Information

  • Customer name

  • Contract #

  • Contract type

  • Conducted on

  • Prepared by

  • Location
  • Contact name and info

Job Access Information

  • Contact Person

  • Contact phone number and email if available

  • Specific parking <br>

  • Guard Shack

  • ID Badge required

  • Sign in and out

  • Specific Training

  • Elevator available to move equipment and materials?

  • Other Access Info

Sustainable Safety

  • Does Customer have a Hot Work Permit Process

  • Who is the contact to acquire permit

  • Does customer require additional training for Hot Work?

  • If Hot Work is being performed do you have Trane/IR Hot Work Permit?<br>

  • no label
  • Is roof access required ?

  • Access location

  • Roof access type

  • Will portable ladder able to be secured with anchor or strap to ensure safe access?

  • Ladder(s) in good condition

  • Roof hatch in good, safe working condition?

  • Is step ladder needed for job

  • How tall does step ladder need to be ?

  • Are there special emergency procedures

  • Are there specific training required ?

  • Adequate lighting in work area?

  • Are hazardous chemicals present in work area

  • Please list HAZ MAT

  • Are MSDS available

  • Will technician have to come in contact with HAZ MAT ?

  • Safe access to VAV Boxes

  • Will rooftop work need to be performed ?

  • Is fall protection needed and is equipment and anchor points available to be used effectively ?

  • Is there a power source available for equipment ?

  • Is there any asbestos identified in work area

  • Take photo of ACM

  • Is asbestos marked and contained ?

  • Does work involve PERMIT required confined space ?

  • Has all training and atmospheric tests been performed with all emergency/rescue procedures in place ?

  • Is fire extinguishers available in area if needed ?

  • Is LOTO Equipment needed and available

  • Is refrigerant monitor in place where refrigerant exposure may exist ?

  • Is working area(s) free from trip and slip hazards ?

  • Emergency procedures in place and trained

  • Additional concerns or information

  • Additional photos

  • Add more information or photos
  • Additional concerns or information

  • Additional photos

  • Any identifiable upgrades ? (UCP2, New Pumps, Etc.)

  • Are there BAS controls

  • Manufacturer controls

  • Who provides maintenance controls

  • Current water treatment provider

  • Can Trane help bring equipment up to code ?

  • Is cooling contingency on file ?

  • Hot water heating systems

  • Cooling water systems

  • Other equipment information and specifications

  • Signature of auditor

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.