Title Page
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UCB1- GPS PSO Report
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MSF/ 805 Belfast
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Conducted on
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Prepared by
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Other PSO on site
Interior
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Are there employees on site?
- YES
- NO
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Are they signed in?
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Are Office Doors Secure?
- YES
- NO
- SOME
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How many doors were insecure?
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Washrooms checked?
- YES
- NO
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Are the Electrical rooms secured?
- YES
- NO
- SOME
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What Electrical doors were left open?
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Are all the tool boxes secured?
- YES
- NO
- SOME
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Where were the tool boxed insecure?
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Are all the bay doors secured?
- YES
- NO
- SOME
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What bay doors were left open?
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Are there safety hazards?
- YES
- NO
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What are the Issues/ Who was notified.
Exterior
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Are all Gates Secure?
- YES
- NO
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What gates are open?
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Are there employees on site?
- YES
- NO
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Are they signed in?
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Are Exterior Doors secured?
- YES
- NO
- SOME
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What doors are insecure?
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Number of vehicles on site
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License Plates Recorded
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What equipment is on site, is it secure?
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What Equipment is insecure?
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Are Contractor Trailers secure?
- YES
- NO
- SOME
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What trailers are insecure?
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Are all C-Cans secure?
- YES
- NO
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How many C-Cans are insecure?
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Are there any Safety Hazards?
- YES
- NO
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Identify the Hazards/ who were they reported too?
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PSO Notes
End of Shift
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Location
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End of shift
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PSO Signature
