SITE QHSE INSPECTION CHECK LIST (L10) - rev 2.0

• Document No.

• Site

• Blg No

• Location
  Address

• Client

• Job Title

• DEL / Contractor

• Type of work inspected

  Response

  PPM

  Recall

  MNW

  Other

• Inspector Name

  Sign

• Site / Contractor Rep

• Site / Contractor Name

• Conducted on

  Date

HEALTH & SAFETY

• Asbestos

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• SSW / COSHH

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• PPE / RPE / FPE

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Competence / Training / Supervision

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Fire Prevention Measures

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• RA Method Statement in Place & Approved

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Housekeeping

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Procedural

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Behaviour

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

ENVIRONMENTAL MANAGEMENT

• Waste Management

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Recycling

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Waste transfer notes in use

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Noise & Dust Control

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

• Land Contamination & Pollution Control

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• PERSON RESPONSIBLE

• COMMENTS / ACTIONS

• Target Date

  Date

• Completion Date

  Date

QUALITY OF WORKMANSHIP

• HVAC

• Pre filter status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Chilled Water Temp (supply & return)

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Fan blower belt & motor status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Drain Tray and line status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Vibration or noise

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Supply and return air temp

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Control System (Thermostat, Actuator & Damper)

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Coil & Valves status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Unit overall condition

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Supply and return grills condition

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• ELEC

• Indication Lamps

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Auto hand switch

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• General inspection of MCB, ELCB, loose connection and load

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Emergency and Exit Light

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Common area light (color variation)

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Pre filter status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• No extension cords to be used

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• PLUMB

• Check water heater leakage, set point and temperature

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Inspect tap and bottle trap

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Floor Drain

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Isolation valves

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

• Pre filter status

  Select 1N 2N 3N 4N S N/A

  • 1N
  • 2N
  • 3N
  • 4N
  • S
  • N/A

• COMMENTS / ACTIONS

• PERSON RESPONSIBLE

• Target Date

  Date

• Completion Date

  Date

Comments/Recommendations/Remedial Actions:-

• Overall Assessment

  Satisfactory

  Not Satisfactory