Title Page
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Conducted on
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Prepared by
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Location
Sub-contractor details
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Sub-contractor name
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Sub-contractor service
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Technician name(s)
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Task carried out at the time of inspection?
Client details
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Client name
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Client contact name(s)
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Site location
Health and safety
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If at any time the answer 'No' is given, please add comments to the 'Notes' section stating any corrective action that followed.
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Risk assessment and method statement and permit to work (where relevant) available?
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Is the technician/engineer familiar with the risk and method statement / permit to work?
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Are the procedures and control measures as stated in the risk and method statement / permit to work being followed?
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Please ask the engineer to follow them and ensure that they are before allowing work to continue.
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Please ensure that the engineer fully understands the risk and method statement, follows the safe system of work and risk assessment control measures, then allow them to continue with works.
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Can the engineer / technician give an explanation as to why?
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Please add the explanation below and if proof can be given that the identified control measures are now understood and are being followed, allow the engineer to continue.
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Please ask the engineer to temporarily stop works and provide proof of training and communication of risk and method statement.
- If training and communication can be given ensure safe procedures are followed and allow engineer to continue.
- If training and communication can not be given, stop works and ask engineer to rearrange and return. -
Overall safety score
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Observations and any additional control measures recommended?
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Evidence of inspection and safe procedures.
Sign-off information
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I can confirm that I believe that the information given during the time of this inspection is accurate and true.
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Inspector name and signature.
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Select date