Title Page

  • Presbytery

  • Congregation

  • Site Photo

  • Location
  • Contact

  • Phone Number

  • Email Address

  • Conducted on

  • Date of Last Survey

  • Prepared by

  • Survey Number

Activity Summary

Congregation and Activity Summary

Worship

  • Are worship services held weekly?

  • Worship Services

  • Average weekly attendance

  • Worship Services

  • Average weekly attendance

Other Activities

  • Activities for Young People

  • Activities for Adults

Men's Shed

  • Name of Men's Shed

  • Does the Men's Shed belong to an association?

  • Do you have any form of insurance through your association?

  • Do all activities or tasks take place at the site?

  • Do you manufacture or repair items for sale or donation?

Member Safety

  • Are members identified by a name tag or badge?

  • Do you provide members with an induction and training before they commence in the shed?

  • Training records are kept for all members.

  • Training records have been viewed and considered appropriate.

  • Safety information and start up procedures evident on all machines.

  • Personal Protective Equipment available for members.

  • Incident reports forms and an incident register have been sighted.

  • First Aid Kit available.

  • First Aid officer appointed.

Plant and Machinery

  • Are all electrical items tested and tagged at least annually?

  • Are all items of plant and machinery serviced in accordance with manufacturer's instructions or in accordance with WHS requirements?

  • Maintenance records are being maintained.

  • Maintenance records have been viewed and considered appropriate.

  • Are risk assessments completed on equipment before being used in the shed.

  • Risk assessments have been viewed and considered appropriate.

Special Interest Groups

  • Nature of Special Interest Groups

Sporting Groups

  • Nature of Sporting Groups

  • Community and Special Events

Camps

  • Number of Family Camps

  • Number of Camps for Children or Youth

  • Number of Sleepovers in Church Buildings

Child Care Services

  • Is the centre located on the church property?

  • Op Shop Address
  • How many children is the centre licensed to accommodate?

Op Shop

  • Is the shop located on the church property?

  • Op Shop Address
  • Are electrical items sold?

  • Are items tested and tagged before being made available for sale?

  • Are items sold with safety information or user manuals?

  • Do you sell medical aids or child safety equipment?

Car Boot Sales

  • Do stallholders pay to participate in the sale?

  • Are safety instructions and site inductions provided to stallholders before the sale commences?

  • Do stallholders sign waivers or indemnity forms before participating in the sale?

  • Are stallholders required to have their own insurance cover?

  • Are certificates of currency obtained from the stallholders?

Sales, Fetes and Markets

  • Number of Sales

  • Do all sales take place on church grounds?

  • Location of Event
  • Are electrical items sold?

  • Are items tested and tagged before being made available for sale?

  • Are items sold with safety information or user manuals?

  • Do you sell medical aids or child safety equipment?

Other Activities

    Ministry
  • Ministry Name

  • Does the ministry take place on the church property?

  • Location of Event
  • How often does the ministry occur?

  • Has a risk assessment or risk management plan been completed?

Congregation Administration

Leadership

  • Church Council Chairperson

  • Church Council Secretary

  • Church Council Treasurer

  • ATO Contact

  • ACNC Contact

  • Is the data relating to leadership correct?

  • Which records need to be updated?

  • New Current Church Council Secretary

  • New Current Church Council Chairperson

  • New Current Church Council Treasurer

  • New ATO Contact

  • New ACNC Contact

  • This information will be shared with our Property Resources team who will contact you to ensure the appropriate information is obtained to adjust the Synod's Records. You can update your records using the Change of Key Persons form available on the Synod's website (https://ucaqld.com.au/wp-content/uploads/2017/01/Change-of-key-persons-form-2016-1.pdf).

ACNC - Responsible Persons

  • List of Responsible Persons

  • Are all members of the Church Council listed as Responsible Persons on the ACNC Register?

  • The Australian Charities and Not-for-profits Commission (ACNC) is the independent national regulator of charities. It is a requirement that each church committee continues to provide Synod Support Services with their current information so that the ACNC has accurate data and the committee avoids any penalties or fines. Here are a few things church communities need to do to ensure compliance with ACNC obligations.

    Check your details
    You are responsible for ensuring that the details on file with the ACNC are correct. You can check your details with the ACNC by searching for your charity on the ACNC website at acnc.gov.au/acnc/findcharity. Search using your charity name or charity ABN and review the details periodically.

