Title Page

  • Audit Report Number: (year / office / staff initial / Number per year)

  • Survey Report Number:

  • Type of Survey audited:

  • Type of Build

  • Client

  • Location / site address
  • Conducted on

  • Auditor

  • Surveyor Name:

Survey Details / Requirements:

  • Are the details supplied by the office correct, accurate and sufficient for the surveyors needs (state):

  • Are there any limitations for the survey (state)

  • Since the last audit, has the surveyor had any concerns regarding impartiality?

  • If yes, please give details

1.0 Respiratory Protective Equipment:

  • 1.1 Does the surveyor have the mask that they have been face fit for?<br>(If the answer is no the audit must stop unless they are going to be using a hood)

  • 1.2 Is the surveyor clean shaven?

  • 1.3 What mask does the surveyor have:

  • Model:

  • Size:

  • Mask No (red tag)

  • State exp date marked on filter:

  • Add media

  • 1.4 Is the mask and storage box clean :

  • Notes:

  • 1.5 Is the RPE checked as outlined in the company procedures for checking RPE (Seals, valves, head straps, filter)

  • Notes:

2.0 Personal Protective Equipment:

  • 2.1 Does the surveyor have coveralls available:

  • Type:

  • Notes:

  • 2.2 Does the surveyor have cover shoes available:

  • Notes:

  • 2.3 Do they have the necessary equipment to conduct the survey safely?

  • Notes:

  • List all RPE worn by the surveyor

  • Add media

3.0 Surveyors Tools:

  • 3.1 Torch:

  • 3.2 Screwdrivers - flat and crosshead:

  • 3.3 Knife:

  • 3.4 Chisle:

  • 3.5 Bradawl:

  • 3.6 Fibre Suppressant:

  • 3.7 Sample Bags:

  • 3.8 Filler and Paint:

  • 3.9 Tape:

  • 3.10 Wet Wipes:

  • 3.11 Sample labels:

  • 3.12 Coloured Pens:

  • 3.13 FB Keys:

  • 3.14 Square Drive Key:

  • 3.15 Hammer:

  • 3.16 Crowbar:

  • 3,17 Digital camera: and or Tablet:

  • H- Type Vacuum

  • Drop Sheet

  • Other:

4.0 Access Equipment:

  • 4.1 Does the surveyor have ladders sutable for the survey:

  • 4.2 Are they company issue:

  • Ladder ID number(s)

  • Date of next inspection(s)

  • Notes:

  • 4.3 Are they still in a serviceable condition:

  • Add media

5.0 Risk Assessment:

  • 5.1 Has the surveyor completed the site Risk Assessment and is it truly representative of the site:

  • Was a Risk Assessment supplied by Management:

  • Was a Risk Assessment done on Teams:

  • If not was Risk Assessment done on other paperwork:

  • Notes:

6.0 Recording of Information:

  • 6.1 What does the surveyor use to record information and when do they complete it:

  • 6.2 Plans - Do they show all sample refs and N/A areas:

7.0 Witnessing of Survey by Auditor:

  • 7.1 Approach to survey: communication with occupants required, system, methodical, throughout:

  • 7.2 Level and Method of intrusion: are they required to take images of intrusive inspection points and do they:

  • 7.3 Sampling Activities: describe what they sample and how. Do they sample as they go or leave sampling to the end of the survey:

  • 7.4 Was the area vacated prior to sampling?

  • 7.5 Give an example (choose a sample taken) and describe how the sample area and sample was prepared, how it was taken and then stored and how the sample point was made good

  • Add media

8.0 Auditors Report: state conclusions any, NCW and / or Obs

  • Notes:

9.0 Signature Page

  • Signature of Auditor:

  • Select date

  • Signature of Auditee

  • Select 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.