Title Page

  • Site conducted

  • Conducted on:

  • Workorder Number:

  • Report Designation:

  • Conducted By:

  • Conducting Company:

  • Location

Inspection Documentation

  • Conformance Documentation

  • Landlord name and contact details

  • Landlord name and contact details

  • Retailer name and contact details

  • Retailer name and contact details

  • Proof of Insurance

  • Proof of Insurance

  • Electrical COC

  • Electrical COC

  • LP Gas COC

  • LP Gas COC

  • HVAC Latest Service Records

  • HVAC Latest Service Records

  • Refrigeration Latest Service Records

  • Refrigeration Latest Service Records

  • Fire Detection latest service records

  • Fire Detection latest service records

  • Fire Protection latest service records

  • Fire Protection latest service records

  • Extraction canopy cleaning and latest service records

  • Extraction canopy cleaning and latest service records

  • Generator latest service records

  • Generator latest service records

  • Goods Hoist latest service records

  • Goods Hoist latest service records

Landlord and Retailer Details

  • Contact Details:

Landlord Details

  • Landlord Name

  • Landlord E-mail and Contact Numbers

  • Head Lease

Retailer Details

  • Retailer Name

  • Retailer E-mail and Contact Number

Detailed Report

  • Detailed Report

  • Retailer Responsibility

Retailer Responsibility

  • Areas of Responsibility:

  • All Interior Building Fabrication and Equipment

Retailer Report

  • Detailed Report

  • Detailed in Retailer Report

  • Detailed description of findings:

  • Landlord Responsibility

Landlord Responsibility

  • Areas of Responsibility:

  • All Exterior Building Fabrication

Landlord Report

  • Detailed Report

  • Detailed in Landlord Report

  • Detailed description of findings:

Report Priority Rating Legend

  • P1 - Critical - Replacement

  • P2 - Severe - Rehabilitation

  • P3 - Bad - Repairs Required

  • P4 - Fair Condition Based Maintenance

  • P5 - Good - Preventative Maintenance

Building Interior (Retailer)

  • Retailer Responsibility

  • Admin Offices

Admin Offices

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Ablutions

Ablutions

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Fire Protection and Detection:

  • Fire Protection

  • Is there fire protection installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • Fire Detection

  • Are there fire detection sensors installed?

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Canteen

Canteen

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Fire Protection and Detection:

  • Fire Protection

  • Is there fire protection installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • Fire Detection

  • Are there fire detection sensors installed?

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Butchery

Butchery

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • HMR

HMR

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Bakery

Bakery

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Trade Floor

Trade Floor

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Flammable Refrigerants

  • R290

  • Please take note that the refrigerant used within these refrigerators is highly flammable. Please
    make sure to maintain these units on a regular basis to prevent any incidents from occurring.

    R290.jpg
  • R600

  • Please take note that the refrigerant used within these refrigerators is highly flammable. Please
    make sure to maintain these units on a regular basis to prevent any incidents from occurring.

    R600a.jpg
  • Are there any OHS concerns?

  • OHS Concerns:

  • Shop Fronts

Shop Fronts

  • Are all shop fronts in good operation condition?

  • Priority Level:

  • Remedial Action Required:

  • Is all glazing in good order?

  • Priority Level:

  • Remedial Action Required:

  • Are all night latches in good working order?

  • Priority Level:

  • Remedial Action Required:

  • Are all bulkheads in good order?

  • Priority Level:

  • Remedial Action Required:

  • Are all guides, rails and rollers in good operating order and free of obstruction?

  • Priority Level:

  • Remedial Action Required:

  • Coffee Shop

Coffee Shop

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Are there fire detection sensors installed?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

  • Back Of House

Back of House

  • Is the electrical installation in good order?

  • Is the electrical installation compliant with SANS10142?

  • Non-Compliance Issues:

  • Plumbing

  • Is the plumbing in good order and good working condition?

  • Is the plumbing compliant?

  • Is there fire protection installed?

  • Fire Detection

  • Are there fire detection sensors installed?

  • Does all fire protection equipment comply with SANS codes?

  • Please refer to SANS 10400t; Sans 1910; SANS 1475-1; SANS 10105-1

  • Non-Compliance Issues:

  • is the building fabrication in acceptable and safe conditions (tiles, doors, windows, concrete, ceilings)?

  • Extraction

  • Is all extraction/fresh air in good working order?

  • Are there any OHS concerns?

  • OHS Concerns:

Building Equipment & Disciplines (Retailer)

  • Retailer Responsibility

Building Infrastructure

Internal structures

  • Is the building structurally sound?

  • Is the building free of any concrete spalling or structural cracks?

  • Are the steel structures sound and free of rust or distortion?

  • Are the buildings paint coverings in good order?

  • Is the building free of any structural hazards or notices?

  • Is there currently any construction or alterations in progress?

Aesthetics & Appearance

  • Is all signage in good working order, inclusive of general signage?

Electrical Reticulation

Electrical Distribution

  • Are the LV/LT boards secure and safe?

  • Are all distribution boards marked and have updated legend cards displayed?

  • Are all cable ways correctly installed?

  • Do all electrical reticulated installations comply with SANS10142?

  • Non - Compliance Issues:

  • DB Signs 1.png
  • Power Factor Correction

  • Is the power factor correction in good working order?

  • Are all electrical installations and distribution boards free of obstruction?

Metering

  • Are all meters and sub-meters working correctly?

  • Are there any signs of visible tampering?

Generator

  • Is the generator secure from tampering and unauthorized personnel?

  • Is all safety signage installed warning of moving parts, electrical shock and correct PPE required?

  • Generatorroom_1024x1024.png
  • Is there fire protection Installed?

  • Is the generator free of leaks, obstructions and any visible concerns?

  • Has the generator been serviced in the specified hours or date?

  • Service Hours

  • Last Service Date

Fire, Security & Access

Fire Detection

  • Is there fire detection installed?

  • Has all the relevant fire detection equipment been inspected?

  • Is all the fire detection equipment in good working order?

  • Has all the fire detection equipment been serviced within the specified service dates?

  • Next Service Date:

  • Non-Conformity Concerns:

  • Square Meterage:

  • Any building containing an occupancy classified as:

  • In accordance with SANS 10400-T:

    shall be equipped with a fire detection system and alarm system that is designed, installed and maintained by competent persons in accordance with SANS 10139.

Fire Protection

  • Has all the relevant fire protection been inspected?

  • Is all fire protection equipment in good working order?

  • Has all the fire protection equipment been serviced within the specified service dates?

  • Fire equipment next service date:

  • Fire Sprinkler System

  • Has the fire sprinkler valve been serviced within the 3 year window and are there spare gaskets attached to the valve?

  • Fire sprinkler valve next service date:

  • Non-Conformance concerns:

  • Non-Conformance concerns:

Security

  • Is the store fitted with an alarm system?

Mechanical & Plant Equipment

  • HVAC

HVAC

  • Has all HVAC been inspected?

  • Are the HVAC systems operating as designed?

  • Has the HVAC been serviced as per manufacturer specifications?

Refrigeration

  • Is the refrigeration plant room secure from tampering and unauthorized personnel?

  • Is all safety signage installed warning of moving parts, electrical shock and correct PPE required?

  • Refrigeration Plant Room.png
  • Is there fire protection installed within the plant room?

  • Is there fire detection installed within the plant room?

  • Are there any points of concern within the refrigeration plant?

  • Has the refrigeration been serviced as per manufacturer specifications?

  • Vertical Transport-Lifts/Hoists/Conveyors/Dock Levellers

Vertical Transport-Lifts/Hoists/Conveyors/Dock Levellers

  • Are there lifts, conveyors, dock levellers or hoists installed in the shop?

  • Are all lifts, conveyors, dock levellers and hoists in good working order?

  • Are all lifts, conveyors, dock levellers and hoists free of obstruction and hazards?

  • Have all lifts, conveyors, dock levellers and hoists been serviced?

  • Last Service Date:

  • Are all dock levellers safe and access restricted during operation?

Water Reticulation

Plumbing

  • Is all reticulated plumbing in good working order and compliant with SANS code?

  • Is all Drainage clear and free of obstruction?

  • Are all water supplies functioning correctly?