    Inform the Synod office of changes
    You must inform the Queensland Synod office within 28 days if there is a change to your:

    • responsible persons: complete a Change of Key Person form available at ucaqld.com.au/acnc (note that all members of the church council are responsible persons for ACNC purposes)
    • legal name
    • financial year end date
    • address for service
    • charity’s contact person
    • charity’s email address

  • Are there persons to remove from the ACNC register?

  • Is there more than one person needing to removed?

  • Person to be removed:

  • This information will be supplied to the relevant persons within the Synod office. They will contact the Church Council Secretary to ensure the appropriate documentation to reflect these changes is obtained. In the meantime the change of key person form can be completed and returned to our office. This form can be found on the Synod's website (https://ucaqld.com.au/wp-content/uploads/2017/01/Change-of-key-persons-form-2016-1.pdf).

  • Responsible persons to remove from ACNC Register:

  • Responsible Person
  • Responsible Person

  • This information will be supplied to the relevant persons within the Synod office. They will contact the Church Council Secretary to ensure the appropriate documentation to reflect these changes is obtained. In the meantime the change of key person bulk form can be completed and returned to our office. This form can be found on the Synod's website (https://ucaqld.com.au/wp-content/uploads/2017/02/Change-of-key-person-bulk-form-2017.xlsx).

  • Are there persons to add to the ACNC register?

  • Is there more than one person needing to be added?

  • Responsible persons to add to the ACNC Register:

  • Responsible Person
  • Responsible Person

  • This information will be supplied to the relevant persons within the Synod office. They will contact the Church Council Secretary to ensure the appropriate documentation to reflect these changes is obtained. In the meantime the change of key person bulk form can be completed and returned to our office. This form can be found on the Synod's website (https://ucaqld.com.au/wp-content/uploads/2017/02/Change-of-key-person-bulk-form-2017.xlsx).

  • Person to be added:

  • This information will be supplied to the relevant persons within the Synod office. They will contact the Church Council Secretary to ensure the appropriate documentation to reflect these changes is obtained. In the meantime the change of key person form can be completed and returned to our office. This form can be found on the Synod's website (https://ucaqld.com.au/wp-content/uploads/2017/01/Change-of-key-persons-form-2016-1.pdf).

Income

  • What is the weekly income from tithes and offerings?

  • Do you allow giving by bank transfer or EFTPOS?

  • Are your premises leased to outside organisations or the general public?

  • What is your rental income?

  • What is your annual from other sources?

  • Total annual income?

Previous Survey Review

Requirements

  • As part of the previous survey some risk improvements were made that needed to be addressed to comply with either the requirements of legislation or meet the expectations of our insurers. Each of the risk improvements needing to be addressed is listed below.

  • Risk Improvement

  • Requirement
  • Summary of Risk Improvement

  • Suggested risk improvement completion date:

  • Has this risk improvement been addressed?

  • Date the risk improvement was addressed:

  • Has evidence of the risk improvement being addressed been sighted?

  • Has any work been done to address the risk improvement?

  • Details of work that has been done to date:

  • What work still needs to be done to complete this risk improvement?

  • When should the risk improvement be addressed?

  • Who is responsible for completion of the risk improvement?

  • Email Address:

  • Phone Number:

Documentation Review

Registers

  • Register of Workers / Blue Card Register

Register of Workers / Blue Card Register

  • Is the congregation using the Safe Ministry with Children template?

  • Is the register stored securely?

  • Number of people on the register.

  • Date register was last updated:

  • Number of people on the register.

  • Does the register include dates that records are updated?

  • Date register was last updated:

  • Does the register include a person's full name and date of birth?

  • Does the register details the worker's role with the congregation?

  • Does the register stipulate whether a blue card is required for the role?

  • If a blue card is not required for the role does the register explain why this is the case?

  • Does the register include the information on the Blue Card application process?

  • Does the register include Blue Card or Exemption Card details including expiry dates or exemption card validation dates?

  • Does the register include details of the appointment by church council?

  • Does the register include information regarding their exit from the role?

  • Does the register include information regarding screening and training of workers?

  • Does the register include details of those workers with first aid qualifications?

  • Does the register include details of approved drivers?

Register of Workers

  • Do you run any children's activities?

  • Has a resolution been passed the you will not conduct children's ministries?

