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Audit Summary Report

Document # F103-20Release Date: 11-Feb-2013 of 14

Section 1: Basic audit data

Client/Address Client ID Derry City Council 1366Head Office Audit Criteria98 Strand Road OHSAS 18001:2007Derry Date(s) of auditBT48 7NN 7th, 8th, 9th & 10th September 2015

Initial Audit - Stage I Stage II Surveillance audit No: 2

Re-certification Audit Change of scope (specify): Special surveillance purpose (specify): Other: Documentation review included

Audit TeamLead Auditor Paul McGeown Audit-Day(s): 4Auditor (if needed) - Audit-Day(s): -Auditor (if needed) - Audit-Day(s): -Observer (if needed) - Audit-Day(s): -Interpreter (if needed) - Affiliation: -

Scope of certification (if applicable specify scope for each site and each standard)

Environment and Regeneration Directorate: Activities covering waste management, property and fleet management, design and project management, parks and cemeteries management and building control and environmental health management activities

Business and Culture Directorate: Activities covering leisure management, community management, sport development, economic development and heritage and museums management activities

Health and Community Directorate: Activities covering Civic Offices management activities

Section 2: Overall Results

Revision no. Description of change Date

No Action Required

The management system was found to be fully effective (no nonconformities issued)

Action RequiredThe management system was found to be effectively implemented although minor nonconformities were cited.

Immediate Action RequiredThe management system was found to be ineffectively implemented due to major/critical nonconformities cited.



Section 3: Executive summary

Strengths

1. A well documented system which has the full backing of senior management involvement and which is in general well implemented across all departments

2. Excellent new asset management tool (Asset HQ) being developed3. Excellent new site audit tool being developed by Emma Barron and her

team for use on iPads which hopefully will be issued to Park Rangers

Weaknesses No nonconformances were raised during this audit

Opportunities

1. Management need to urgently review the Council’s current lock out procedure for electricians working on electrical systems and as a minimum introducing signage as well as just removing fuses

2. The circuit diagram in the fuse box in the ‘old bar area’ kitchen is very old and refers to previously named areas which have been renovated, extended etc. over the years. Management should introduce a programme to check that all circuit diagrams in council owned and operated buildings are accurate

3. There is no system in place for plumbers to check the accuracy of their thermometers used in legionella testing (e.g. simple ice and boiling water tests)

4. There is a wall holder in the corridor of the offices on the Skeoge site for Health and Safety meeting minutes – the last set of minutes in this holder are over 15 months old

5. The interceptor in the vehicle washing area in Skeoge site is blocked again. This is an ongoing issue with the likely cause being a problem with the design / construction of this structure

6. There is no mention of low overhead power cables in the Route Risk Assessment for the Gransha Road / Judge’s Road route

7. The delivery of household waste to the new facility at River Ridge’s Newbuildings site was observed during the audit and it is a very busy and confined area with only one weighbridge (team delays and frustration). Management of the Waste Collection department need to highlight this in some way to their teams through a new risk assessment or regular site-specific toolbox talks

8. River Ridge is being contracted by Council to remove some Council skips from Council amenity sites to Newbuildings waste transfer station. However it is not clear whether the Council or River Ridge is responsible for any injury or damaged caused by the transport lorry or skip during this operation

9. The Council’s new state of the art leisure centre Foyle Arena in St Columb’s Park has only been opened a few months. However it was observed during the audit that there are several issues Council need to discuss with the relevant project team members such as the Principal Contractor including:-

There is a leak under the swimming pool through the ceiling of the plant room below

There is also water leaking through the wall in another downstairs plant room

Can air-conditioning systems be turned off in rooms which are not being used e.g. the studio / wrestling room and the strengthening / conditioning room were fully on during the site tour

The vermin exclusion mesh in the roof plant room is a poor finish and there are large holes in several places which vermin such as pigeons could pass through easily



Some of the lighting sensors on the ground floor emergency exit corridors only seem to be working for people entering the building and not for people trying to leave the building

There are piles of builders materials including paper records, packaging materials, paint tins in several locations across the site

10. There was an incident reported during the audit of a member of the public getting into difficulties in the pool recently and being assisted out of the pool by a lifeguard. However this was not recorded as a near miss by site staff as the person involved left the building before any details could be taken

11. It was not made clear during the audit how Council ensures that the food and drink dispensed from vending machines owned and operated by contractors across Council properties are safe for use

12. The recent risk assessment created for the Foyle Arena site for use of the cryotherapy spa has no number (for document control purposes)

13. The subcontractors’ risk assessments and method statements provided by the current tree cutters to the Grounds Maintenance department have no names, dates or links to these organisations. It is therefore not clear how these RAMS were checked and accepted by Council

14. No records could be found for the statutory inspections of the grave diggers’ trench box pumps

15. With the move of the Grounds Maintenance department’s equipment to Skeoge, the external storage space on this site is now very cluttered

16. It is recommended by the Royal Life Saving Society that all lifeguards complete ongoing CPD training of at least one hour every month to maintain their National Pool Lifeguard Qualification. This is not currently being done for all lifeguards in the Foyle Arena

17. The system currently being used by staff in the Guildhall printing off all risk assessments, the majority of which have not changed and signing them each year as evidence that they understand them is both time consuming and a waste of paper. A simpler system of an annual toolbox talk on risk assessments which staff sign an attendance sheet would be more effective

18. Form CHS32 Issue 2 (Group Toolbox Talk Record) does not have the ‘understand / agreement to comply’ statement at the bottom

19. The Training Matrix for Guildhall staff does not include casual staff. Management must ensure that the HR department is fully aware of all casual workers before they start working in any Council buildings and that they have carried out all pre-employment checks and training

20. The Training Matrix seen on the Guildhall site shows a row indicating the expiry duration of certain training e.g. 3 years, 4 years etc. However this does not match legislative requirements and in some cases there is no legislative requirement for training or refresher training in that area. Management therefore may wish to add an additional row above or below the current ‘expiry’ row to indicate what the legislative requirements are. This may help HR with organising refresher training

Threats1. No threats to the OHSMS were noted during this audit



Section 4: Findings summarySee attached findings for further details.

Major Issued Major Closed Minor Issued Minor Closed # Open NC’s

Previous Activity 0 0 1 0 1

Current Activity 0 0 0 0 0

Section 5: Evidence Summary

The evidence of the state of the management system is summarized belowOn review of the client’s processes in relation to ISO 18001 requirements, it appears that the systems are working in a satisfactory manner and no nonconformances (weaknesses) have been raised at this audit. However twenty observations (Opportunities) have been raised which the senior management team must take on board as real opportunities for improvement to the system.

Management System Performance (Objectives / Targets / KPIs / Trend Analysis)

OHSMS responsibilities and authorities are defined within the OH&S Policy Manual, the H&S Statement and OH&S procedures. A Council organisation chart is in place and is included in the OH&S Policy Manual. This chart includes the role of the OH&S Representatives. Adequate physical resources have been provided by the management team to enable all Council staff to adhere to all health and safety policies and procedures.

Management have shown real commitment to the implementation and effectiveness of the OHSMS through provision of resources, carrying out internal audits and management reviews, establishing policies, objectives and targets and communicating to all staff the importance of working in a safe environment at the same time as meeting the requirements of all relevant health and safety legislation and regulations.

The Council uses various forms of trend analysis. Management has set numerous health & safety objectives and targets for the 2015 - 2016 period. The effective completion these objectives and targets is monitored by the three Directorate’s Senior Management H&S team at their quarterly meetings.

All critical activities and performances which have a health and safety risk are monitored in various ways by the management team including achievement of KPIs, various management meetings, project meetings, internal and external audit results and the annual management review process. Regular health and safety audits of Council sites are carried out by Supervisors and Managers. Internal audits of the OHSMS are currently being carried out by an external consultant under the direction of the Corporate Health & Safety Officer Oonagh O’Doherty.

There are several Health, Safety & Wellbeing teams and committees consisting of personnel from different levels within the Council including senior management, HR personnel and union representatives and these meet at least every quarter and minutes including action points are held on file. In addition a monthly health, safety and wellbeing meeting is carried out by senior management team (SMT) to monitor health and safety performance statistics including objectives and targets and the status of all open nonconformances.



