Van Safety

• Engineers Name

• Vehicle Registration Number

• Prepared for

• Location
  Address

• Test Date

  Date

• Next test date

  Date

• Prepared by

Vehicle Condition

• Tyre and wheel condition

  Pass

  Fail

  n/a

• Is the spare wheel stored in the back of the van

  Pass

  Fail

  n/a

• Is the spare wheel stored/secured properly

  Pass

  Fail

  n/a

• Vehicle lights functioning correctly

  Pass

  Fail

  n/a

• Hazard lights functioning correctly

  Pass

  Fail

  n/a

• Vehicle horn functioning correctly

  Pass

  Fail

  n/a

• Windscreen wipers functioning correctly

  Pass

  Fail

  n/a

Gas cylinders

• Gas cylinders must not exceed the following quantities: 1×R404a or other (max 13kg), 1×R134a or other (max 13kg), 1×small recovery cylinder, 1×Nitrogen bottle or oxy-acetalene porta pack (if not carrying porta pack, a small brazing set and hand held brazing torch in addition to the Nitrogen), 1 disposable flammable refrigerant (500grams)

• Please provide cylinder serial numbers

  Yes

  No

  N/A

• Please provide the serial numbers of each cylinder

• Is the quantity of refrigerant gas being carried acceptable

  Pass

  Fail

  n/a

• Are all refrigerant gas cylinders strapped to the bulk head of the van

  Pass

  Fail

  n/a

• Is the engineer carrying an excess quantity of Nitrogen on the van

  Pass

  Fail

  n/a

• Is all brazing equipment stored upright and securely strapped

  Pass

  Fail

  n/a

Environmental hazards

• Is all hazardous waste stored correctly

  Pass

  Fail

  n/a

• Has all inventory been filled out correctly

  Pass

  Fail

  n/a

Documentation and other

• Does the engineer know what the HSQE Policy is and able to show you where to find it

  Pass

  Fail

  n/a

• Does the engineer have all his RAMS

  Yes

  No

  N/A

• Does the engineer have barriers

  Yes

  No

  N/A

• Does the enginner have the correct ladders

  Yes

  No

  N/A

• Does the engineer carry a lock off kit

  Yes

  No

  N/A

• Are the engineers hand tools fit for purpose

  Yes

  No

  N/A

• Does the engineer have all his required PPE

  Yes

  No

  N/A

Results & further comments

• Has the engineer any HSQE concerns to raise with the auditor

  Yes

  No

  N/A

• Overall result of audit following actions completed

  Pass

  Fail

  n/a

• Auditors signature

  Sign

• Engineers signature

  Sign