Title Page

  • Office Location

  • Conducted on

  • Conducted by

  • Document No.

1.0 Employee Facilities

Source of Risk - Unhygienic conditions, poor housekeeping, lack of supplies, lack of consideration for fellow workers.

  • Reference Document - Code of Practice Managing the Work Environment & Facilities
    http://www.safework.nsw.gov.au/__data/assets/pdf_file/0016/50074/managing-work-environment-facilities-code-of-practice-3567.pdf

  • 1.1 Is the meals area kept clean? (Floor swept, tables wiped down etc)

  • 1.2 Are tables and chairs in good condition?

  • 1.3 Is the food preparation area and sink clean? (Dishes in sink, bin full)

  • 1.4 Is the fridge clean? (Mouldy, rotting or expired food or beverages)

  • 1.5 Is the microwave clean (check internally)

  • 1.6 Are the toilets facilities clean & sanitary? (used hand towel on floor, hand basins not cleaned, slip hazard form wet floor)

  • 1.7 Is there spare toilet paper available?

  • 1.8 Is there sufficient amounts of liquid soap?

  • 1.9 Where applicable, are there sufficient hand towels available?

2.0 Emergency Planning & Fire Safety

Source of Risk – Uncontrolled fire, confusion during evacuation, loss of life, damage to property.

  • Reference Document - WHS Regulations Clause 43
    https://www.legislation.nsw.gov.au/#/view/regulation/2017/404/chap3/part3.2/div4/sec43

  • Emergency Planning

  • 2.1 Is the Emergency Evacuation Plan displayed on?

  • 2.2 Is the Emergency Control Organisation team poster displayed?

  • 2.3 Are emergency exit doors clear of obstructions? (clearance of 1 metre both internally & externally when doors open)

  • 2.4 Is illuminated exit lighting functioning correctly? (constantly illuminated, no flicker)

  • Fire Safety

  • 2.5 Are portable fire extinguishers and/or fire hose reels serviced at 6 monthly intervals? (check tag for punch mark)

  • 2.6 Are portable fire extinguishers and/or hose reels clears of obstructions and easily accessible? ( minimum 1 metre x 1 metre clearance)

  • 2.7 Are any fire extinguishers missing from locations indicted with permanent signage?

  • 2.8 Is there any permanent signage missing to indicate the location of fire extinguishers or hose reels?

  • 2.9 Is all permanent signage clearly visible?

3.0 First Aid

Source of Risk – Unhygienic conditions, infection, unable to provide correct first aid, workers unaware of first aiders.

  • Reference Document - Code of Practice First Aid in the Workplace
    http://www.safework.nsw.gov.au/__data/assets/pdf_file/0015/52152/first-aid-in-the-workplace-code-of-practice-July-2015-3834.pdf

  • 3.1 Is the list of trained First Aiders and emergency contact numbers displayed?

  • 3.2 Is there clear access to the First Aid cabinet?

  • 3.3 Is the First Aid Cabinet sufficient stocked?

  • 3.4 Is there clear access to the First Aid Cabinet?

4.0 General Housekeeping

Source of Risk – Unsafe Work Environment

  • Reference Document - Code of Practice Managing the Work Environment & Facilities
    http://www.safework.nsw.gov.au/__data/assets/pdf_file/0016/50074/managing-work-environment-facilities-code-of-practice-3567.pdf

  • 4.1 Are entry ways and walkways kept clear? (free of trip hazards and obstacles)

  • 4.2 Is there adequate lighting to all entry ways and walkways?

  • 4.3 Are all stairways kept clear? (free of trip hazards and obstacles)

  • 4.4 Is there adequate lighting to all stairways?

  • 4.5 Are stairway handrails secure?

  • 4.6 Is the office floor free of debris?

  • 4.7 Do all work stations have adequate lighting?

  • 4.8 Are workstation waste bins emptied as required?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.