Title Page
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Conducted on
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Location
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Surveyor Name
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Prepared By
PPE
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Does surveyor have NOPS card?
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Is surveyor wearing steel toe capped boots?
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Is surveyor wearing hi vis clothing?
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Does surveyor have hand sanitiser?
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Does surveyor have gloves?
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Has Surveyor filled out a site risk assessment?
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Does Surveyor have a 4 headed GDU and is it charged?
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Does Surveyor have gate guards and are they in good condition?
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Does Surveyor have the correct pit lifter and is it in good condition?
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Does Surveyor have roller bar and is it in good condition?
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Does Surveyor have kiss tool and is it in good condition?
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Does Surveyor have telescopic rods and are they in good condition?
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Does Surveyor have tape measure or laser measure and is it in good condition?
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Does Surveyor have a traffic cone and is it in good condition?
Sign Off
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Sign Off Time
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Sign Off Location
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Surveyor Signature
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Auditor Signature