  • The church council is responsible for the oversight of all activities with children within the congregation, and will oversee a local structure which is appropriate for the congregation size, taking into account availability of suitable leaders, local need and demographic.

    Congregations not conducting any activities specifically for or with children should formally minute the decision so that it can be articulated if required. A suggested minute could read:

    ”The church council resolves that the will not conduct ministry with children until further notice. Accordingly no church council member will be under statutory obligation to hold a blue card for the purpose of their office.”

  • A resolution must be minuted confirming no children's activities will be undertaken by the:

  • The church council is responsible for the oversight of all activities with children within the congregation, and will oversee a local structure which is appropriate for the congregation size, taking into account availability of suitable leaders, local need and demographic.

    The Register of workers must manage records in a manner which meets the requirements of legislation. The Safe Ministry with Children suite of tools includes a template to help congregations demonstrate that good practice and processes are followed, particularly as they relate to working with children checks.

    It is important that this register is kept up to date to enable congregations to comply with insurance and legislative requirements. These records must remain intact and be stored securely.

  • Are there any specific difficulties being encountered in creating the maintenance schedule?

  • Issues being encountered.

  • A register of workers must be compiled by the:

Key Register

  • Key Register

  • Are there any specific difficulties being encountered in creating a key register?

  • Issues being encountered.

  • A key register need to be created by the:

  • Do keyholders sign for their key?

  • Is the key register reviewed regularly?

  • How often is the register reviewed?

  • What was the date of the last review?

Preventative Maintenance Schedule

  • Preventative Maintenance Schedule

  • Section 203 of the Work Health and Safety Regulation 2011 requires a person with management or control of plant at a workplace to manage risks to health and safety.

    Plant is defined in Section 185 as an item that does not rely exclusively on manual power for its operation and is designed to be primarily supported by hand (e.g. a hammer or screwdriver). Items such as a ladder could be considered plant and should be subject to regular maintenance and inspections.

    This is stipulated in the following sections of the Regulation with Section 213 specifically addressing the maintenance of plant. It states:

    (1) The person with management or control of plant at a workplace must ensure that the maintenance, inspection and, if necessary, testing of the plant is carried out by a competent person.

    The maximum penalty for failing to comply with this section is 36 penalty units (~$4,000).

    (2) The maintenance, inspection and testing must be carried out—
    (a) in accordance with the manufacturer’s recommendations, if any; or
    (b) if there are no manufacturer’s recommendations, in accordance with the recommendations of a competent person; or
    (c) in relation to inspection, if it is not reasonably practicable to comply with paragraph (a) or (b), annually.

  • Are there any specific difficulties being encountered in creating the maintenance schedule?

  • Issues being encountered.

  • A preventative maintenance schedule needs to be compiled by the:

  • Items on the Maintenance Schedule

  • Item
  • Item

  • Who maintains this item?

  • Date last serviced.

Chemical Register

  • Chemical Register

  • Safety Data Sheets (SDS) are documents which outline specific health and safety information relating to a substance or chemical. This information includes:

    • Whether the substance is classified as hazardous
    • Chemical aspects of the substance
    • First aid advice
    • Risk controls to prevent injury

    To ensure all site personnel can readily access this information it is a requirement that a register is compiled for every chemical used on site – both industrial and domestic.

    Section 344 of the Work Health and Safety Regulations 2011 addresses a congregation’s obligations in relation to the obtaining of safety data sheets (SDS). In part (3) the regulations stipulate that the organisation must ensure a SDS is available to workers and emergency services workers. Section (4) then indicates an organisation doesn’t need to obtain if the item is a consumer product and used in quantities that are consistent with household use and (c) (ii) is used in a way that is consistent with household use. Even in the case of household quantities sections (5) and (6) both indicate that an organisation must still make information available to workers, emergency services and any person that asks for it. The easiest way to comply with your obligations under Section 344 of the regulations will be to obtain an SDS for each substance, chemical, cleaning product and fuel that may be stored on site.

    As a minimum the chemical register or SDS folder should be placed where the chemicals are stored and in a secondary location such as a reception area. This gives personnel easy access to information about the on-site chemicals used and, in the event of an emergency (i.e. fire), rescue crews can obtain vital information about on-site substances from various locations.

  • Are there any specific difficulties being encountered in creating a chemical register?

  • Issues being encountered.

