Inspection by (name)

Committee Role

Accompanied by (name)

Inspection Date

Are the keys checked and in the right place? Are the keys checked and in the right place? Yes No

Did you conduct a full building walk through and visual check Did you conduct a full building walk through and visual check Yes No

Log any maintenance requirements here

Fire Alarm Call Point Used Fire Alarm Call Point UsedZone 1Zone 2Zone 3 (loft)Zone 4 (pump room)

Fire Alarm test satisfactory Fire Alarm test satisfactory Yes No

Assembly points/emergency exit signage checked Assembly points/emergency exit signage checked Yes No

Log any remedial action taken wrt fire systems

Have you deep cleaned the kitchen? Have you deep cleaned the kitchen? Yes No Was not required

Have taps been run through if necessary Have taps been run through if necessary Yes No In frequent use - not necessary

Have you checked and cleaned the fridge and freezer? Have you checked and cleaned the fridge and freezer? Yes No

Kitchen: Recorded fridge temperature

Kitchen: Recorded freezer temperature

Storeroom: Recorded fridge temperature

Storeroom: Recorded freezer temperature

Visual checks of electrical equipment: Visual checks of electrical equipment:Electrical/extension leads/plugs etc are in good conditionItems identified to be repaired or replacedNot checked

Log any remedial action taken in the kitchen / electrical items

Are all hazardous chemicals locked away and household cleaners out of reach of children? Are all hazardous chemicals locked away and household cleaners out of reach of children? Yes No, but rectified

Does the hazardous chemical data sheet need updating? Does the hazardous chemical data sheet need updating? Yes No

QUARTERLY ONLY:

Confirm defrost and deepclean of fridge and freezer Confirm defrost and deepclean of fridge and freezer Yes No Not due this month

Do the showerheads need de-scaling? Do the showerheads need de-scaling?Yes, de-scaling completedYes, will scheduleDe-scaling was not neededNot due this month

Any other items checked or requiring attention?

Have any of the following bi-annual or annual checks been completed this month? Have any of the following bi-annual or annual checks been completed this month? Fire Protection Services (bi-annual) Deep clean (bi-annual) PAT testing (annual) Hot water system and heating (annual) Health and Safety Policy Checks / Update (annual) 5 year electrical circuit test (1st due 3Q2022) N/A none due this month