Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
Production area
- Production area
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Location and floor
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Are the floors in good condition?
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Are the windows adequately sealed with any pest guards in good condition?
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Are the walls free from flaking paint and or any debris that presents a risk to food safety?
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Are the ceilings free from flaking paint and or any debris that presents a risk to food safety?
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Are the walls, floors and ceilings free from evidence of water ingress, leakage or contamination?
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Are all drains and down pipes visually free from leakage and or discolouration?
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Are the air intakes and extracts free from debris, dust or containation?
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Are the utility services pipework free from condensation and evidence of leakage?
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Are the pest control stations correctly positioned?
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Are there any other observations or concerns?
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Stairs
- Stairs
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Location
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Ae the emergency exits and routes clearly dislayed?
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Is the correct signage displayed?
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Ae the handrails in good condition?<br>
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Are the nosings clearly defined and in good condition?
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Is the lighting adequate?
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Are the stairs clean and free from debris, dirt or inappropriately stored items?
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Is the stair structure, covering or fabric in good condition with no raised or loose sections?
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Any other observations?
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Lift
- Lift
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Location and or reference?
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Is the lift functioning correctly?
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Are the lights functioning?
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Do the doors close correctly?
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Are the internal walls, floor and ceiling in good condition?
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Is the signage correct?
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Ae the external frames and doors free from loose paint, damage, dirt and litter?
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Any other observations?
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Plant room
- Plant room
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Location or reference number
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Is the access door secure and in good condition with adequate signage?
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Is the emergency exit sign functioning?
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Is there a fire extinguisher?
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Is there an emergency telephone?
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Is the plant room free from obstructions including incorrectly stored items?
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Is the plant room clean and tidy?
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Is the fabric of the plant room in good condition?
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Are the windows secure and correctly designed?
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Is the plant room free from leakage or contamination?
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Is the signage adequate and correct?
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Is the plant free from obvious faults?
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Any other observations?
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Doors
- Doors
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Location or reference number
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Is the door correctly signed and secured for its required function?
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Does the door close correctly?
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Is the door in good condition?
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Is the door furniture including any pest control measures in good condition and adequate?
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Any other observations?
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Roof
- Roof
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Location
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Is there correct PPE at the access points?
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Are the access points secure and in good condition?
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Is the roof clean and tidy?
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Is there evidence of standing water?
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Are trip hazards correctly identified?
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Is the signage adequate and in good condition?
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Is the roof free from loose items that present a risk of falling?
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Are the roof specific stairs in good condition?
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Are all items of plant free from obvious visual fault and in good repair?
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Any other observations?
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General area
- General area
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Location
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Area type?
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Is the area in good condition?
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Is the signage adequate?
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Are the pest control measures adequate?
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Is the lighting adequate?
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Is the area free from leaks, debris or contamination?
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Is the correct PPE and or safety equipment provided?
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Are the windows in good condition and adequately protected for there required function?
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Are the floors, walls and ceilings in good condition?
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Any other observations?
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Outdoor
- Outdoor area
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Location
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Is the area free from environmental hazards?
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Is the area free from Safety hazards?
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Is the area free from quality hazards?
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Further action required?<br>
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Immediate action required?
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Comments
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Photographic evidence
Substation
- Substation
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Location or reference number
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Adequate door security and signage?
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Is the emergency exit sign functioning?<br>
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Is there a fire extinguisher?
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Is there an emergency telephone?
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Is the substation free from incorrectly stored items?
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Is the substation clean and tidy?
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Is the substation fabric in good condition?
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Is the substation enclosure, windows, walls in good condition?
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Is the substation signage correct?
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Is the plant free from visual faults?
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Is the substation free from leakage and contamination?
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Comments
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Faults general
- Fault/concern
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Location
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Type of fault
- Hygiene
- Floors
- Walls
- Drains
- Pest control
- Utility plant
- Leaks
- Process plant
- Other
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Urgency
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Description
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