  • A chemical register detailing all chemicals and fuels stored at the site and relevant safety information is required. Safety Data Sheets (SDS) need to be obtained for all chemicals and fuels stored at the site. The register or SDS folders need to be created and kept with the chemicals and in a secondary location by the:

  • Are Safety Data Sheets present for all cleaning products?

  • Are products on site stored in household capacities?

  • Safety Data Sheets (SDS) are documents which outline specific health and safety information relating to a substance or chemical. This information includes:

    • Whether the substance is classified as hazardous
    • Chemical aspects of the substance
    • First aid advice
    • Risk controls to prevent injury

    To ensure all site personnel can readily access this information it is a requirement that the SDS is obtained for chemicals used on site. This includes all industrial products and domestic products that are stored or kept in bulk.

  • Safety Data Sheets (SDS) must be obtained for all industrial and domestic products stored in bulk and included in your chemical register by the:

Incident Register

  • Incident Register

  • Is the congregation using the the Safe Ministry with Children Incident Register template?

  • Does your register include an incident number field?

  • Does your register include the date of incident or the date hazard was noted?

  • Does your register include information about the type of hazard/incident?

  • Does your register include information on who incident has been reported to (i.e. Presbytery, Synod, Workplace Health and Safety Queensland etc.)?

  • Does your register include space for a summary of incident or hazard investigation?

  • Does your register include space for incident investigation recommendations to be detailed?

  • Does your register allow for confirmation that recommendations have been met to be added?

  • What is the date of the most recent incident?

  • What is the date of the most recent incident?

  • An Incident Register is a document used to record a brief summary of all accidents and incidents that have occurred over a period of time. The information is used to plan strategies for managing risks faced by the workers and visitors to your site.

    For example, it is very valuable to be able to trace back the history of incident and accident occurrences to realise that an accident resulting in a broken window that has just been reported is the 4th similar occurrence in 6 to 12 months, or even 2 years.

    The Accident and Incident Register should provide an overview of the following:

     Date and time of the incident or accident,
     The workers name, age and address,
     What task was the worker doing at the time of the incident or accident,
     Nature and date of the accident or incident,
     Cause of the accident or incident?
     Was this a notifiable occurrence?-
     Name of person filling out the report.

    The register can be placed at the front of the incident report folder and used for quick and easy reference.

  • Are there any specific difficulties being encountered in creating an incident register?

  • Issues being encountered.

  • An incident register needs to be developed by the:

Hazard/Risk Register

  • Hazard/Risk Register

  • All congregations face risks that can affect the achievement of their their mission. The risks can be wide and varied, they include funding and income risks, loss of key workers, regulatory change, inappropriate behaviour, health and safety issues and loss of assets.

    The protection of the congregation and the wider Church’s reputation and the ability to recognise and respond to opportunities is fundamental to the success of any congregation. So too is the ability to provide a safe and secure workplace and protect the property, assets and people of the congregation and the community.

    If a congregation understands the risks they face, how they are caused and their likely impact it is possible to make changes that will help them achieve all of these goals. A risk register is critical in this process.

Procedures

Hire Agreements and Procedures

  • Hire Agreements and Hiring Procedures

  • Are there any specific difficulties being encountered in completing hire agreements?

  • Issues being encountered.

  • Hire agreements need to be completed for all hirers by the:

  • Are all hire agreements Uniting Church approved agreements?

  • Is evidence of insurance cover attached to each agreement?

  • Are all hire agreements counter-signed by The Uniting Church in Australia Property Trust (Q)?

Cash Handling Procedures

  • Cash Handling Procedures

  • Are there any specific difficulties being encountered in drafting the cash handling procedures?

  • Issues being encountered.

  • Documented cash handling procedures need to be in place by the:

  • When were the cash handling procedures last reviewed?

  • Do the procedures include information around handling the offering?

  • Does the procedure include information around storage of the offering?

  • Do the procedures include information around transporting cash to the bank?

  • Do the procedures include information around cash handling for special events?

  • Do the procedures cover payment of accounts?

  • Do the procedures cover cash reimbursements?

  • Do the procedures also cover other activities and areas where money may be collected (i.e. op shop, participation fees, drink sales etc.)

  • Are financial accounts audited annually?

Work Health and Safety

Risk Assessments or Risk Management Plans

  • Risk Assessments or Risk Management Plans for children's activities and other events

  • Is the congregation using the planning safe programs tool from Safe Ministry with Children?