Overall OHSMS Management Review meetings are held every six months and are attended by the senior management team as well as the external consultant. These meetings cover the requirements of OHSAS 18001:2007. Data is collected throughout the year to provide relevant information for review by management team at this annual review meeting. This data includes health and safety performance and all accidents, incidents, issues, problems and complaints as well as opportunities for improvements.

Comparison of results with previous audit activity / Re-certification Activity

The previous audit carried out in June 2015 raised no noncompliances (weakness) but twelve observations (opportunities for improvement) were raised and the status of these is as follows.

It was not made clear if the incident involving a Council lorry on 8/05/2015 which damaged a Housing Executive wall was recorded in the OHSMS as a near miss (recorded in the Team Solutions Incident Manager)

It was not made clear if the incident involving a false alarm of the fire alarm system at the Templemore Leisure Centre on 1/02/2015 which resulted in the fire brigade being called was recorded in the OHSMS as a near miss (recorded in the site Fire Log Book)

Management of Council properties used by vulnerable and special needs adults and children need to review their risk assessments and in particular regarding emergency situations (ongoing project to review all Council owned and operated buildings’ fire risk assessments. Also revisions made to the Application for Hire Form)

The Register of Legislation currently does not include certain legislation relevant to the PCSP Department e.g. Policing NI Act 2000, Justice Act 2011 and The Rehabilitation of Offenders Act (only some of these have been included in the register)

Cycling proficiency training is not currently included in the training matrix for the Community Safety Wardens (matrix revised to include cycling proficiency but no entries made as yet)

The experience and qualifications of R. Houston from the Strabane District Council in the area of risk assessments are not being fully utilised by the HS & Welfare teams (he is now being used as the Council’s full-time H&S trainer)

There is currently no system in place whereby anyone from the Council checks the Booking Forms used by groups and individuals when booking Council amenities are properly completed and evidence of information has been verified e.g. in relation to child protection, risk assessments, equipment PAT tested etc. (revisions made to the Application for Hire Form)

There was no PAT test sticker on the hotplate in the site office on the Brandywell Civic Amenity Site (now there is)

The Council’s waste management licence(s) issued by the NIEA still refer to Derry City Council (legally cannot be changed until the next issue of the licences)

Several items of old electrical equipment were seen in the stores of the Templemore Leisure Centre which have been left there after the Lisnagelvin site closed down - these have not been PAT tested and should either be sent for recycling or suitably marked for use as parts (some have been dumped and some have been marked as spare parts)

This audit has raised no noncompliances but has raised twenty opportunities for improvement.

No threats to the system have been noted during this audit.



Impact of Significant Changes (if any)

The reorganisation of the Council’s corporate management structures continues after its amalgamation with Strabane District Council on 1st April 2015 and the operation of the OHSMS has successfully mirrored these changes.

Additional Information / unresolved issues

Central System ControlsClause 4.2: Environmental and OH&S Policies:The Corporate Health Safety and Wellbeing Policy statement is included in the Health Safety and Wellbeing Policy and authorised annually by the new Mayor as well as the current Town Clerk & Chief Executive. This was done by Mayor Brenda Stevenson and Sharon O’Connor respectively on 30/06/2014 and is displayed in the offices throughout the Council properties. All requirements of 4.2 for OHSAS 18001:2007 are covered in this policy.

Clause 4.3.1: Hazard Identification, Risk Assessment and Determining Controls:Risk assessments reviewed and these are updated as and when required by the Sectional Managers. Evidence exists that staff have read and understood the risk assessments relevant to their work through training and tool box talks. In addition the Department requests subcontractors to submit risk assessments / method statements before being allowed to work on Council premises. Evidence exists that the Department reviews subcontractors’ risk assessments / method statements for approval before being permitted to work on Council premises.

Clause 4.3.2: Legal and Other Requirements:The initial Register of Relevant Legislation was created on 4/03/2011 by an external consultant and contains all current environmental and health and safety legislation relevant to Northern Ireland. This register is reviewed at least annually and updated if necessary – the last update was on 4/08/2014 and recent changes highlighted in red font. Checked it against various websites such as HSENI etc. and found that it is accurate. This latest review covered the additional legislation applicable to the extension to scope activities / departments.

