Title Page

  • Conducted on

  • Prepared by

Store Details

  • Store Name:

  • Store Number:

  • Checkout Type:

  • Actual Quantity of Checkouts In Store

PPM Details:

  • PPM Date:

  • PPM Engineer/Engineers

  • Photo of signing in book:

  • Audit Date

  • PPM Checklist Input & Output Belted Checkout

  • Add Checkout
  • Checkout Number Being Audited

  • Asset Number

  • Photo of Asset Number

Electrical Components:-

  • Checkout Controller Fully Operational ?

  • Detail Controller Faults

  • Input Belt Safety Flap Sensor Working ?

  • Output Belt Safety Flap Sensor Working ?

  • Input Belt Eye Beam/Beams Working ?

Input Belt:-

  • Input Belt Condition ?

  • Stainless Nose Cone Cover Cleaned ?

  • Photo

  • Stainless Side Trims Cleaned ?

  • Photo

  • Stainless Eye Beam Trim Cleaned ?

  • Photo

  • Input Belt Stainless Safety Flap Cleaned ?

  • Photo

  • Input Belt Eye Beam/Beams Cleaned?

  • Photo’s

  • Input Belt Eye Beam reflector cleaned ?

  • Photo

  • Input Belt Motor Roller Cleaned?

  • Photo

  • Input Belt Idle Roller Cleaned?

  • Photo

  • Input Belt Checkout Bed Cleaned?

  • Photo

  • Input Belt Crumb Tray Cleaned?

  • Photo

Output Belt:-

  • Output Belt Condition ?

  • Output Belt Stainless Safety Flap Cleaned ?

  • Photo

  • Output Belt Motor Roller Cleaned?

  • Photo

  • Output Belt Idle Roller Cleaned?

  • Photo

  • Output Belt Checkout Bed Cleaned?

  • Photo

  • Output Belt Crumb Tray Cleaned?

  • Photo

  • PPM Checklist Input Belted Checkout Only

  • Checkout
  • Checkout Number Being Audited

  • Asset Number

  • Photo of Asset Number

Electrical Components:-

  • Checkout Controller Fully Operational ?

  • Detail Controller Faults

  • Input Belt Safety Flap Sensor Working ?

  • Output Belt Safety Flap Sensor Working ?

  • Input Belt Eye Beam/Beams Working ?

Input Belt:-

  • Input Belt Condition ?

  • Stainless Nose Cone Cover Cleaned ?

  • Photo

  • Stainless Side Trims Cleaned ?

  • Photo

  • Stainless Eye Beam Trim Cleaned ?

  • Photo

  • Input Belt Stainless Safety Flap Cleaned ?

  • Photo

  • Input Belt Eye Beam/Beams Cleaned?

  • Photo’s

  • Input Belt Eye Beam reflector cleaned ?

  • Photo

  • Input Belt Motor Roller Cleaned?

  • Photo

  • Input Belt Idle Roller Cleaned?

  • Photo

  • Input Belt Checkout Bed Cleaned?

  • Photo

  • Input Belt Crumb Tray Cleaned?

  • Photo

  • PPM Completed as per job description?

  • Detail Issues:

  • Auditors Comments/Snags/Notes

Photos

Checkout Photo’s

  • Add photo’s of checkouts:

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.