Spill Kits Inspection Form

Date: PIC/ Name:

Location of Spill Kit: Signature:

Spill Kits Readiness Jan Feb Mar Apr May Jun Jul
It's Tamper- Proof or tie- Place
Spill Kits clean, marked,
undamaged and visible
It's stored in dry condtion or in
weather resistance container

Kits Item Number of Available YES/NO Condition Date

Carry Bag
Oil Absorbent Mat pads
Oil Absorbent Socks
Disposal Bags
Wipers
Dust Pan
Chemical Resistance Gloves
Latex Glove
Safety Shoes
Safety Masks
Safety Goggles
Splash Apron
Others items

Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the inspection form to supervisor/ma
oppurtunity. If there are items that are missing or need to be replaced inform the supervisor/manager/ PIC immediately.
rm
PIC/ Name:
Signature:

Aug Sept Oct Nov Dec

Notes

ection form to supervisor/manager/PIC at the earniest

anager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.

Spill Kits Inspection Form Spill Kits Inspection Form

Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √ √ √ √ √
resistance resistance
container container

Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.

Spill Kits Inspection Form Spill Kits Inspection Form

Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.

Spill Kits Inspection Form Spill Kits Inspection Form

Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.

Spill Kits Inspection Form Spill Kits Inspection Form

Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks
Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ √ clean, marked, √ √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ √ in weather √ √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ √ Proof or tie- √ √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ √ clean, marked, √ √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ √ in weather √ √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ √ Proof or tie- √ √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ √ clean, marked, √ √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ √ in weather √ √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ √ Proof or tie- √ √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ √ clean, marked, √ √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ √ in weather √ √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ √ Proof or tie- √ √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ √ clean, marked, √ √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ √ in weather √ √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ √ Proof or tie- √ √
Place Place

Spill Kits Spill Kits

clean, marked, √ √ clean, marked, √ √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ √ in weather √ √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.
 Spill Kits Inspection Form Spill Kits Inspection Form
Date: 2022 PIC/ Name: Rahim Date: 2022 PIC/ Name: Rahim
Location: ED Signature: Location: TOP COAT Signature:

Spill Kits Spill Kits

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Readiness Readiness
It's Tamper- It's Tamper-
Proof or tie- √ Proof or tie- √
Place Place

Spill Kits Spill Kits

clean, marked, √ clean, marked, √
undamaged undamaged
and visible and visible

It's stored in It's stored in

dry condtion or dry condtion or
in weather √ in weather √
resistance resistance
container container
Number of Number of
Kits Item Yes/No Condition Date Notes Kits Item Yes/No Condition Date Notes
Available Available
Carry Bag Carry Bag
Oil Absorbent Oil Absorbent
Mat pads Mat pads
Oil Absorbent Oil Absorbent
Socks Socks

Disposal Bags Disposal Bags

Wipers Wipers
Dust Pan Dust Pan
Chemical Chemical
Resistance Resistance
Gloves Gloves
Latex Glove Latex Glove
Safety Shoes Safety Shoes
Safety Masks Safety Masks
Safety Safety
Goggles Goggles
Splash Apron Splash Apron
Others items Others items

Marks the colums as applicable with a tick (√) Marks the colums as applicable with a tick (√)

If the chemical spill kits items condition are correct and in good order, please hand over the If the chemical spill kits items condition are correct and in good order, please hand over the
inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are inspection form to supervisor/manager/PIC at the earniest oppurtunity. If there are items that are
missing or need to be replaced inform the supervisor/manager/ PIC immediately. missing or need to be replaced inform the supervisor/manager/ PIC immediately.