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Notes: Do not “tick”. Write Ok or use the code of the specific deviation in the legend. If the Guard is defective it must be tagged “Defective” and must be reported to the person responsible for the repair of the equipment. If the guard is beyond
repair, it must be replaced by a new guard to discourage the use of make shift equipment.
Legend:
1. Unserviceable and to be repair; 2. Unsafe and need to be replace. 3. Provide storage facilities e.g. racks; 4. Not provided and need to be supply;
LG = Legend; DQ = Quantity of Damages; TQ = Total Quantity
Sr. JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
No ITEMS INSPECTED
D D D D D D D D D D D D
. LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ LG TQ
Q Q Q Q Q Q Q Q Q Q Q Q
1 BROOMS
2 MOPS
3 SQUEEGEES
4 TROLLEYS
5 TOOLBOX
6 RING SPANNERS
7 SCREW DRIVERS
8 PLIERS
9 CHISELS
10 HAMMERS
11 SPADES / SHOVELS
12 PICKS / GWALA
13 RAKES
14 WHEELBARROW
15 KNIVES
16 OTHERS:
NAME OF INSPECTORS :
INSPECTOR’S INITIALS
DATE INSPECTED
SPOT CHECK / AUDIT