WHS Store Assessment

• WH&S Assessment

• WH&S Assessment number:

• Store Name:

• Location:
  Address

• Conducted on

  Date

• Completed by:

• Store Representative:

1.0 - Work Health & Safety Policy

• The Store should have a Workplace Health & Safety (WHS) Policy indicating their commitment to the health and safety of their employees.

• 1.1 - Does the company have a WH&S Policy?

  Yes

  No

  N/A

• 1.2 - Is the senior person (PCBU) responsible for WH&S matters identified, and is this through their employment contract, their position description or the WHS Policy?

  Yes

  No

  N/A

• 1.3 - Was the WH&S policy developed in consultation with employees?

  Yes

  No

  N/A

• 1.4 - Do all employees know about the policy?

  Yes

  No

  N/A

• 1.5 - Is the policy written in language suitable for all employees ? (e.g. other languages, plain English).

  Yes

  No

  N/A

• 1.6 - Is it displayed in a prominent position in the workplace? (eg noticeboard)

  Yes

  No

  N/A

• Comments:

2.0 - Work Health & Safety Consultation

• What method of consultation is used in the workplace?

• 2.1 - is there a formal WH&S consultation process in the workplace?

  Yes

  No

  N/A

• 2.2 - Is there regular consultation?

  Yes

  No

  N/A

• 2.3 - Has the consultation process been established in accordance with the WH&S Act 2011?

  Yes

  No

  N/A

• 2.4 - Has adequate training been provided?

  Yes

  No

  N/A

• 2.5 - Does the Health & Safety Representative (HSR) or WH&S committee participate in the development of policies and procedures that affect the health and safety of employees?

  Yes

  No

  N/A

• Comments:

3.0 - Specific Health & Safety Policies and Procedures

• 3.1 - Are there written policies and procedures addressing specific health and safety issues? (eg manual handling, hearing conservation or return to work?)

  Yes

  No

  N/A

• 3.2 - Are WH&S responsibilities included in the job descriptions of all employees?

  Yes

  No

  N/A

• 3.3 - Are regular workplace inspections conducted to identify hazards? Regular workplace inspections of both the workplace and work practices should be conducted.

  Yes

  No

  N/A

• 3.4 - Are regular reviews of work practices being conducted?

  Yes

  No

  N/A

• 3.5 - Are WH&S policies and procedures reviewed and updated where necessary? (eg when materials, methods, equipment and/or processes change)

  Yes

  No

  N/A

• 3.6 - Do the policies and procedures identify when reviews will be undertaken?

  Yes

  No

  N/A

• Comment:

4.0 - Risk Management

• 4.1 - Is a risk management system in place?

  Yes

  No

  N/A

• 4.2 - Does the Risk management system rank hazards into High-Medium-Low risk categories?

  Yes

  No

  N/A

• 4.3 - Is there a hierarchy of controls - Eliminate.... to .....Personal protective equipment ?

  Yes

  No

  N/A

• 4.4 - Are all tasks/jobs risk ranked?

  Yes

  No

  N/A

• 4.5 - Are controls in place and working for all high risk tasks?

  Yes

  No

  N/A

• 4.6 - Are all the employees trained in the use of Risk Assessment techniques/tools?

  Yes

  No

  N/A

• 4.7 - Are the risk assessment results recorded?

  Yes

  No

  N/A

• 4.8 - Are the Risk Assessment results used to produce Safe Work guides / procedures?

  Yes

  No

  N/A

• 4.9 - Are there Safe Work Procedures in place and are they reviewed regularly? (12 months minimum)

  Yes

  No

  N/A

• Comments:

5.0 - First Aid Facilities and Procedures

• 5.1 - Are first aid facilities in accordance with the Safe Work Australia Code of Practice "First Aid in the workplace"?

  Yes

  No

  N/A

• 5.2 - Is there a First Aid kit?

  Yes

  No

  N/A

• 5.3 - Are First Aid kits checked regularly (should be checked at least once a month or after use)

  Yes

  No

  N/A

• 5.4 - Are there designated staff responsible for providing first aid?

  Yes

  No

  N/A

• 5.4.1 - Are they trained First Aid officers, and do they hold a current First Aid certificate from an approved provider?

  Yes

  No

  N/A

• 5.5 - Are all employees aware of, and informed who the first aid offers are, and their location? (noticeboard, uniform)

  Yes

  No

  N/A

• Comment:

6.0 - Induction Procedures

• As part of a comprehensive induction package all employees should be given an induction package that should include information about company policy and procedures and employee duties and responsibilities.

• 6.1 - Is there a structured induction procedure for all new employees?

  Yes

  No

  N/A

• 6.2 - Are all new employees informed about;<br>Work Health & Safety procedures & policies, procedure for reporting an injury or near miss, legislative rights and responsibilities, representative on WH&S matters (if applicable), workplace hazards, safe use of tools, plant, equipment and substances they will encounter, the use of PPE equipment were appropriate, first aid facilities and procedures, emergency procedures?

  Yes

  No

  N/A

• 6.3 - Is the induction suitable for employees from non-English speaking backgrounds?

  Yes

  No

  N/A

• 6.4 - Does an appropriate person conduct the induction training?

  Yes

  No

  N/A

• Comment:

7.0 - Workplace Training

• 7.1 - Are training programs conducted on a regular basis for Managers, supervisors, employees, health & safety representatives and/or committee members?

  Yes

  No

  N/A

• 7.2 - Do qualified personnel conduct workplace training?

  Yes

  No

  N/A

• 7.3 - Are the training programs delivered in a way suitable for all employees (eg literacy levels, language?)

  Yes

  No

  N/A

• 7.4 - Are the training programs developed in response to the needs of the employees?

  Yes

  No

  N/A

• 7.5 - Are records kept on the training provided?

  Yes

  No

  N/A

• Comments:

8.0 - Accident and Near Miss Investigation

• All injuries and near misses should be investigated to determine the cause. This will assist in the development of measures to prevent future incidents. A person should be nominated to investigate all injuries and near misses. The person should be trained in accident investigation.

• 8.1 - Does your organisation investigate all injuries, all near misses and other incidents? (eg property damage, abusive customers) ?

  Yes

  No

  N/A

• 8.2 - Is there an appropriately trained person/team nominated to investigate injuries and near misses?

  Yes

  No

  N/A

• 8.3 - Is there a standard written procedure for investigating all injuries and near misses?

  Yes

  No

  N/A

• 8.4 - Is the injury/near miss investigated immediately after it has occurred?

  Yes

  No

  N/A

• 8.5 - Is a standard report form used for investigating injuries and near misses?

  Yes

  No

  N/A

• 8.6 - Does the report include; general information, description of how the incident happened, detail of the events leading up to the incident, details of damage to plant and equipment, findings from the investigation, recommended corrective action, who is responsible for actions, followup monitoring and evaluation, general comments?

  Yes

  No

  N/A

• 8.7 - Are the findings discussed at staff meetings and/or WH&S committee or with the Health & Safety Representative?

  Yes

  No

  N/A

• 8.8 - Do the reports go to senior management for review?

  Yes

  No

  N/A

• 8.9 - Are the findings used to prevent further injuries or near misses, develop health & safety procedures, develop training programs for employees?

  Yes

  No

  N/A

• 8.10 - Is implementation of recommendations monitored?

  Yes

  No

  N/A

• Comments:

9.0 - Injury recording and reporting systems

• 9.1 - Do you have a 'Register of Injuries' ?

  Yes

  No

  N/A

• 9.2 - Is this readily accessible?

  Yes

  No

  N/A

• 9.3 - Is someone responsible for recording injuries in the register?

  Yes

  No

  N/A

• 9.4 - In the event of an injury is the following information recorded in a 'register of injuries'; name, address, age, gender, occupation of the injured person, date, time, type of injury (eg cut/sprain), body part injured (eg hand/foot), how the injury occurred, the activity at the time, use of safety processes or equipment at the time, lost time resulting from the injury, any treatment?

  Yes

  No

  N/A

• 9.5 - Are the following notified in the event of an injury - The First Aid officer? management? local Workcover/Worksafe authority (if required)?

  Yes

  No

  N/A

• 9.6 - In the occurrence of a near miss ("hazard") is the following information recorded - date, time, how, the activity being conducted at the time of the near miss, location, what the near miss was? (eg can toppled from top of another one and hit floor next to foot)

  Yes

  No

  N/A

• Comments:

10.0 - Noise Control

• A workplace is unsafe and is a risk to health if any person is exposed to noise levels that: exceed an 8 hour equivalent of 85dB(A) or that peak at more than 140dB(lin) - Code of Practice - 'Managing Noise and Preventing Hearing loss at work'

• 10.1 - Have you had a noise survey conducted?

