Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Untitled Page

Training and Supervision

  • Training is treated as a valuable investment and is scheduled regularly

  • The Training provided by the company is effective

  • Supervisors, managers, and workers have safety training that is appropriate to their job

  • Everyone is aware of potential risks that exist and make efforts to mitigate them

  • I understand my rights and responsibilities under the Occupational Health and Safety at Work Act

  • We all get induction training when we start

  • We all get trained in safe work procedures for our jobs

  • I can describe what steps within my job are safety critical

  • I can identify the hazards associated within the job

  • I can describe how to report a hazard, near-miss or injury

  • Our manager/supervisor makes sure we can do the work safely

  • We are always made aware of safety issues

Safe Work Procedures

  • Our employer has safe work procedures for all task-based activities in my area that have safety risks

  • Workers are always involved in reviewing safe work procedures

  • I know about the risk assessments and safe systems of work for my job, and I take them seriously

  • The risk assessments and safe systems of work for my job are not fit for purpose

  • Safety policies are clear and well understood through the organisation

  • PPE is provided and worn properly by all workers and managers if it is required

  • My PPE is comfortable

  • Workplace safety and wellbeing is important to me

  • Supervisors, managers enforce health and safety rules and standards across the organisation

  • Supervisors, managers enforce health and safety rules and standards with appointed contractors

  • We always follow safe work procedures

  • Our employer reviews and updates our safe work procedures regularly

  • We have enough time to learn our safe work procedures

  • We always do a risk assessment when we start a new process or when a process is changed

  • I can identify the exit route that should be used during an emergency

  • I am aware of what action should be taken when a fire alarm is sounded

  • I am aware of the fire assembly point number

  • I am aware of the fire alarm testing day

  • Entrances and exits are free of blockages

  • Work areas are clean and tidy

  • Guards are present across all work equipment

  • Guards are being used, where fitted

  • Equipment is available to assist with heavy lifting where required

  • There is a preventative maintenance program in place for all machinery / work equipment

  • Fire extinguishers are present and have been checked within the last 12 months

  • My work area is free from slip, trip and fall hazards

  • Equipment is available to assist with bending, twisting, or over-reaching

  • The standards of house-keeping within my area of work are high

  • The walking surfaces within my area of work are free from slip, trip and fall hazards,

Consultation & Communication

  • Managers communicate with us and listen to us about health and safety

  • Management always takes notice of what we say about safety

  • I regularly receive communication from my supervisor about health and safety matters i.e. toolbox talks etc

  • We always get feedback (eg minutes, tool box talks) on what’s happening with our safety issues within seven days

  • Each department participates in safety communication initiatives, such as safety talks

  • There is evidence of company-wide communication regarding matters that affect both health and safety and changes in safe working procedures

  • All workers are aware of their rights to participate, know, and refuse unsafe work

  • Workers participate in safety surveys or other platforms where they can have a say in safety

  • We know who our safety committee member (or safety rep) is

  • If there has been an injury in the department, I can describe the cause and corrective actions associated with the incident

  • Managers/supervisors mean what they say and do what they say, in safety matters

Reporting Safety

  • We have safety reporting procedures (for incidents and issues), and we use them

  • I know who the first aiders are

  • We are always encouraged to report safety incidents

  • All incidents, near-misses, and unsafe or unhealthy conditions are reported

  • All incidents, near-misses, and unsafe or unhealthy conditions are investigated, and new, more robust control measure implemented

  • Notices boards are displayed in your work area that contain safety information

  • Safe work procedures are always reviewed and updated if there is an incident report, to find out why the incident happened and how to fix it

  • I would feel confident refusing to work in unsafe conditions

  • When hazards are reported, they are addressed immediately or as soon as possible

  • I am aware of how to report unsafe conditions in the workplace

  • When a safety concern is brought forward, the reporter and others affected are kept up to date on the status of the hazard, and they are notified when it has been controlled

  • If a H&S risk exists, would you walk past the hazard as it is not your problem?

  • All workers are empowered to voice health and safety questions and concerns

  • There is a blame culture that exists within the organisation

  • I know where the accident book / reporting process is located

  • Employees do not take responsibility for occupational safety

  • I am happy and confident to report any health and safety concerns that I have to my supervisor

  • I am happy and confident to report a health and safety incident / accident to my supervisor

  • Our safety training is always reviewed or updated if there is an incident

  • If we report a serious problem where someone could get hurt, they put in a solution and fix it straight away

  • Any hazards I notice are always addressed once reported

  • I know who the fire marshals are

  • If there is an incident, accident or near hit, then is there a tendency to blame the person involved rather than highlighting the failure of a process or failure in an operational control

Management Commitment

  • Safety is a high priority for our employer

  • Managers seem to understand what we and they should do regarding safety

  • Safety practices are followed by all workers, including managers and supervisors

  • The health and safety management team is updated regularly about workplace health and safety matters

  • I know who the person is responsible for health at Safety at this company

  • Health and safety is the most important issue at this company

  • The H&S responsible persons inspect the workplace and meet regularly

  • Top management supports and promotes the H&S responsible persons at all levels, from the top downward including production supervisors

  • I understand the contributions that the H&S team makes to workplace health and safety

  • If I didn’t follow a safety instruction, I'd feel like I was letting the team down

  • Action is taken proactively to prevent incidents before they happen

  • I am aware that there is a health and safety management system, and workers are trained on its contents

  • Management always gets involved in safety issues

  • Management participates in continuous health and safety improvement initiatives

  • Any supervisor or manager who disciplines a worker for raising health or safety concerns would be held accountable

  • Consequences for not following safety rules are applied consistently at ALL levels

  • All members of top management are held accountable for working safely

  • Occupational safety is an integral part of a company’s DNA

  • I believe that my safety is a priority for my direct manager

  • There is regular exchange about safety related issues between employees and management

  • All resources, information, and equipment required to do my job safely are available

  • There is enough time put into safety

  • I feel that there are enough resources/money put into safety

  • I feel like my health and safety matters here

  • Management is consistent in their approach to following up on safety problems

  • There is a strong management commitment towards maintaining and improving safety

Injury management and return to work

  • I know who to ask about what to do if I get injured at work

  • We all have to report all injuries straight away

  • All injured workers are offered suitable duties and a return to work plan is worked out for them

  • Our return to work program helps get injured workers back to work whenever possible

  • Safety is mainly a matter of chance and accidents are seen as an inevitable part of day-to-day work

  • Do you have any additional comments, questions or concerns regarding the safety culture in your organization?

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.