  • Have all plans been reviewed and approved by Church Council?

  • Have all children's ministries been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all off-site activities been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all adult ministries been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all worship services been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all special events (including meals and catering services) been assessed?

  • List of ministries or activities still to be risk assessed:

  • Does the risk assessment template being used include a breakdown of activities?

  • Does the template include possible hazards or things that could go wrong?

  • Does the template include a risk rating?

  • Does the template include loss control measures to be taken?

  • Does the template detail who is responsible for ensuring control measures are implemented?

  • Have all children's ministries been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all off-site activities been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all adult ministries been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all worship services been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all special events (including meals and catering services) been assessed?

  • List of ministries or activities still to be risk assessed:

  • Have all plans been reviewed and approved by Church Council?

  • Risk assessments are very important as they form an integral part of a good occupational health and safety management plan. They help to:

    •Create awareness of hazards and risks.
    •Identify who may be at risk (workers, members, visitors, contractors, the public, etc).
    •Determine if existing control measures are adequate or if more should be done.
    •Prevent injuries or illnesses when done at the design or planning stage.
    •Prioritize hazards and control measures.

    The aim of the risk assessment process is to remove a hazard or reduce the level of its risk by adding precautions or control measures, as necessary. By doing so, you have created a safer and healthier workplace.

    A tool to assist in planning safe programs is available within the Safe Ministry with Children section of the Synod's website.

  • Are there any specific difficulties being encountered in completing the checklist?

  • Issues being encountered.

  • Risk assessments must be conducted of all congregational activities, commencing with children's activities and activities that take place away from the premises, by the:

Worker Training Records

  • Worker Training Records

  • Do workers sign in and sign out when they attend to perform voluntary work for the church?

  • Does the record include site induction?

  • Does the record include job specific training (i.e. working with children, how to use the garden equipment, etc.)?

  • Does the record include fire training?

  • Does the training include work health and safety information (use of Personal Protective Equipment, manual handling, etc.)

  • Without your workers your mission cannot be achieved. They need to be your number one priority and they deserve to be looked after.

    When it comes to protecting people some of the risks that are often overlooked include;

    • Providing a safe and suitable environment for your people to work,
    • Ensuring appropriate processes to keep workers safe are in place and communicated to workers,
    • Providing adequate training and resources for people to confidently complete their tasks, and
    • Providing adequate supervision of tasks.

    It is important that training records are maintained for workers.

  • Worker training records need to be created by the:

Fire and Evacuation Plan

  • Fire and Evacuation Plan

  • What type of fire and evacuation plan should be in place?

  • As the owner or occupier of a building in Queensland, you have a legal obligation to ensure the safety of any person in that building in the event of a fire or hazardous material emergency. A fire and evacuation plan is designed to assist you in managing your compliance with the Fire and Emergency Services Act 1990 and the Building Fire Safety Regulation 2008.

    A Fire and Evacuation Plan for a low occupancy building will need to contain the following items that are necessary to comply with the requirements of the Building Fire Safety Regulations 2008:

    * Building Information (including name, address and contact details)
    * Person responsible for administering the Plan
    * Person responsible for giving General Evacuation & First Response Instruction
    * Fire Safety Adviser name and contact details
    * Fire and Evacuation Plan Annual Review date
    * Evacuation Coordination Procedures
    * Emergency Evacuation Procedures
    * Method of operation of firefighting equipment and fire alarms
    * Procedures for giving fire and evacuation instructions
    * Relevant Building Approvals
    * Fire Safety Management Procedure - Alternative Solutions
    * Evacuation Sign and Diagram

  • A fire and evacuation plan for a high occupancy building needs to be developed by the:

  • As the owner or occupier of a building in Queensland, you have a legal obligation to ensure the safety of any person in that building in the event of a fire or hazardous material emergency. A fire and evacuation plan is designed to assist you in managing your compliance with the Fire and Emergency Services Act 1990 and the Building Fire Safety Regulation 2008.