  Yes

  No

  N/A

• 10.2 - Do you understand the Code of Practice Managing & preventing hearing loss at work?

  Yes

  No

  N/A

• 10.3 - Do you have a noise management program?

  Yes

  No

  N/A

• 10.4 - Do you consult with employees in the development of measures to reduce the level of noise?

  Yes

  No

  N/A

• 10.5 - Are all employees informed of the effect of excessive noise exposure?

  Yes

  No

  N/A

• 10.6 - Is appropriate Personal protective equipment supplied for all employees?

  Yes

  No

  N/A

• Comments:

11.0 Manual Handling

• 11.1 - is the company aware of the Hazardous Manual Tasks Code of Practice?

  Yes

  No

  N/A

• 11.2 - Has the Manual Handling Model been implemented?

  Yes

  No

  N/A

• 11.3 - Are all work tasks assessed in accordance with the model Code of Practice?

  Yes

  No

  N/A

• 11.4 - Is training in Manual Handling included at induction for all employees?

  Yes

  No

  N/A

• 11.5 - Does training in Manual Handling for all employees, supervisors and managers include: risk identification and assessment, control of risks, legislative requirements, safe manual handling techniques, safe use of mechanical aids?

  Yes

  No

  N/A

• 11.6 - Are training programs specific to the tasks that the employes perform?

  Yes

  No

  N/A

12.0 - Hazardous Chemicals

• 
  The Code of Practice to manage risks associated with hazardous chemicals is an approved code under Section 274 of the WH&S Act 2011

• 12.1 - Has an audit of Hazardous Chemicals in the workplace been conducted?

  Yes

  No

  N/A

• 12.2 - Does the workplace have a hazardous chemicals register listing the chemicals used, produced or sold in the workplace?

  Yes

  No

  N/A

• 12.3 - Have Safety Data Sheets been obtained for all Hazardous Chemicals?

  Yes

  No

  N/A

• 12.4 - Are the current Safety Data Sheets readily accessible to the workers?

  Yes

  No

  N/A

• 12.5 - Has a qualified person carried out a risk assessment of Hazardous Chemicals?

  Yes

  No

  N/A

• 12.6 - Are all Hazardous Chemicals in the workplace stored in accordance with the information provided on the Safety Data Sheet and compatibility directions?

  Yes

  No

  N/A

• 12.7 - Are measures in place to control workplace Hazardous chemicals?

  Yes

  No

  N/A

• 12.8 - Is regular monitoring of Hazardous Chemicals conducted?

  Yes

  No

  N/A

• 12.9 - Is the Personal Protective Equipment provided adequate and suitable, readily available and property maintained?

  Yes

  No

  N/A

• 12.10 - Is training and education about Hazardous chemicals provided for all employees?

  Yes

  No

  N/A

• 12.11 - Are emergency procedures in place?

  Yes

  No

  N/A

• 12.12 - Is placarding present on all entrances (including HAZCHEM on entrances) if applicable?

  Yes

  No

  N/A

• 12.13 - Is equipment appropriate for the Hazardous Chemicals (spark retarded forklift etc)

  Yes

  No

  N/A

• 12.14 - Are spill kits on site?

  Yes

  No

  N/A

• 12.14.1 - Are they appropriate to the products?

  Yes

  No

  N/A

• 12.14.2 - Are personnel trained to use spill kits?

  Yes

  No

  N/A

• 12.14.3 - Is there a record of this training?

  Yes

  No

  N/A

• 12.14.4 - Are the spill kits in an appropriate location?

  Yes

  No

  N/A

• 12.15 - Is drainage present?

  Yes

  No

  N/A

• 12.16 - Is bunding present and appropriate if required?

  Yes

  No

  N/A

• 12.17 - Is a smoking policy included in the dangerous goods procedure?

  Yes

  No

  N/A

• 12.18 - Is ventilation required?

  Yes

  No

  N/A

• 12.18.1 - Is the ventilation appropriate to the dangerous goods stored?

  Yes

  No

  N/A

• 12.19 - Is there a manifest and plan locating dangerous goods available and accessible to emergency services?

