Title Page

  • Conducted on

  • Location
  • Surveyor Name

  • Prepared By

PPE

  • Does surveyor have NOPS card?

  • Is surveyor wearing steel toe capped boots?

  • Is surveyor wearing hi vis clothing?

  • Does surveyor have hand sanitiser?

  • Does surveyor have gloves?

  • Has Surveyor filled out a site risk assessment?

  • Does Surveyor have a 4 headed GDU and is it charged?

  • Does Surveyor have gate guards and are they in good condition?

  • Does Surveyor have the correct pit lifter and is it in good condition?

  • Does Surveyor have roller bar and is it in good condition?

  • Does Surveyor have kiss tool and is it in good condition?

  • Does Surveyor have telescopic rods and are they in good condition?

  • Does Surveyor have tape measure or laser measure and is it in good condition?

  • Does Surveyor have a traffic cone and is it in good condition?

Sign Off

  • Sign Off Time

  • Sign Off Location
  • Surveyor Signature

  • Auditor Signature

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.