7.0 SAMPLE PERMITS, FORMS AND CHECKLISTS SELF INSPECTION CHECKLIST

Transcription

1 7.0 SAMPLE PERMITS, FORMS AND CHECKLISTS The Permits, forms and checklists shown within this section are an example of the type of controls that should be in place to help effectively manage Health & Safety and Contractors on-site. 7.1 Self Inspection Checklist SELF INSPECTION CHECKLIST SELF INSPECTION CHECKLIST Completed by:. Date Fire Exits Yes No N/A Are fire exit routes clear? Are fire doors clear? Are fire exit doors unlocked when occupied? Are there fire evacuation notices by each call point? Are fire exit doors/routes checked daily? Are fire exits clear externally? Are fire doors/shutters unobstructed? Are self closing devices working? FIRE EXTINGUISHERS Are fire extinguishers provided? Are all fire extinguishers wall mounted? Is there a current maintenance contract in force? Is there a fire point notice above each extinguisher, block of extinguishers? Are all extinguishers unobstructed and easily accessible? Have discharged extinguishers been refilled? 38

2 Hose Reels Are all hose reels unobstructed? Is there a current maintenance contract in force? Is location of hose reels clearly identified? Storage Is storage neat and tidy? Is top of storage clear of light fittings (at least 0.5m)? Are there adequate gangways around each clock of storage and aisles clear? Is outside storage kept well away from building? Kitchens Are all filters regularly cleaned? Are suitable fire extinguishers provided? Is a fire blanket provided? Waste Is waste removed daily? Are electrical service cupboards clear? Are the premises free of any accumulations of waste? Are stock rooms regularly swept? Electrical Are portable appliances regularly inspected? Has fixed electrical installation been tested in last 5 yrs? Have all multi-socket adapters been taken out of use? If a battery charger is in use, is a clear space of at least 1m maintained around charging units? The area well ventilated? 39

3 Are all cables and leads in good condition and showing no signs of wear or defects? Is switchgear clear of storage and unobstructed? Heating Are boiler rooms clear of storage? Are heaters clear of storage? Are portable heaters in use? If yes: ~ Are these suitably positioned to prevent them being knocked? ~ Are electric cables routed so as not to create tripping risks? ~ Are they protected to avoid contact with materials/ passers by? NB. The use of portable heaters should be prohibited unless their use is unavoidable Building / Unit Is there any evidence of impact damage or structural damage? If yes, has this been notified to managing agent? Fire Alarms Is the fire alarm tested weekly using different test points? Are alarm connections in order? Sprinklers Is stock at least 0.5m below sprinkler heads? Is sprinkler pipe work clear of suspended items? Have all heads which may have been painted been replaced? Have all broken brackets been replaced? Is installation tested weekly? Are all ceiling tiles in place? 40

4 Flammable Liquids / Gas Bottles Are there any flammable liquids / gas bottles? If yes: ~ Are these properly secured and safely stored? ~ Have COSHH assessments been prepared? Oil Tanks Are all oil tanks suitably bunded? Are contents levels monitored? Are bunds clean and empty? TENANTS MANUAL Is a copy of the Tenants Manual held on the site? Is the unit manager familiar with this? RECORD KEEPING Date of last Portable Appliance Testing? Date of last Electric Wiring Installation inspection? Date of issue of Fire Certificate? (if not applicable state N/A) Date of issue of Fire Risk Assessment or latest audit? Date of last maintenance visit for emergency lighting system? Management should act on any negative responses arising from this checklist! Other general comments, suggestions or recommendations: 41

5 7.2 Contractors Liability Policy Details CONTRACTORS LIABILITY POLICY DETAILS We hereby confirm the following particulars regarding our Client s Liability Insurances. Name: Address: Business Description: Type of Policy Insurer Expiry Date Limit of Liability Employers Liability: Any one event. Public Liability: Any one occurrence. Products Liability: One occurrence/in the aggregate. Commercial Vehicle: (Third Party Any one accident. Property Damage Limit) Cover Extensions Does the policy wording incorporate the following? Indemnity in respect of interference with rights? I.e. loss of YES/NO amenities obstruction, trespass, nuisance? An Indemnity to principal s clause? YES/NO Cover in respect of premises occupied for the purpose of YES/NO carrying out work therein or thereon? Contractual Liability? YES/NO Liability arising from detective design, materials or workmanship? YES/NO Cover in the joint names of the Employer and Contractor for YES/NO damage to surrounding property by subsidence, collapse, heave vibration, weakening of support or lowering of ground water? Cover for the following activities: * Demolition and/or evacuation? YES/NO * Direct application of heat? YES/NO * Work at height? YES/NO Please give details of any relevant warranties, exclusions or other restrictive conditions that apply to this policy. (Where applicable, show on the reverse side of this form). Dated: Signed by: On behalf of: 42

