Title Page

  • Conducted on

  • Property Name

  • Prepared by

  • Location

Outside of Property

Outside of Property

  • Lawn - good condition and recently mown<br>

  • Gardens - not overgrown and clear of weeds<br>

  • Paths, Parking & Driveways - not broken, no uneven surface, clear of weeds<br>

  • Front Door and Entry - door/entry opens and locks

  • Any other comments

Bedroom / Single Room Accommodation

  • Add a new section for each bedroom or single room accommodation unit located at the property. Name each room to make it easier to identify.

  • Bedroom / Single Room Accommodation
  • Room Name

  • Windows <br>(glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Airconditioner/Heater/Fan<br>Not working, missing remote<br>

  • Smoke Alarm and/or Fire Extinguisher<br>Removed, not working

  • Beds <br>Broken, bunk not secure

  • Storage<br>Missing, broken drawers, broken door<br>

  • TV<br>Broken, not secure, missing remote

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Bathroom

  • Add a new section for each Bathroom located at the property. Name each room to make it easier to identify.

  • Bathroom
  • Shared or Single Person?

  • Room Name

  • Windows <br>Glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Exhaust / Fan<br>Not working, signs it's not being used (mould)

  • Vanity Unit / Basin<br>Condition, doors / drawers broken, hot/cold taps working

  • Shower<br>Shower head working, hot and cold taps working, shower relatively clean and free from mould

  • Toilet<br>Flushing, functioning

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Kitchen

  • Add a new section for each Kitchen area located at the property. Name each room to make it easier to identify.

  • Kitchen
  • Shared or Single Person?

  • Room Name

  • Windows <br>Glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Smoke Alarm and/or Fire Extinguisher and/or Fire Blanket<br>Removed, not working

  • Cupboards<br>Broken doors/drawers, missing

  • Oven and Stove<br>Broken, not cleaned

  • Microwave<br>Broken, not cleaned

  • Fridge<br>Broken, full, not cleaned, leaking

  • Sink<br>Hot/Cold taps work, clean, functioning

  • Cookware and Cutlery<br>Enough cutlery, cookware, plates, etc, for people

  • Food storage<br>Food being stored safely and away from pests

  • Exhaust / Fan<br>Not working, signs it's not being used (mould)

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Lounge Room / Recreation Room

  • Add a new section for each Lounge/Recreation area located at the property. Name each room to make it easier to identify.

  • Lounge Room / Recreation Room
  • Room Name

  • Windows <br>(glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Airconditioner/Heater/Fan<br>Not working, missing remote<br>

  • Smoke Alarm and/or Fire Extinguisher<br>Removed, not working

  • TV<br>Broken, not secure, missing remote

  • Lounge<br>Broken, missing cushions, dirty not sufficient for workers

  • Furniture<br>Missing, broken drawers, broken door<br>

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Dining Area

  • Add a new section for each Lounge/Recreation area located at the property. Name each room to make it easier to identify.

  • Dining Area
  • Room Name

  • Windows <br>(glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Airconditioner/Heater/Fan<br>Not working, missing remote<br>

  • Smoke Alarm and/or Fire Extinguisher<br>Removed, not working

  • Table<br>Broken, missing, not big enough

  • Chairs<br>Broken, missing, dirty, not enough for number of workers living there

  • Furniture<br>Missing, broken drawers, broken door<br>

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Laundry

  • Add a new section for each Laundry located at the property. Name each room to make it easier to identify.

  • Laundry
  • Room Name

  • Windows <br>Glass broken not opening or closing, missing handle, no locks.<br>

  • Blinds / Curtains <br>Not on window, not able to open/close, broken, ripped, torn

  • Doors<br>Not opening/closing, broken glass/wood/etc, no able to lock, handle broken

  • Flyscreens<br>Holes, not opening/closing, missing

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Walls<br>Holes, new stains, mould, marks

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Washing Machine<br>Working, not mouldy, electrical connections safe

  • Dryer <br>Working, not mouldy, electrical connections safe

  • Clothes Line<br>Functioning

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

Other

  • Add sections as appropriate

  • BBQ Area
  • Workers only or Public Area

  • Room Name

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Lighting<br>Working, sufficient for room

  • Smoke Alarm and/or Fire Extinguisher and/or Fire Blanket<br>Removed, not working

  • BBQ<br>Broken, not cleaned

  • Gas bottle<br>Switched off when not used, safely stored

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

  • Outdoor Patio
  • Room Name

  • Flooring<br>Holes, torn, new stains, broken tiles, uneven surface

  • Ceiling<br>Holes, stains, mould

  • Lighting<br>Working, sufficient for room

  • Table<br>Broken, missing, not big enough

  • Chairs<br>Broken, missing, dirty, not enough for number of workers living there

  • Electrical<br>All cords have been tested and tagged within timeframe, cords are free from damage and safe

  • Cleanliness, Hygiene, Rubbish<br>Relatively clean and tidy, no rubbish or uncovered food left out

  • Safety <br>Any other matters that may present an unsafe condition for workers<br>

  • Comments

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.