Clause 4.3.3: Objectives, Targets and Programmes:Health, safety and wellbeing objectives and targets are set at the start of each calendar year. These are reviewed at various departmental and management levels monthly, quarterly and every six months. Currently there are twelve open health, safety and welfare objectives and targets.

Clause 4.4.1: Resources, Role, Responsibility and Authority:Adequate resources have been provided for the management of health and safety within the Department. Roles, responsibilities and authorities have been adequately defined in the Health Safety and Wellbeing Policy and within individual procedures.

Clause 4.4.2: Competence, Training, and Awareness:Training and competence records of employees was reviewed. Refresher training is given to all staff through regular training sessions including toolbox talks for Operatives. All new staff (even temporary workers) are given health safety and wellbeing awareness training as part of their induction to the Council. All staff are listed on the Council’s training matrix and individual training records including a training matrix are maintained for various areas including:-

Fire prevention and emergency First aid COSHH Manual handling Use of electricity and power tools



Abrasive wheels DSE / VDU Working at heights (including client sites) PPE Safe forklift operations Safe driving Part time staff e.g. cleaners Street Cleansing / Public Realm Maintenance, Refuse Collection, Waste & Resource Management Spillages

Checked training records for various staff interviewed during the audit including:- Adrian McCourt, Uel Borland, Paul Higgins, Tony McGilloway, Steve Setterfield, Donna Philson,

Danny McCartney, Bertie Magee, Conor Feeney, Emma Barron, Raymond Magee, Kieran Dunne, Gary McMenamin and John Quinn

Clause 4.4.3: Communication, Participation and Consultation:Excellent internal communication implemented through system of notices, emails, memos. External communications aided by the Council’s website www.derrycityandstrabanedistrict.com. There are several health, safety and wellbeing committees and the Department operates an open door policy to the management team. External health safety and wellbeing communications with third parties, the public, suppliers and other interested parties are held on file. Records reviewed and observed to be in place: Notices on notice boards Communications with HSENI Risk assessments Induction and refresher training records

Clause 4.4.4: Documentation / Clause 4.4.5: Control of Documents:All documents detailed in 4.4.4 are in place as a part of the IMS. All OHSMS documentation is controlled on the server as read only documents. The Health Safety and Wellbeing Policy dated 30/06/2014 describes the OHSMS. Twenty-two procedures have been issued to cover all high risk areas and processes – these are at various issues. No hard copies of the OHSMS manual and procedures have been printed but all office-based personnel can access them on the server. Site-based personnel are kept up to date on OHSMS changes through toolbox talks.

Clause 4.4.7: Emergency Preparedness and Response:Environmental incident reporting procedure implemented. No incident reports raised to date. Emergency lighting, burglar and fire alarms tested four times per year by external contractors – visit different at different times annually. Fire extinguishers are serviced by Gladeon again at different times for different sites. Fire drills are conducted at least annually to cover all offices, stores and the maintenance workshop. Records reviewed and seen to be in place:

Fire alarm systems tested by external contractors – serviced annually Fire extinguisher service is carried out annually by external contractors Evacuation drills conducted at least annually Emergency signage in place on all exit doors Fire wardens appointed and trained First aiders appointed and trained Suitable and sufficient COSHH assessments in place and available All hazardous materials properly stored and locked

http://www.derrycityandstrabanedistrict.com/



Clause 4.5.1: Performance Measurement and Monitoring:The Department monitors its health, safety and wellbeing performance and figures are currently being collected as a basis for future year-on-year comparisons and for setting objectives and targets.

Clause 4.5.2: Evaluation of Compliance:Compliance checks against relevant Northern Ireland are carried out at least annually with the help of an external consultant, usually at the same time as the updating of the Register of Relevant Legislation – last check was on 4/08/2014 – no issues were raised.