6 7.3 Compliant Contractor Questionnaire Compliant Contractor Questionnaire Please provide details of all of the following in a bound submission in the order requested: 1.0 General Information 1.1 Company name and address: 1.2 Principle contact names: 1.3 Telephone number: 1.4 Fax number: 1.5 Principle contacts addresses 1.6 Emergency telephone numbers: 1.7 Description of services to be provided: 2.0 Documentation 2.1 Company Health & Safety Police: 2.2 Company Organisation for Health & Safety: 2.3 Health & Safety Work procedures for employees: 2.4 Health & Safety advisors or any external consultants employed by the Company and evidence of their competence: 2.5 Occupational Health professional employed by the Company 2.6 Health surveillance carried out by the Company as a result of a COSHH assessment: 2.7 Risk assessments carried out for services to be provided, including Safety Data Sheets, COSHH assessments and manual handling assessments: 2.8 Method statements for services to be provided: 2.9 Company Permit and Permission to work procedures: 2.10 Procedures employed to assess any sub-contractors competence and resourcing for Health & Safety: 3.0 Insurance 3.1 Insurance advisor or broker: 3.2 Professional Indemnity insurance (if any) including the company and limit: 3.3 Employers Liability insurance including company and limit: 3.4 Third Party insurance: 3.5 Contractor s All Risk insurance: 3.6 Claims over the past 3 years against any of the above policies: 4.0 Accidents: 4.1 Procedures for reporting accidents within the Company: 4.2 Reportable accidents or diseases which have occurred within the last 3 years 4.3 Details of non lost time accidents and civil injury claims: 5.0 Prosecutions / Prohibition Notices: 5.1 Prosecutions and convictions under health and safety legislation within the last 5 years: 5.2 Improvement of prohibition notices issued within the last 5 years: 6.0 Employee Training 6.1 Evidence of competence of employees who will be carrying work out related to the services: 6.2 Health & Safety training attended by persons who are likely to manage or supervise work at Milton Park 6.3 Health & Safety training provided for employees who are likely to work on Milton Park: 7.0 Control of Work 43

7 7.1 Details of supervision to be provided at Milton Park: 7.2 Internal Permission to Work and Permit to Work and Hot Work Permit procedures: 7.3 Procedures for monitoring the health & safety of your employees and subcontractors to be employed at Milton Park: 8.0 Other 8.1 Experience in carrying out similar services at other sites: 8.2 Any other relevant information that relates to your services at Milton Park: Print Name: Position: Date: Signature: 44

8 7.4 Limitation of Work Permit Used by MEPC Milton Park to manage contractor work. In addition further permits are issued to cover Hot Works, Confined Spaces, Electrical Work, Working at Heights, etc,. 45

9 7.5 Notification of Alterations to Sprinkler Installations Form NOTIFICATION OF ALTERATIONS TO SPRINKLER INSTALLATIONS FORM (To be completed by ALL Tenants in respect of alteration work on sprinkler protected premises) TO: (Name of Facilities Manager) FACILITIES MANAGERS: FROM: (Name of Tenant) ADDRESS: LOCATION OF WORK GIVE UNIT NO. OR FLOOR NO. IF APPROPRIATE SCOPE AND IMMEDIATE LOCATION OF WORK MAIN CONTRACTOR NAME AND ADDRESS CONTRACT SUM CONTRACT DURATION START DATE: ANTICIPATED COMPLETION: DETAILS OF CONTRACT AND INSURANCE CLAUSES 46

10 CONTRACTS TENANT MANAGEMENT HEAD OFFICE MANAGEMENT (IF APPROPRIATE) BUILDING CONSULTANCY SPRINKLER ADAPTATION (YES OR NO) IF YES, STATE DETAILS OF WORKS TO BE CARRIED OUT WILL SPRINKLER SYSTEM BE TURNED OFF OVERNIGHT IF YES, FOR HOW LONG OTHER GENERAL COMMENTS E.G. Hot working permits to be issued during the contract ARE SITE PLANS AND SPRINKLER DRAWINGS ENCLOSED AS APPROPRIATE SIGNED: DATED: (PLEASE PRINT NAME) FOR FACILITIES MANAGERS USE ONLY COPIES SENT TO: DATE: 47

11 7.6 Bomb Warning Checklist 48