  • Hazardous Substances

Hazardous Substances

  • LP Gas Storage

LP Gas Storage

  • Are all cylinders secured from tampering by unauthorized personnel?

  • Is area clear of all combustible materials?

  • Are all Cylinders located on a firm, clean, well drained and level base?

  • Is all safety signage installed?

  • LP Gas Signage.png
  • Are all change over valves and isolation valves functional?

  • Are regulators and manifolds in good working condition?

  • Is all copper piping in good order and protect through walls?

  • Is there a fire protection device installed?

  • Does the LPG installation comply with SANS 10087-1:2008?

  • Non-Compliance Issues:

  • Fuel Storage

Fuel Storage

  • Is the Fuel storage area secure from tampering and unauthorized personnel?

  • Is the area free of debris and other materials?

  • Is the ground clean and dry, free from spills or leaks?

  • Are all of the containers in good condition?(free of dents and corrosion, not bulging, or otherwise deteriorating?)

  • Are all containers properly sealed closed?

  • Are containers hazardous labels legible and facing forward?

  • Are the containers compatible with their contents?

  • Are there spill kits readily available?

  • Spill kit.png
  • Are there fire protection devices installed?

  • Is all safety signage installed warning of hazard, its effects and correct PPE required?

  • fuel.png

Building Exterior (Landlord)

  • Landlord Responsibility

Building Exterior

Plumbing

External Drainage

  • Are all manhole covers in place?

  • Are all drains and manholes visibly clear?

  • Are all run-offs and open drainage systems clear of obstruction and damage?

Perimeter Fences & Walls

  • Inspect condition of all perimeter fencing and walls?

  • List perimeter wall or fencing type:

  • Access Control

  • Are there booms or controlled access?

  • Condition of the booms/Controlled Access:

Building Infrastructure

Roofing & Gutters

  • Have all visible and accessible roofs/gutters been inspected?

  • Are there any signs of roof damage?

  • Are there any signs of gutter damage?

  • Are all down pipes intact and secure?

  • Are all overhangs and canopies in good order and free of damage and rust?

External Structures

  • Is the building structurally sound?

  • Is the building free of any concrete spalling or structural cracks?

  • Are the steel structures sound and free of rust or distortion?

  • Is the building free of any structural hazards?

  • Are there currently any construction or alterations in progress?

  • Car Park and Pavings

  • Car Park

Car Park

  • Is the car park in good order - Paving and tarred surfaces?

  • Are all the parking bays painted?

  • Are there sufficient parking bays for disabled persons?

  • Is the car park clean?

  • Has the car park got lighting, and are the lights in good order?

  • Rear Paving

Rear Paving Areas

  • Is the rear paving in good order - Paving and tarred surfaces?

  • Is the rear paving clean?

  • Has the rear paving area got lighting, and are the lights in good order?

Cleaning & Hygiene

  • Is the building perimeter clean and hygienic?

  • Public Ablutions

  • Are there public ablutions?

  • Are the public ablutions clean and secure?

  • Are the general areas/entrance to spar clean and hygienic?

  • Are there any cleaning and hygiene hazards visible?

Aesthetics & Appearance

  • Building Paint Work

  • Is the building paint work in good order?

  • Are the tiled/floor coverings in good order?

Operational Health and Safety

  • Retailer

Retailer

  • Are all fire escape routes clearly marked and free of obstruction?

  • IN44L_1024x1024.png
  • Exit.png
  • Is all fire protection equipment clearly marked and designated for ease of access?

  • Fire Demarcation.jpg
  • Is the fire escape plan visible to all employees and patrons and marked with assembly points?

  • Landlord

Landlord

  • Are all fire escape routes clearly marked and free of obstruction?

  • IN44L_1024x1024.png
  • Exit.png
  • Is all fire protection equipment clearly marked and designated for ease of access?

  • Fire Demarcation.jpg
  • Is the fire escape plan visible to all employees and patrons and marked with assembly points?

  • Are there any General Operational Health and Safety concerns?

  • OHS Concerns:

Signatures & Comments

Retailer Signature

  • Add signature

Inspector Signature

  • Add signature

Retailer Comments

  • undefined

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.