Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Mechanical Safety

  • Are all machine guardings on rotating parts or moving equipment are in place?

  • Are the flange connections with complete bolts and nuts?

  • Sampling point is directed to the ground to prevent horizontal splashing?

  • Is there sufficient operation and maintenance space for all equipment?

  • Hot surface or piping is insulated to prevent accidental touch with skin?

Electrical Safety

  • Are all equipment and cables free from obvious signs of damage? Elevated to Cable tray prevent a tripping hazard?

  • Are the lamp casing fixed properly?

  • At wet or outdoor location, all sockets, plugs, and electrical connections are suitable for use in that environment?

  • All electrical enclosures are sight fitted and in good condition?

  • All emergency buttons are in good condition?

  • Are controls in place to prevent access electrical cabinets for unauthorized persons?

  • Are electrical dangers posted?

  • Proper fire extinguisher(s) provided near electrical panels?

  • Are terminals equipped with required covers (cover used), are boxes sealed to prevent dust and water ingress?

Walking & Working Surfaces

  • Are all elevated working platforms installed with complete top rail, mid rail and toe-boards?

  • Is a guard-rail installed when the gap between a platform and the structure of a machine or wall is creating a risk of fall?

  • Are all temporary and permanent wall openings protected by standard guardrails, and/or doors that cover the opening?

  • Are skylights, or any other fragile roof element/part protected by guard rails barriers grids or protection / not?

  • Are access ways (doors, ladders, stairs) to unprotected roofs platform or structure blocked and controlled with lock?

  • Are removable railings or covers, doors (e.g. hoisting areas), secured/locked when not in use?

  • Are aisles and passageways kept clear?

  • Are slippery surfaces covered with non-slip material if any?

  • Is there safe clearance for walking in aisles where motorized or mechanical handling equipment is operating?

  • Are walking/working surfaces free from any protruding nails, screws?

  • Do fixed ladders in excess of 20ft / 6m have fall protection installed?

  • Are any portable ladders used onsite and in good condition?

Flammable Liquids/Materials

  • Have empty containers been removed?

  • Are only appropriate containers being used to store flammables?

  • Are containers stored in appropriate area(s)?

  • