Title Page

  • Conducted on

  • Prepared by

  • Location

Area Audited

  • Area / Team Audited

  • Shift Supervisor / Responsible Manager

  • Number of Personnel who require RPE

  • List of Names

  • Are all of the above Face-Fit Tested?<br>[Check Records]

  • Have all of the above been provided with RPE<br>[Confirm all produce RPE]

  • Has all RPE been subject to recorded inspection and maintenance, including filters changed, within the last month?

  • Do any individuals report issues (damage; wear; blocked filters; etc.)?

  • Are all of the above individuals conversant with WHEN and WHERE the RPE must be used?

  • Are the requirements for WHEN and WHERE RPE is required clearly stated in Site Rules?

  • Are there suitable stock of spare filters for the RPE?

  • Are personnel conversant with how & when to replace RPE filters?

Feedback & Follow-up

  • Feedback provided to the Shift Supervisor:

  • Acceptance of Feedback

  • Feedback provided to Relevant Manager:

  • Acceptance of Feedback

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.