Self Assessment of PPE & Service Vehicle
Service Technician
*
First Name
Last Name
Registration
*
Date
*
/
Day
/
Month
Year
AM
PM
AM/PM Option
Are all respirators clean and free from damage?
*
Yes
No
Please photograph the respirator
*
Remarks
Are all respirators in a sealed bag?
*
Yes
No
Remarks
Do you have spare half face filters?
*
Yes
No
Remarks
Do you have spare uncontaminated clothing?
*
Yes
No
Remarks
Are your gloves clean?
*
Yes
No
Remarks
Do you have water?
*
Yes
No
Remarks
Do you have soap?
*
Yes
No
Remarks
Do you have a towel?
*
Yes
No
Remarks
Do you have a complete spill kit?
*
Yes
No
Remarks
Do you have a complete First Aid Kit?
*
Yes
No
What is the expiry date for the First aid kit
-
Month
-
Day
Year
Date
Remarks
Do you have a Fire Extinguisher?
*
Yes
No
Is it within date and within green on the pressure gauge?
*
Yes
No
Remarks
Do you have a fall protection harness free of rips/tears/damage?
*
Yes
No
Remarks
Is this part of a complete roof workers fall protection system free of rips/tears/damage?
*
Yes
No
Remarks
Service Body
Have you checked the oil in the main tank motor?
*
Yes
No
Remarks
Have you checked the oil in the compressor motor and pump?
*
Yes
No
Remarks
Are the cabinets clean?
*
Yes
No
Please photograph the cabinet
*
Remarks
Is the main tank clean?
*
Yes
No
Please photograph the Tank
*
Remarks
Is it tidy?
*
Yes
No
Please photograph the mess
*
Remarks
Is there a measuring jug? Is it clean?
*
Yes
No
Remarks
Is the hoses clean?
*
Yes
No
Remarks
Is the hose and reel in working order?
*
Yes
No
Remarks
Is the main tank gun oiled and clean?
*
Yes
No
Remarks
Is the main tank gun in working order?
*
Yes
No
Please photograph the gun
*
Remarks
Is the compressor in working order?
*
Yes
No
Remarks
Is the guard on the compressor?
*
Yes
No
Remarks
Is the motor and pump in working order?
*
Yes
No
What issues are present with the motor and pump
*
Remarks
Safety Boots in good condition
*
Yes
No
Remarks
Is the REGA/BNG clean (Including filters and base) and in working order?
*
Yes
No
Remarks
Are the cabinet doors alarms working on all four doors?
*
Yes
No
Remarks
Are the ladder/s free from defects and in good condition?
*
Yes
No
Remarks
Boot Covers
*
Yes
No
Remarks
Safety Goggles & Chemical Goggles
*
Yes
No
Remarks
Hat
*
Yes
No
Remarks
Nitrite Gloves
*
Yes
No
Remarks
Hearing Protection
*
Yes
No
Remarks
Wasp Hood in good condition (no holes or rips)
*
Yes
No
Please photograph the Hood
*
Remarks
Torch
*
Yes
No
Remarks
Pest Control Signage
*
Yes
No
Remarks
Hammer Drill / Drill bits (in working condition)
*
Yes
No
Please photograph the issue
*
Remarks
Cordless Tools in good working order
*
Yes
No
Please photograph the issue
*
Remarks
Tool Kit
*
Yes
No
Please photograph the issue
*
Remarks
Dustpan & Brush
*
Yes
No
Remarks
Does the Vehicle have a Jack and Wheel brace kit
*
Yes
No
Remarks
Spare spark plugs and Oil
*
Yes
No
Remarks
Any Additional Information / Notes
I hereby declare that the information above is,to the best of my knowledge, complete, accurate and true.
*
First Name
Last Name
*
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