Information
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Document No.
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Department name
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File name - standard format 'audit_department_year_document status'
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Conducted on
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Prepared by
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Document status
DETAILS
AUDIT DETAILS
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Department audited
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Areas inspected during audit
areas
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Areas inspected
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Areas excluded during this audit
excluded
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Areas excluded
AUDIT SUMMARY
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Summary comments
AUDIT DATES
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Lead auditor
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Date audit started
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Additional visits made
visits
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Date of additional visit
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Reason for additional visit
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Date information gathering closed
SOURCES OF INFORMATION
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People consulted during the audit
people
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Person(s) consulted
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Documents consulted or examined during the audit
documents
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Documents consulted or examined during the audit
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Standards consulted or examined during this audit
standards
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Relevant standards consulted
CORE
CORE REQUIREMENTS
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Department health & safety arrangements available
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Department health & safety risk assessments available
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Department inspection records available
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Department action tracking information available
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Add notes & comments
NOTES
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Notes
WORKPLACE
HOUSEKEEPING
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Housekeeping included in inspection / audit
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Work areas kept clean and clear of clutter and waste
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Waste in work areas well managed
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Slip & trip hazards in work area well controlled
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Housekeeping standards acceptable
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Add notes & comments
NOTES
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Notes
WORKPLACE
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Workplace included in the inspection / audit
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Workplace has suitable storage facilities for the activities undertaken
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Workplace can be secured against unauthorised entry
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Workplace flooring is intact and the floor covering is suitable for the activities undertaken
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Workplace lighting levels are suitable for the activities undertaken
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Workspace has sufficient work space for the activities undertaken
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Workplace temperature is suitable for the activities undertaken
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Workplace noise level is suitable for the activities undertaken
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Workplace glazed areas are clearly marked when there is a risk people might walk into them
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Workplace contains suitable welfare facilities
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Suitable toilets
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Suitable hand washing facilities
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Source of potable water available
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Workplace well managed
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Add notes & comments
NOTES
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Notes
WORK ACTIVITIES
ELECTRICAL EQUIPMENT
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Electrical equipment included in the inspection / audit
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Equipment subject to an inspection and/or testing regime
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Frequency of inspection / testing is appropriate for the equipment & circumstances of use
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Electrical inspection and/or testing records are kept
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Suitable electrical equipment provided for the activities undertaken and the persons using them
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Electrical sockets loading satisfactory
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Electrical gang sockets used in an appropriate manner
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Electrical equipment well managed
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Add notes & comments
NOTES
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Notes
COMPUTER WORKSTATIONS
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Computer workstations included in the inspection audit
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Computer workstations provided to a suitable standrd
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Computer workstation risk assessments completed
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Assessment records kept
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Remedial action completed or being tracked
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Next round of assessments has been scheduled
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Process in place to ensure assessments for new staff between assessment rounds
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Computer workstation prioritised action list available
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Computer workstations well managed
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Add notes & comments
NOTES
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Notes
WORK AT HEIGHT EQUIPMENT
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Work at height considered in the inspection / audit
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Suitable kick stools provided to access items at mid heights
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Suitable ladders provide to access items at high level
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Work at height well controlled
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Add notes & comments
NOTES
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Notes
MANUAL HANDLING
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Manual handling considered in the inspection / aidit
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Manual handling areas kept clear or obstructions and trip hazards
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Trolleys or trucks available for heavier loads
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Heavy items stored in accessible locations at a suitable height
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Heavy loads are split into smaller loads
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Manual handling risks are well controlled
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Add notes & comments
NOTES
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Notes
EMERGENCIES
FIRE & EVACUATION
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Fire precautions and evacuation included in the audit / inspection
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Personal emergency evacuation plans
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Aware of procedures and formats for completing PEEPS
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Able to report on need for a PEEP and completed PEEPs in their area
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Fire prevention
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Ignition sources are well controlled
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Fuel sources are well controlled
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Provisions made for sounding the alarm and fighting fires
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Automatic fire detection installed
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Manual alarm activation call points installed
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Suitable provision has been made to fight fires
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Provision made to enable a successful evacuation
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Fire wardens appointed and operating
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Fire action notices on display
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Fire exit doors are kept closed OR are only held open with automatic devices linked to the fire alarm system
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Fire escape routes clear and unobstructed
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Fire escape routes clearly signed
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Final exits are clear and unobstructed
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Fire exit doors fitted with suitable mechanisms
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Fire risk is well managed
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Add notes & comments
NOTES
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Notes
FIRST AID
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First aid pro ion included in the inspection / audit
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First aiders identified
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First aid materials identified
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Checks of first aid materials clearly delegated
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Checks carried out and records kept
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System in place to replenish first aid materials
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First aid provisions advertised within Department
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First aid provisions well managed
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Add notes & comments
NOTES
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Notes
SIGNATURES
OTHER ISSUES
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Add notes & comments
NOTES
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Notes
SIGNATURES
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Signature of auditor
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Signature of auditee
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Other persons involved
person
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Signature of other persons involved
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Role in inspection / audit