Clause 4,5,3.1: Accident / Incident Investigation:Not covered during this audit

Clause 4.5.3.2: Nonconformity, Corrective and Preventive Action:Not covered during this audit

Clause 4.5.4: Control of Records:All IMS records are maintained by the Department in various files and folders in the offices. Retention periods are now defined as a minimum of two years. Adequate back up procedures are in place for all electronic records.

Clause 4.5.5: Internal Audit:A full set of internal audits of the OHSMS was carried out by an external Consultant in 2014 – all issues were closed out. The 2015 Audit Schedule is in place and is due to finish in November 2015. Some nonconformances remain open.

Clause 4.6: Management Review:A Management Review of the OHSMS is carried out by the management team every six months – the last meeting was during March 2015 and attended by the senior management personnel and an external consultant. Comprehensive minutes taken including action points which are monitored by the various health, safety and wellbeing teams and committees. Management Review meetings cover all of the requirements of 4.6 of the Standard.

Operational Controls

The Council is divided into three Directorates:- Environment and Regeneration Directorate Business and Culture Directorate Health and Community Directorate

In addition there are three ‘cross-cutting’ units serving all three Directorates:- Governance Unit Improvement Unit People Unit (HR)

These directorates are divided into various services and departments which operate over many sites and offices. Currently the OHSMS covers only Derry City but plans are in place to add Strabane District to the scope later in 2015. Derry City has two main administration sites at the Skeoge Operating Centre and the head offices on Strand Road in the centre of the city. The Strand Road site is a five storey office block with parking facilities. The Skeoge site is a large workshop and stores facility with vehicle parking area with a number of offices, canteen and training room. Street Cleansing & Public Realm Maintenance, Refuse Collection, Waste & Resource Management practices in place and heating is by gas boilers which are serviced annually by local SafeGas registered company. Storage of fuels, oils and chemicals on the Skeoge is well controlled as are activities of contractors on site. The OHSMS is maintained by a number of health and safety committees and teams overseen by the Corporate Health and Safety Officer, Oonagh O’Doherty. Health, safety and welfare planning is mainly carried out in the head offices while the operational records are often held on individual council



sites and properties including (as appropriate):- PPE issue records and usage Induction records / toolbox talk records Accident and incident reports State of tools, vehicles and equipment PAT test indicators and records Working at heights / edge protection State of ladders and stairs State of storage racking Storage of hazardous materials / COSHH State of electrical equipment Noise, dust and smells Flammable goods storage Contractors / visitors site induction training records Contractors’ permits to work Contractors’ Method Statements / competence certificates / insurance records MSD Sheets and COSHH assessments for materials being brought on to site by subcontractor Evidence that staff have read and understood the risk and COSHH assessments

Environment and Regeneration Directorate Clause 4.4.6 Operational Control - Property, Plant & Fleet Asset Maintenance – Fleet Management:Not covered during this audit

Clause 4.4.6 Operational Control - Property, Plant & Fleet Asset Maintenance – Electrical & Mechanical:Visited two jobs being carried out at Templemore Sports Complex and Irish St Community Centre where electrical and mechanical works were being carried out by Barney Robinson, Willie Meehan and Conor Feeney. The works included changing out old 2 x 2 modular light fittings with new LED light panels and testing water temperatures in the changing rooms at Irish St Community Centre’s playfield changing rooms. Checked records for this job back in the Skeoge depot with Paul Higgins and Tony McGilloway for:- Ladder inspections for ladder ME 49 – due November 2015

Several observations were noted during these site visits and are listed at the start of this report.

Clause 4.4.6 Operational Control - Property, Plant & Fleet Asset Maintenance – Controlled Properties:Not covered during this audit

Clause 4.4.6 Operational Control - Property, Plant & Fleet Asset Maintenance – Council Premises:Toured the Skeoge premises with Fleet Manager Bertie Magee concentrating on external areas only. The traffic management system on this site is still temporary after over three year’s occupancy and continues to pose a risk to pedestrians and drivers alike. The Council’s management team is aware of this situation but cannot resolve it until the most efficient use of the site can be determined. In addition this department oversees the maintenance of over 100 buildings under the Council’s control. Operational controls of these Council-owned and operated buildings includes carrying out risk assessments, controlling contractors, vehicle check records, training and competence records and property inspection records. These records include:- Electrical services Boiler services Lightning protection Emergency lighting



PAT testing Fire alarm maintenance Generators Air handling units

Several observations were noted during the Skeoge site tour and are listed at the start of this report.

