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Safety Inspection Record
Record that an inspection by a safety representative has taken place
Inspection Reference Number
Date of Inspection
Time
Area Inspected
Names and signatures of representatives taking part in the inspection
Name of safety representative | Signature | Name of employer (or representative) | Signature |
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(This record does not imply that the conditions are safe and healthy or that the arrangements for welfare at work are satisfactory)
Record of receipt of Inspection form by the employer (or employer's representative)