Premises Inspection Form - Free Download | Lumiform

Premises Inspection Form

About the Premises Inspection Form

Walking the premises of your property with a checklist is like babyproofing the house. Much like how parents must look at the world around them through the eyes of their babies to protect them from choking hazards, an inspector must do the same, but for adult health and safety. Possessing the foresight to conduct property inspections with a checklist can prevent slips, trips, and falls along with a myriad of other risk factors. Here’s a short list of the covered subjects in the premises form below:

• Tripping hazards
• Falling objects
• Harmful substances
• Ventilation
• Lighting
• Hyginene
• Maintenance
• Security
• Gas
• Legionella
• Asbestos

Related categories

Maintenance templates

Preview of the template

Audit

PROJECT DETAILS:

Project Name:

Project Code:

Project Address:

Project Manager:

Project Contact Number:

DETAILS OF PERSON CONDUCTING THE INSPECTION:

Select date

SLIPS, TRIPS, HAZARDS & FALLS:

Are there any hazards that could cause a slip, trip, or fall?

Are there any trailing leads supplying computers, printers fax machines, etc?

Are there any areas of loose carpets or mats?

Are there any access routes blocked by debris, waste bins, etc?

Please detail any other slips, trips, and fall hazards identified:

FALLING OBJECT HAZARDS:

Are there any objects that could fall on people?

Please detail any other falling object hazards identified:

SUBSTANCE RELATED HAZARDS:

Are there any substances used that could cause harm from contact or inhalation:

Has any staff member complained of any persistent or increasing allergic reactions: running nose or eyes coughing, sneezing, itching skin, etc?

Are adequate COSHH risk assessments conducted for all substances hazardous to health on site?

Please detail any areas of concern:

VENTILATION HAZARDS:

Are all areas adequately ventilated?

Have air condition units (where installed) been serviced this month by a competent contractor?

Please detail any areas of concern:

LIGHTING:

Are all light diffusers clean and securely fixed?

Are all light working and free from defects?

Are there any areas of which are poorly lit and cause concern?

Please detail any areas of concern:

HYGIENE HAZARDS:

Are sanitary provisions sufficient to reduce the risk of infection or contamination:

Please detail any areas of concern:

SIGNAGE:

Is signage suitable and sufficient?

Please detail any areas where further signage is required:

MAINTANANCE:

Is there any requirement for maintenance or repair on the premises or for equipment?

Please list identified maintenance or repair requirements:

SECURITY:

Has an entry control procedure and safe system of work been developed for and adopted by the project?

Are all door release systems operational?

Is CCTV in working order:

Has a safe system of work for response to panic alarm been developed and adopted by the project?

Are an appropriate number of Intruder Alarm Key Holders nominated?

Please detail any areas of concern:

PASSENGER & STAIR LIFT (Where Installed)

Has scheduled maintenance been carried out this month?

Have any faults been reported within the past month?

Please detail any areas of concern:

ELECTRICAL SAFETY:

Has a hard wire test been conducted by a competent contractor this month? (Tests are required at 5 year intervals)

Has PAT testing been conducted by a competent contractor this month? (Test are required annually only)

Has a visual inspection been conducted this month?

Are there any extension leads or multi socket adaptors on site which pose a risk?

Findings of visual inspection:

GAS SAFETY:

Has a gas safety check been undertaken by a competent contractor this month? (Checks are required annually only)

Are Carbon Monoxide Detectors (Patch or Alarm) installed by any boiler present on site?

Has the Carbon Monoxide Detector been checked this month?

Has a visual inspection been undertaken this month?

Please detail any areas of concern or findings of visual inspection:

LEGIONELLA CONTROL:

Has a Legionella Risk Assessment been undertaken on the premises?

Is a preventative water cleaning schedule in place?

Have monthly water temperature checks been undertaken and recorded in the Water Hygiene Log Book?

Please detail any areas of concern or findings of water temperature checks identified as a risk:

ASBESTOS MANAGEMENT:

Has an Asbestos Risk Assessment been carried out for the premises by a competent person?

Has an Asbestos Management Schedule been introduced to the premises?

Are staff, volunteers, peer mentors and peer advocates aware of any asbestos present on site?

Has a visual check been undertaken on any areas of known asbestos:

Please detail any areas of concern or findings of asbestos check:

SUMMARY OF ACTIONS FROM PREMISES INSPECTIONS:

PLEASE REFER TO PREVIOUS MONTHS PREMISES INSPECTION FORM AND ENSURE ALL ACTIONS HAVE BEEN COMPLETED AND SIGNED OFF

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

ACTIONS IN ORDER OF PRIORITY:

Select date

Add signature

The Assessor and Project Manager should sign below to show that the assessment is a correct and reasonable reflection of the hazards and of the control measures and actions required:

Assessors Name:

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Line Managers Name:

Add signature

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The completed form should be kept within the Premises Inspection Toolkit Section of the H&S Manual. A copy must be forwarded to the Health and Safety Co-ordinator in March and September

SUBMISSION OF PREMISES INSPECTION FORM IN JANUARY & JULY:

Maintenance Log Attached:

Received By Health & Safety Co-Ordinator:

Select date

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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.