Clause 4.4.6 Operational Control - Property, Plant & Fleet Asset Maintenance – Contractor Vetting and Controls:Not covered during this audit

Clause 4.4.6: Operational Control – Street Cleansing & Public Realm Maintenance, Refuse Collection, Waste & Resource Management - Household Collections and Disposals:Followed Household Waste Collection team of Raymond Magee, Kieran Dunne and Sean McGowan along part of the Gransha Road route including Judge’s Road. They were operating the 26 tonne waste collection vehicle registration TUI 8224 (Asset No. 150). Followed this vehicle to the waste transfer station in Newbuildings and observed it empty its load. Also on site were 15 tonne waste collection vehicle TUI 5086 (Asset No. 147), skip lorry TUI 4250 (Asset No. 432) and River Ridge skip lorry Reg. PO 56 OER carrying Council skip 012.

Several observations were noted during this site visit and are listed at the start of this report.

Clause 4.4.6: Operational Control – Street Cleansing & Public Realm Maintenance, Refuse Collection, Waste & Resource Management - Civic Amenity Centres:Not covered during this audit

Clause 4.4.6: Operational Control – Street Cleansing & Public Realm Maintenance, Refuse Collection, Waste & Resource Management – Street Cleansing:Not covered during this audit

Clause 4.4.6: Operational Control – Parks, Play and Greenway Development. Grounds Maintenance and Cemeteries - Parks and Open Spaces:Visited St Columb’s House and St Columb’s Park with Oonagh O’Doherty, Jason Flood, Emma Barron and Gary McMenamin. A Park Rangers’ hut is being constructed on this site for use by the Council’s six Park Rangers who operate across the city. Emma demonstrated an excellent new site audit tool which will be rolled out for use on iPads by Council staff including the Park Rangers.

Clause 4.4.6: Operational Control – Parks, Play and Greenway Development. Grounds Maintenance and Cemeteries - Grounds Maintenance:Checked records in office with Margaret Donaghy in relation to the control of subcontractors used in grounds maintenance. Noted that the RAMS submitted by the two firms currently being used by the Council had no names, dates, signatures or any connection to these firms and it is therefore not clear how these have been accepted by the management of this department. Checked records of subcontractor inspections carried out by William Ferguson on Elagh Tree Services on 30/08/2015 at Lisnagelvin Playing Fields. Also checked records of inspections of works carried out by Council staff e.g. by Paul Coyle on 2/09/2015 at City Cemetery on three Operatives – D Thompson, A Burrell and A Curry. All issues noted during these inspections are reported to Kathleen Keely in Skeoge as well as the Property and Fleet teams using the POWRA Action Log (Point of Work Risk Assessment) – e.g. 4/09/2015 – noted by Squad 1 who were grass cutting at Prehen Playing Fields noted the gate beside the changing rooms needed replacing.

One observation was noted during this site visit and is listed at the start of this report.



Clause 4.4.6: Operational Control – Parks, Play and Greenway Development. Grounds Maintenance and Cemeteries – Cemeteries:Visited Altnagelvin Cemetery with Danny McCartney and Shaun Boyd. Toured the graveyard as well as the small site office, stores, toilets, dry room and public toilets. Very few records are held on this site as it is only manned during funerals and when maintenance works are being carried out such a grass cutting, opening of graves and grave level top up works. Checked records for legionella flushing of toilets and external water taps – last done 30/07/2015. Checked PAT test stickers in kitchen – last done 9/03/2015. Checked first aid kit. Checked for records of statutory inspections of the trench box and pump – not available although reported to have been done by MIMS NI Ltd.

One observation was noted during this site visit and is listed at the start of this report.

