioned to avoid fumes?

  Yes

  No

  N/A

• 10.6 - Are floor coverings non-slip and in good condition?

  Yes

  No

  N/A

General Information

• Is the DSE Health and Safety Statement on view? This may not be displayed in the area that you are auditing but should be displayed in a communal area within the building.

  Yes

  No

  N/A

• If not how are staff made aware of it?

• Is the Division Health and Safety Policy on view? This may not be on display in the area that you are auditing but may be displayed in a communal area or on your team website.

  Yes

  No

  N/A

• If not how are staff made aware of it?

• Is the Health and Safety notice board up to date? This may not be in the area you are auditing but may be in a communal area within the building.

  Yes

  No

  N/A

• Any additional issues that have not already been covered?

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• Auditor's signature

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