Title Page

  • Name of customer

  • Address of customer

  • Location
  • Prepared by

  • Conducted on

Untitled Page

  • Have you walked around the job and explained the work you are carrying out?

  • Have all surfaces and walk ways been made clear and protective coverings been used to cover what is needed such as carpets?

  • Have fire extinguishers been put out in correct areas?

  • Is all correct PPE equipment out and being used when needed?

  • Are all ladders and working at height equipment been checked for safety before using?

  • Are all tools pat tested and checked for images before use?

  • If samsung controller is not attached to cylinder - the agreed location is agreed with customer?

customer walk round

  • Customer is aware of the work to be carried out?

  • Customer is happy about location of cable runs and where isolator switch is going?

  • Customer is satisfied with the level of practice to reduce mess such as dust sheets?

  • Customer is aware of the time frame of the work being carried out?

  • Customer has agreed to the placing of the samsung controller?

  • Customer is happy for the electricians to commence the work?

  • Signed by customer

  • Print name

  • Date

  • signed by electrician

  • Print Name

  • Date

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.