Clause 4.4.6: Operational Control – Capital Development and Building Control - Capital Development and Project Management:Not covered during this audit

Clause 4.4.6: Operational Control – Capital Development and Building Control - Civil, Architectural and Technical Design Services:Not covered during this audit

Clause 4.4.6: Operational Control – Capital Development and Building Control - Building Control and Property Certificates:Not covered during this audit

Business and Culture Directorate Clause 4.4.6: Operational Control – Business - Economic Development and Job Creation:Not covered during this audit

Clause 4.4.6: Operational Control – Business - Rural Development:Not covered during this audit

Clause 4.4.6: Operational Control – Business - City and Regional Investment Opportunity:Not covered during this audit

Clause 4.4.6: Operational Control – Business - Business Support and Engagement, Employment Skills and Training:Not covered during this audit

Clause 4.4.6: Operational Control – Business - Procurement Business ICT and Digital:Not covered during this audit

Clause 4.4.6: Operational Control – Culture - Tourism, Arts and Culture:Not covered during this audit

Clause 4.4.6: Operational Control – Culture - Events, Festival Programming and Management:Not covered during this audit

Clause 4.4.6: Operational Control – Culture - Visitor Services, Heritage and Museums:Visited one visitor centre at the Guildhall in the centre of the city during this audit. Interviewed Uel Borland and Adrian McCourt.

The following were checked during this visit:- Site risk assessments and safe systems of work Building fire risk assessment Staff training and qualifications records



Access to the OHSMS on the server including to Normal Operating Procedures Communications with head office Operational controls Emergency preparedness including emergency signage

Several observations were noted and are listed at the start of this report.

Clause 4.4.6: Operational Control – Culture - Marketing, Branding and Promotions, Media and PR:Not covered during this audit

Health and Community DirectorateClause 4.4.6: Operational Control – Community Development and Leisure - Community Services:Not covered during this audit

Clause 4.4.6: Operational Control – Community Development and Leisure - Children and Young People:Not covered during this audit

Clause 4.4.6: Operational Control – Community Development and Leisure - Community and Good Relations:Not covered during this audit

Clause 4.4.6: Operational Control – Community Development and Leisure - Policy and Community Safety Partnership (PCSP):Not covered during this audit

Clause 4.4.6: Operational Control – Community Development and Leisure - Leisure Services and Sports Development:Visited one leisure centre at Foyle Areana Leisure Center in St Columb’s Park Sports Complex during this audit. Interviewed various site management and staff including Centre Manager Steve Setterfield, Jayson McIntyre one of the Duty Managers and Donna Philson Climbing Wall Instructor,

The following were checked during this visit:- Site risk assessments and safe systems of work COSHH assessments Building fire risk assessment Staff training and qualifications records Staff vetting records Access to the OHSMS on the server including to Normal Operating Procedures Communications with head office Health and safety files and records including building maintenance records PAT test records Chemical storage and availability of COSHH assessment sheets Operational controls Emergency preparedness including emergency signage Pest control records Accident and incident records Water testing records Statutory equipment test records

Several observations were noted and are listed at the start of this report.



Clause 4.4.6: Operational Control – Health and Community Wellbeing – Environmental Health, Health promotion, Environmental Promotion and Control:Not covered during this audit

Clause 4.4.6: Operational Control – Health and Community Wellbeing – Animal Welfare:Not covered during this audit

Clause 4.4.6: Operational Control – Health and Community Wellbeing – Public Event Safety:Not covered during this audit

Clause 4.4.6: Operational Control – Health and Community Wellbeing – Registrar Services:Not covered during this audit

Clause 4.4.6: Operational Control – Health and Community Wellbeing – Licensing and Street Trading:Not covered during this audit

Clause 4.4.6: Operational Control – Health and Community Wellbeing – Public Conveniences:Not covered during this audit

Cross Cutting Services

Clause 4.4.6: Operational Control – Cross Cutting Services – Governance Unit:Not covered during this audit

Clause 4.4.6: Operational Control – Cross Cutting Services – Improvement Unit:Not covered during this audit

Clause 4.4.6: Operational Control – Cross Cutting Services – People Unit:Not covered during this audit

^

Section 5: Client’s acknowledgement

The client acknowledges the content in the report and the attached nonconformities (if applicable).

Management Representative

Name Oonagh O’Doherty

Address As above

Report acknowledged by (if different)

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