Title Page

  • Site conducted

  • Location/Site
  • Contractor

  • Conducted on

  • Prepared by


Pre-Site Visit Checks

  • Confirmed if tenant risk rating exists. If yes, identify response.

  • Confirmed if property risk info exists. If yes, identify response

  • Arranged visit as per established protocols.

Pre-Entry Site Checks

  • Up-to-date hazard board displayed at site entrance

  • Carrying Site Safe Passport and wearing correct PPE for this site

  • Site access control and induction protocol observed

  • Site Hazards (Select the applicable hazard or note any others)


Signage and Site Access

  • Warning signs and hazard board displayed.

  • Site access control and induction in place.

  • Current SSSP available on site and evidence of use.

Site General

  • Workplace is tidy and orderly, free of trip hazards.

  • No excessive dust, noise, heat and surface water.

  • Waste is segregated and managed appropriately.

  • Exposed reinforcing bars are capped.

  • Traffic management is provided.

PPE and Manual Handling

  • PPE is used in accordance with the hazard board

  • Specialist PPE is used where required

  • Acceptable manual handling for the tasks observed

Working at Heights

  • Fall hazards identified and suitably barriers in place.

  • No Elevated Work observed within 4 metres of power lines.

  • Ladders in use meet Work Instruction guidelines.

  • Scaffold in use meets Work Instruction guidelines.

Electrical Hazards

  • Power supplies have RCD protection

  • Leads have valid test tags, are in good condition, dry.

  • Other considerations.

Hazardous Substances

  • Management of asbestos complies with acceptable practice.

  • Management of lead-based complies with acceptable practice.

  • Management of other hazardous substances is in line with acceptable practice.

Other Observations

  • Record any other significant observations, including conversations with site personnel.

Observation Summary

  • Does site management comply with HNZ’s requirements, SSSP?

  • If ‘No’, identify corrective action required, and carry forward summary to Site Visit Report form.


Attached forms:

  • Hazard Self-assessment

  • Health and Safety Observation

  • Observations / Work in Progress

  • Personnel, Plant and Equipment on Site

  • Communications with Contractor

  • Health and Safety Observations

  • Actions Required

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