Title Page

  • Audit Report Number: (Year / Office / Surveyor / Number per year)

  • Survey Report Number:

  • Type of Survey audited:

  • Purpose of Audit

  • Type of Building

  • 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?

  • If yes, please give details

  • 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>

  • Can they still undertake the survey safely

  • 1.2 Is the surveyor clean shaven?

  • Is the face collapse test still effective?

  • Escalate to line manager

  • 1.3 What mask does the surveyor have?

  • Other - Please State

  • 1.4 Mask Details - Mask No (red tag or other unique identifier) TAKE PHOTO OF UNIQUE ID

  • 1.5 State exp date marked on filter (manufacturers exp date):

  • 1.5.1 Is an expiry date marked on filter (company exp date):

  • what is the date?

  • Add media

  • 1.6 Is the mask and storage box clean :

  • Notes:

  • 1.7 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:

  • can they prevent cross contamination to their person?

  • Type:

  • 2.3 Does the surveyor have a hard hat?

  • 2.4 Is the surveyor wearing suitable safety footwear? (Steel toe capped boots for example)

  • 2.5 Is the surveyor wearing their lone working device?

  • List all of the PPE worn by the surveyor during the survey, ideally when taking a sample. (Other items to consider include gloves, ear defenders, Hi-visibility clothing etc).

3.0 Surveyors Tools:

  • 3.1 Torch:

  • 3.2 Screwdrivers - flat and crosshead:

  • 3.3 Knife:

  • 3.4 Chisel:

  • 3.5 Bradawl:

  • 3.6 Fibre Suppressant:

  • 3.7 Suitable sample Bags:

  • 3.8 Filler and Paint:

  • 3.9 Tape:

  • 3.10 Wet Wipes:

  • 3.11 Sample labels:

  • 3.13 FB Keys:

  • 3.14 Square Drive Key:

  • 3.15 Hammer:

  • 3.16 Crowbar:

  • 3.17 Tablet with TEAMS access?

  • Can they locate procedural and guidance documents through TEAMS?

  • how do they record their survey and is is suitable?

  • 3.18 H- Type Vacuum

  • 3.19 Drop Sheet

  • 3.20 Pliers (not serrated)

  • 3.21 Warning signage

  • 3.22 Core sampling kit (describe)

  • 3.23 Spares?

  • 3.24 Is the tool box clean?

  • 3.25 Other:

  • 3.26 Are the tools available suitable for the task?

4.0 Access Equipment:

  • 4.1 Does the surveyor have ladders suitable 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:

  • is this because the surveyor does their own dynamic assessment?

  • is this enough?

  • 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? ie TEAMS ( tablet), paper, digital camera/phone, other?

  • 6.2 Plans - Do they show all sample refs?

  • 6.3 Plans- do they show inspection item references as generated by TEAMS?

  • 6.4 Plans - if none provided, are they drawn as an accurate reflection of the area subject to the survey?

  • Can plans be obtained during the survey/site work?

  • 6.5 Plans - if provided does the surveyor check accuracy?

  • 6.6 Plans - do they show all N/A areas?

  • 6.7 MAS - are the scores accurate?

  • 6.8 PAS - are the scores accurate?

7.0 Witnessing of Survey by Auditor:

  • 7.1 Approach to survey: communication with occupants required, systematic, 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

  • 7.6 Do they demonstrate that they can locate the presence and accurately record the extent of ACM, and to assess their condition (MAS) as applicable, in relation to occupant activities ie management survey techniques).

  • describe/record an example

  • 7.7 Do they demonstrate that they can locate the presence and accurately record the extent of ACM, and to assess their condition (MAS) as applicable in relation to the planned project ie refurbishment survey techniques.

  • describe/record an example

  • 7.8 Do they demonstrate that they can locate the presence and accurately record the extent of any ACM, and also to assess their condition (MAS) if needed/applicable, in relation to the planned demolition project.

  • describe/record and example

8.0 Auditors Report: Conclusion, Recommendations for Authorisation etc.

  • Purpose of audit

  • Your conclusion - competency demonstrated?

  • If No, state why

  • More details? (optional)

  • Premises types to be considered by for authorisation? Select multiple if applicable.

  • Survey types to be considered for authorisation? Select multiple if applicable.

  • Other comments

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.