    A Fire and Evacuation Plan for a low occupancy building will need to contain the following items that are necessary to comply with the requirements of the Building Fire Safety Regulations 2008:

    * Building Information (including name, address and contact details)
    * Person responsible for administering the Plan
    * Person responsible for giving General Evacuation & First Response Instruction
    * Fire and Evacuation Plan Annual Review date
    * Evacuation Coordination Procedures
    * Emergency Evacuation Procedures
    * Method of operation of firefighting equipment and fire alarms
    * Procedures for giving fire and evacuation instructions
    * Relevant Building Approvals
    * Fire Safety Management Procedure - Alternative Solutions
    * Evacuation Sign and Diagram

  • A fire and evacuation plan for a low occupancy building needs to be developed by the:

  • What type of Fire and Evacuation Plan is in place?

  • To comply with the requirements of the Building Fire Safety Regulation 2008 your fire and evacuation plan will need to include the following items:

  • Building information (including name, address and contact details)

  • Person responsible for administering the plan

  • Person responsible for giving General Evacuation and First Response instruction

  • Fire and Evacuation Plan annual review date

  • Has the plan been reviewed in the last 12 months?

  • What is the date of the last review?

  • Evacuation coordination procedures

  • Emergency evacuation procedures

  • Method of operation of firefighting equipment and fire alarms

  • Procedures for giving general evacuation and first response instructions

  • Relevant building approvals

  • To comply with the requirements of the Building Fire Safety Regulation 2008 the relevant building approvals include:

  • Fire Safety Installation Checklist

  • Certificate of Classification (possibly called a certificate of approval)

  • Has a request been made to your local council for a copy of the certificate to be supplied?

  • Is a copy of the request included in the fire and evacuation plan?

  • Evacuation sign and diagram

  • Are records being kept with the fire and evacuation plan of training that has been given to workers in general evacuation, first response and in evacuation coordination?

  • Date training was last undertaken:

  • Are records of evacuation practices (fire drills) being maintained?

  • Date of last evacuation practice:

  • Are maintenance records for fire equipment readily available?

  • Is the annual occupier's statement being completed?

  • Date statement was last completed:

  • To comply with the requirements of the Building Fire Safety Regulation 2008 your fire and evacuation plan will need to include the following items:

  • Building information (including name, address and contact details)

  • Person responsible for administering the plan

  • Person responsible for giving General Evacuation and First Response instruction

  • Fire Safety Adviser appointed?

  • Name of Fire Safety Adviser:

  • Phone Number:

  • Email:

  • Qualification:

  • Training organisation that issued qualification:

  • Date qualification issued:

  • Fire and Evacuation Plan annual review date

  • Has the plan been reviewed in the last 12 months?

  • What is the date of the last review?

  • Evacuation coordination procedures

  • Emergency evacuation procedures

  • Method of operation of firefighting equipment and fire alarms

  • Procedures for giving general evacuation and first response instructions

  • Relevant building approvals

  • To comply with the requirements of the Building Fire Safety Regulation 2008 the relevant building approvals include:

  • Fire Safety Installation Checklist

  • Certificate of Classification (possibly called a certificate of approval)

  • Has a request been made to your local council for a copy of the certificate to be supplied?

  • Is a copy of the request included in the fire and evacuation plan?

  • Evacuation sign and diagram

  • Are records being kept with the fire and evacuation plan of training that has been given to workers in general evacuation, first response and in evacuation coordination?

  • Date training was last undertaken:

  • Are records of evacuation practices (fire drills) being maintained?

  • Date of last evacuation practice:

  • Are maintenance records for fire equipment readily available?

  • Is the annual occupier's statement being completed?

  • Date statement was last completed:

Annual Property Maintenance Checklists

  • Annual Property Maintenance Checklists

  • Are there any specific difficulties being encountered in completing the checklist?

  • Issues being encountered.

  • The annual property maintenance checklist needs to be completed by the:

  • Date last completed.

Additional Risk Improvements

  • Were any additional risk improvements suggested during the site visit?

Requirements

  • The following requirements must be carried out within the agreed timescales. Failure to do so may result in your insurance cover being prejudiced or possibly fines being imposed for failing to comply with your legislative requirements.

    It is important to advise us when these requirements have been completed.

  • Requirement
  • Nature of Requirement

  • Description of issue and suggested solution:

  • Photos of issue

  • This issue needs to be addressed by the:

Recommendations

  • The following recommendations should be carried out as part of a well-managed program of risk reduction and/or prevention. We encourage implementation of these improvements however non-compliance will not prejudice your current insurance cover.

  • Recommendation
  • Nature of Recommendation

  • Description of issue and suggested solution:

  • Photos of issue

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.