  Yes

  No

  N/A

• 12.20 - Are environment protection guides and segregation charts available?

  Yes

  No

  N/A

• 12.21<br> - Are copies of shipping documents kept?

  Yes

  No

  N/A

• 12.34 - Is the company licensed or registered with the council or local government for the storage of hazardous chemicals?

  Yes

  No

  N/A

• Comments:

13.0 - Mechanical Equipment

• 13.1 - Do all machines have safe operating instructions?

  Yes

  No

  N/A

• 13.2 - Has equipment been assessed for hazards?

  Yes

  No

  N/A

• 13.3 - Are dangerous moving parts on machines guarded? There are four main types of guard: fixed (preferable), interlock, photoelectric, combination.

  Yes

  No

  N/A

• 13.4 - Do machine guards prevent access to all dangerous areas that are within reach of an operator or a passer-by?

  Yes

  No

  N/A

• 13.5 - Is regular maintenance conducted on equipment?

  Yes

  No

  N/A

• 13.6 - Are there safe work procedures for maintenance workers?

  Yes

  No

  N/A

• 13.7 - Before purchasing new machinery, plant or equipment, does management consult with WH&S representative, the workers or the WH&S Committee, machine and equipment operators and maintenance staff?

  Yes

  No

  N/A

• 13.8 - Is training provided for all workers that operate mechanical equipment?

  Yes

  No

  N/A

• 13.9 - Is there adequate supervision of new or inexperienced workers?

  Yes

  No

  N/A

• 13.10 - Are regular workplace inspections conducted on plant and equipment?

  Yes

  No

  N/A

• 13.11 - Has a checklist been developed for inspection of all mechanical equipment?

  Yes

  No

  N/A

• 13.12 - Are the emergency stops clearly marked and immediately accessible?

  Yes

  No

  N/A

• 13.13 - Is there an isolation procedure for all equipment?

  Yes

  No

  N/A

• Comments:

14.0 - Electrical

• 14.1 - Are all electrical hand tools, equipment and leads tested by a qualified person?

  Yes

  No

  N/A

• 14.2 - Are all electrical hand tools, equipment and leads tagged appropriately?

  Yes

  No

  N/A

• 14.3 - Is there a procedure for visual checking before use for electrical apparatus?

  Yes

  No

  N/A

• 14.4 - Is an "out of service" procedure in place for faulty equipment?

  Yes

  No

  N/A

• 14.5 - Is there a regular test/inspection program in place for all leads/tools/equipment?

  Yes

  No

  N/A

• Comments:

15.0 - Lighting

• 15.1 - Is lighting in the workplace suitable for the work performed?

  Yes

  No

  N/A

• 15.2 - Is lighting included as part of regular workplace inspections?

  Yes

  No

  N/A

• 15.3 - Are stairwells and exits well illuminated?

  Yes

  No

  N/A

• 15.4 - Are faults such as flickering globes, blown globes replaced/repaired immediately?

  Yes

  No

  N/A

• 15.5 - Is glare minimised in the work area?

  Yes

  No

  N/A

16.0 - Housekeeping

• 16.1 - Do all floors comply with Code of Practice "Managing the work environment and facilities?" (that is: clean, free of dust and/or dirt, uncluttered, no pot-holes and level surfaces)

  Yes

  No

  N/A

• 16.2 - Are guardrails around floor openings in compliance with AS 1657?

  Yes

  No

  N/A

• 16.3 - Do all fixed platforms, walkways, ladders and stairways comply with AS 1657?

  Yes

  No

  N/A

• 16.4 - Do regular workplace inspections include housekeeping?

  Yes

  No

  N/A

• 16.5 - Do inspection checklists include floors, aisles, windows, entrances and exits?

  Yes

  No

  N/A

• 16.6 - Are there Housekeeping checklists specific to all sections/departments?

  Yes

  No

  N/A

• 16.7 - Are all entrances, doorways and stairs kept clear at all times?

  Yes

  No

  N/A

• 16.8 - Are work areas kept clean and tidy?

  Yes

  No

  N/A

• 16.9 - Are materials and equipment stored correctly?

  Yes

  No

  N/A

• Comments:

17.0 - Airborne Substances

• 17.1 - Has a qualified individual conducted an assessment of the hazards associated with Airborne Substances?

  Yes

  No

  N/A

• 17.2 - Is air monitoring done at regular intervals?

