Title Page
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Name
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Conducted on
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Prepared by
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Project Review is being completed on
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Project Number
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Job title
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Employment detail
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Company name
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Kit bag in place
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Kit bag condition
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Safety Helmet in place
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Helmet condition
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High Viz long and short sleeve in place
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High Viz condition
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Safety footwear in place
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Safety footwear condition
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UVEX ultrasonic goggles in place
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UVEX ultrasonic goggles condition
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Safety glasses in place
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Safety glasses condition
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Ear defenders in place
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Ear defender condition
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Hot cutting goggles in place
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Hot cutting goggles condition
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Hot cutting jacket and gauntlets in place
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Hot cutting jacket and gauntlet condition
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Waterproof jacket and trousers in place
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Waterproof jacket and trousers condition
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Safety Harness and Lanyard in place (add numbers)
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Safety Harness and Lanyard condition (add last inspection date)
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Any other PPE (list and condition)
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R.P.E sundstrom SR100 in place (add serial number)
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Face fit certificate with operative and serial numbers match mask
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R.P.E condition
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Storage box in place
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Storage box condition
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Any other R.P.E list
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Description of maintenance for R.P.E given
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Actions required
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Operative comments
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Sign inspector
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Sign operative
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Disclaimer
The inspector believes the information contained within this review to be correct at the time of the inspection. The inspector and company will accept no responsibility for any consequences arising from the use of the information herein. The information is based on observations during the interview on the day and at the time the inspection report was carried out. -
Inspector
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Interviewee
