Annual Workplace Safety Assessment

• Site:

• Prepared by

• Conducted on

  Date
• Location
  Address

• Personnel

Emergency Planning

• Emergency Management Plan in place?

  Yes

  No

• Further Comment:

• Evacuation Diagrams current? (within 5 years)

  Yes

  No

• Date of issue?

  Date

• Evacuation Diagram relevant to building?

  Yes

  No

• Further comment:

• Exit signs clearly visible?

  Select Signs above emergency exit doors Illuminated Signs in place No signs above doors No Illuminated signs in place

  • Signs above emergency exit doors
  • Illuminated Signs in place
  • No signs above doors
  • No Illuminated signs in place

• Does site have Emergency Preparedness Kit? Fully Stocked?

  Yes

  No

• List of contents:

  Select Flashlight Radio Customer Medication List Customer Photo Id Emergency Summary Sheet No Flashlight No Radio No Customer Medication List No Customer Photo Id

  • Flashlight
  • Radio
  • Customer Medication List
  • Customer Photo Id
  • Emergency Summary Sheet
  • No Flashlight
  • No Radio
  • No Customer Medication List
  • No Customer Photo Id

• Fire Warden poster on display (inc photos)?

  Yes

  No

• Fire Drills conducted?

  Yes

  No

• Verified?

  Yes

  No

• Further Comment:

Emergency Equipment

• Fire extinguishers in place?

  Select Checked in last 6 mths Not checked in last 6 months Signs in place above equipment No signs above equipment Fire blanket in kitchen No fire blanket

  • Checked in last 6 mths
  • Not checked in last 6 months
  • Signs in place above equipment
  • No signs above equipment
  • Fire blanket in kitchen
  • No fire blanket

• List of other emergency systems in place:

  Select Smoke Alarms Emergency Lighting Sprinklers No smoke alarm No emergency lighting No sprinklers

  • Smoke Alarms
  • Emergency Lighting
  • Sprinklers
  • No smoke alarm
  • No emergency lighting
  • No sprinklers

• Emergency systems checked monthly? (sprinklers, alarms etc)

  Yes

  No

• Staff trained in emergency procedures within last 12 months?

  Select Yes Training conducted No Training not conducted

  • Yes Training conducted
  • No Training not conducted

• Training to be requested:

  Within 7 days

  By end of month

• Is there an emergency box, located next to First Aid Kit?

  Yes Training conducted

  No Training not conducted

• Further Comment:

Policy and Procedures

• https://nula.northcott.local/my-employment/whs#0

• Both WHS and Injury Management Policies on display?

  Yes

  No, not required

• If You Are Injured poster on display?

  Yes

  No, not required

• EAP poster on display?

  Yes

  No, not required

• SOP's SWP's accessible to all staff?

  Yes

  No, not required

• Safety Committee meetings on display?

  Yes

  No, not required

• Further Comment:

Risk Assessments

• Risk Assessments on file?

  Pass

  Fail

• Current (created in last 12 months)

  Yes

  No, not required

• Training provided on day of assessment.

  Yes

  Date for training scheduled

• Training provided on day of assessment?

  Yes

  No, not required

• Do staff report hazards?

  Yes

  No, not required

• Training provided on day of assessment.

  Yes

  Date for training scheduled

• Further Comment:

Facilities

• Bathrooms clean with adequate supplies soap/hand towels etc

  Select Clean Private Paper Towels Soap Accessible Unclean Not Private No Paper Towels No Soap Not Accessible

  • Clean
  • Private
  • Paper Towels
  • Soap
  • Accessible
  • Unclean
  • Not Private
  • No Paper Towels
  • No Soap
  • Not Accessible

• Dining Facilities clean

  Select Clean Dining area is communal Separate dining area to communal area Staff choose where to dine No dining area provided Dining area not clean

  • Clean
  • Dining area is communal
  • Separate dining area to communal area
  • Staff choose where to dine
  • No dining area provided
  • Dining area not clean

• Parking area within 100 m of work area?

  Select Yes - On Street Parking Yes - Parking available on property No

  • Yes - On Street Parking
  • Yes - Parking available on property
  • No

• Is street well lit?

  Yes

  No, not required

• Is there a footpath installed?

  Footpath in place

  No Footpath

• Home has adequate exterior lighting?

  Yes

  No, not required

Manual Handling

• Customer profiles contain Manual Handling Plans?

  Yes all customers

  Some not all

  No, not required

• Measures in place to prevent falls?

  Yes

  No, not required

• List of measures in place:

  Select Rails in bathrooms Rails throughout home interior Rails at steps and ramps Rails not required Rails needed, not installed

  • Rails in bathrooms
  • Rails throughout home interior
  • Rails at steps and ramps
  • Rails not required
  • Rails needed, not installed

• List manual handling equipment used:

  Select No equipment used Wheelchairs Hoists Commode Shower bed Hi Lo bed

  • No equipment used
  • Wheelchairs
  • Hoists
  • Commode
  • Shower bed
  • Hi Lo bed

• Equipment register in place?

  Yes

  No, not required

• Equipment last serviced?

  Select Not serviced Serviced within last 6 months Serviced within last 12 months

  • Not serviced
  • Serviced within last 6 months
  • Serviced within last 12 months

• Procedure in place to isolate broken equipment?

  Yes

  No, not required

Electrical

• List areas Test / Tagged

  Select Customer bedrooms Office Common Areas (kitchen, lounge, laundry etc) Office only No customer bedrooms No Common Areas (kitchen, lounge etc)

  • Customer bedrooms
  • Office
  • Common Areas (kitchen, lounge, laundry etc)
  • Office only
  • No customer bedrooms
  • No Common Areas (kitchen, lounge etc)

• Are there any electrical faults (broken power points etc) to be reported?

  No

  Yes

• Have Hume/Facilities been notified?

  Select Hume Facilities

  • Hume
  • Facilities

Chemicals

• Chemicals stored in well ventilated area?

  Yes

  No, not required

• Chemical register in place?

  Yes

  No, not required

• Safety Data Sheets current?

  Yes

  No, not required

• Chemicals decanted into labelled bottles?

  Yes

  No, not required

• Further Comment:

Training

• Have all staff completed the 5 mandatory training modules?

  All staff trained

  Training partially completed

  All staff training outstanding

• Training to be requested:

  Within 7 days

  By end of month

Inductions

• All staff completed onsite inductions?

  Compliant

  Non-Compliant

• Submitted to L&D?

  Yes

  No, not required

• All visitors sign in upon arrival?

  Yes

  No, not required

• All visitors advised of emergency procedures and evacuation point as part of the induction?

  Yes

  No, not required

• Further Comment:

Incidents

• Have there been reported injuries (last 12 months)?

  Select No Yes LTI MTI FAI Notification Only

  • No
  • Yes
  • LTI
  • MTI
  • FAI
  • Notification Only

• Cause of injury sustained?

  Select Slip/Trip Manual Handling Customer Behaviour Vehicle Accident Psychological

  • Slip/Trip
  • Manual Handling
  • Customer Behaviour
  • Vehicle Accident
  • Psychological

Signatures

• WHS Representative

  Sign

• Site Representative

  Sign