  Yes

  No

  N/A

• 17.3 - Are there measures in place to control Airborne Substances?

  Yes

  No

  N/A

• 17.4 - Is the ventilation system suitable for the hazards involved?

  Yes

  No

  N/A

• 17.5 - Consideration should be given to: type of ventilation system (exhaust or extraction), are fumes or dust drawn away from the work area? Does clean air replace the air being drawn away? is recycled air efficiently filtered? is there monitoring of the workplace for dust/fumes?

  Yes

  No

  N/A

• 17.6 - Is the ventilation regularly maintained?

  Yes

  No

  N/A

• 17.7 - Are cooling towers maintained in accordance with AS/NZS3666?

  Yes

  No

  N/A

• 17.8 - Is training about the hazards associated with the Airborne Substances int eh workplace provided for all employees?

  Yes

  No

  N/A

• 17.9 - Is appropriate Personal Protective Equipment (PPE) provided for all employees?

  Yes

  No

  N/A

• Comments:

18.0 - Workplace Layout (Code of Practice: "Managing the Work Environment and Facilities")

18.1 Posture

• 18.1.1 - Is the work designed so that the employees don't have to repeatedly work in an awkward position that requires them to twist their trunk or neck, or raise their arms above their shoulder?

  Yes

  No

  N/A

• 18.1.2 - Are frequently used tools and controls within easy reach?

  Yes

  No

  N/A

• 18.1.3 - Are highly repetitive movements limited?

  Yes

  No

  N/A

Sitting

• 18.2.1 - Are the seats provided comfortable?

  Yes

  No

  N/A

• 18.2.2 - Are seats adjustable and adjusted to the person using them?

  Yes

  No

  N/A

• 18.2.3 - When seated, are the workers legs positioned correctly?

  Yes

  No

  N/A

• 18.2.4 - Are the seats easy to get in and out of?

  Yes

  No

  N/A

• 18.2.5 - Does the seat have lumbar support?

  Yes

  No

  N/A

18.3 Standing

• 18.3.1 - Is a footrest available? A footrest can reduce stress on the lower back and the musculoskeletal system

  Yes

  No

  N/A

• 18.3.2 - Is the floor surface appropriate? Cushioned flooring should be provided for workers required to stand to do their work.

  Yes

  No

  N/A

• 18.3.3 - Can the worker alternate between sitting and standing to do their job?

  Yes

  No

  N/A

18.4 Work Surface Heights

• 18.4.1 - Are work heights suitable for the task?

  Yes

  No

  N/A

• 18.4.2 - Are work heights adjustable?

  Yes

  No

  N/A

18.5 Work Pauses

• Rest breaks should be provided when a job requires a sustained period of repetitive or static work and there is no provision for job rotation or task variation.

• 18.5.1 - Are there adequate rest breaks provided?

  Yes

  No

  N/A

18.6 Visual Requirements

• 18.6.1 - Is the lighting satisfactory for the work performed?

  Yes

  No

  N/A

• 18.6.2 - Are the controls/displays panels/screens easily read from the working position?

  Yes

  No

  N/A

18.7 Work Organisation

• 18.7.1 - Is there a period of adjustment for new employees or employees returning to work?

  Yes

  No

  N/A

Work Rates

• 18.8.1 - Work rates should be set realistically and not based on the machine capability. Does the worker have control over the work rate?

  Yes

  No

  N/A

• 18.8.2 - Is the work rate reasonably constant?

  Yes

  No

  N/A

18.9 Job Design

• Task variation should include a mixture of repetitive and non-repetitive work; this will allow for a period of recovery and help to reduce the effects of fatigue.

• 18.9.1 - Do employees have a variety of tasks in their jobs?

  Yes

  No

  N/A

• 18.9.2 - Is there job rotation away from competitive work?

  Yes

  No

  N/A

19.0 - Personal Protective Equipment (PPE)

• All personnel required to wear PPE must be trained in the correct fitting, use, maintenance, storage and cleaning of PPE.

• 19.1 - Has the need for PPE been clearly identified?

  Yes

  No

  N/A

• 19.2 - Are all area's identified as Hazardous and where PPE is required clearly sign posted?

  Yes

  No

  N/A

• 19.3 - Is the PPE appropriate for each hazard?

