Signed by Club Representative (state position within the club) Date Quarterly Health and Safety Audit Quarterly Health and Safety Audit Date: Area Audited: Audited by: Time: from to 1. No. of people in area: 2. Was area clean/tidy? Yes No If no, describe briefly: 3. No. of Fire Extinguishers: Date of last Inspection: 4. Access/Egress Doors: Clear Blocked Comment Spillages Obstacles 5. Floors: 6. Safety Signs: Visible Not Visible Needed 7. Fire Closed Open Comment 8. Evidence of smoking in Prohibited Areas: No Yes Comment 9. Bins Empty Full Comment 10. Has there been any accident/injury in this area in the past quarter? No Yes Details 11. Has the accident/injury been properly reported? No Yes Comment 12. Is lighting adequate in the area? No Yes Comment No Yes 13. Have personnel received fire extinguisher training? Details 14. Are locations of fire hydrants generally known No Yes
Signed by Club Representative (state position within the club) Date Quarterly Health and Safety Audit Quarterly Health and Safety Audit Date: Area Audited: Audited by: Time: from to 1. No. of people in area: 2. Was area clean/tidy? Yes No If no, describe briefly: 3. No. of Fire Extinguishers: Date of last Inspection: 4. Access/Egress Doors: Clear Blocked Comment 5. Floors: Spillages Obstacles 6. Safety Signs: Visible Not Visible Needed 7. Fire Closed Open Comment 8. Evidence of smoking in Prohibited Areas: No Yes Comment 9. Bins Empty Full Comment 10. Has there been any accident/injury in this area in the past quarter? No Yes Details 11. Has the accident/injury been properly reported? No Yes Comment 12. Is lighting adequate in the area? No Yes Comment 13. Have personnel received fire extinguisher training? No Yes Details 14. Are locations of fire hydrants generally known No Yes