Safety in Work
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Inspection
Inspection for:
Client Reference:
Blank Form (#83)
Client Contact Email
Asset ID
Is this the correct equipment?
Yes
No
comment
Location
Visual condition acceptable?
Yes
No
Cable/casing intact?
Yes
No
Plug/connector secure?
Yes
No
ID label present/legible?
Yes
No
Safe to use?
Yes
No
Defect section
Defect description
Severity
– Select –
Low
Medium
High
Remove from service?
Yes
No
Declaration
First Name
Last Name
Role
Inspector Name:
Confirmation
I confirm this inspection was carried out accurately
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Thank you for filling out this survey.
If you would like to discuss how we can help with your health and safety obligations call
089 4946510