  Yes

  No

  N/A

• 19.4 - Does the PPE comply with the relevant Australian Standard?

  Yes

  No

  N/A

• 19.5 - Is the PPE appropriate for each worker (ie fit each worker)?

  Yes

  No

  N/A

• 19.6 - Are the employees and supervisors trained in the correct use of PPE?

  Yes

  No

  N/A

• 19.7 - Is PPE easily accessible to workers who are required to use it?

  Yes

  No

  N/A

• 19.8 - Is PPE adequately maintained?

  Yes

  No

  N/A

• 19.9 - Is PPE available for visitors?

  Yes

  No

  N/A

20.0 - Fire

• 20.1 - Are extinguishers in place? <br>Where practicable, extinguishers shall be located along normal paths of travel and near exits. Their location clearly indicated by placement of a location sigh, clearly visible from a distance up to 20m in all directions of approach.<br>

  Yes

  No

  N/A

• 20.2 - Are extinguishers clearly marked for type of fire?

  Yes

  No

  N/A

• 20.3 - Are there sufficient extinguishers in the workplace to meet the requirement of AS2444?

  Yes

  No

  N/A

• 20.4 - Have the extinguishers been recently serviced (within the last six months)?

  Yes

  No

  N/A

• 20.5 - Are there adequate direction notices to fire exits?

  Yes

  No

  N/A

• 20.6 - Do exit doors easily open from inside?

  Yes

  No

  N/A

• 20.7 - Are the exits clear of obstruction and fire extinguishers?

  Yes

  No

  N/A

• 20.8 - Is the fire alarm equipment functioning correctly?

  Yes

  No

  N/A

• 20.9 - Is the Evacuation Plan on display and available to all employees?

  Yes

  No

  N/A

• 20.10 - Are all employees informed who the Fire Wardens are (noticeboard? Induction?)

  Yes

  No

  N/A

• 20.11 - Are regular fire drills carried out?

  Yes

  No

  N/A

• 20.12 - Is a fire "occurrence book" maintained?

  Yes

  No

  N/A

21.0 - Hot or Cold Environments

• 21.1 - Are there written policies and procedures addressing hot and cold environments?

  Yes

  No

  N/A

• 21.2 - Is training conducted for Hot or Cold environments?

  Yes

  No

  N/A

• 21.3 - Do qualified personnel conduct the training?

  Yes

  No

  N/A

• 21.4 - Is the training delivered in a way suitable for all employees (eg literacy levels, language) ?

  Yes

  No

  N/A

• 21.5 - Are records kept of the training provided?

  Yes

  No

  N/A

• 21.6 - Is suitable PPE provided?

  Yes

  No

  N/A

22.0 - Confined Spaces

• 22.1 - Are confined space areas identified and sign posted?

  Yes

  No

  N/A

• 22.2 - Is there a Safe System of Work for all confined spaces?

  Yes

  No

  N/A

• 22.3 - Are employees trained in testing procedures for confined Space environments?

  Yes

  No

  N/A

• 22.4 - Is there a regular maintenance/calibration system in place for environment testing meters?

  Yes

  No

  N/A

• 22.5 - Is maintenance and recalibration of testing meters done by an authorised/licensed person?

  Yes

  No

  N/A

• 22.6 - Are employes fully trained in areas such as correct use of PPE, actions to take to respond to alarms, use and testing of SCABA (self contained breathing apparatus), recovery tools or equipment use to rescue trapped persons, emergency life support techniques, site emergency communication systems, isolation of potentially hazardous services?

  Yes

  No

  N/A

14.0 - Vehicle Condition

• 23.1 - Is scheduled maintenance performed?

  Yes

  No

  N/A

• 23.2 - Is the condition of the tyres within required standard?

  Yes

  No

  N/A

• 23.3 - Do brakes work correctly?

  Yes

  No

  N/A

• 23.4 - Are all lights working (check reversing/headlights/indicators)

  Yes

  No

  N/A

• 23.5 - Condition of seats?

  Yes

  No

  N/A

• 23.6 - Is the vehicle fully registered?

  Yes

  No

  N/A

• 23.7 - Is there a current First aid kit in the vehicle?

  Yes

  No

  N/A

• 23.8 - Is there a spill kit in the vehicle?

  Yes

  No

  N/A

• On Site Representative - acknowledgement that this person has participated in this audit

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• Franchise Business Manager

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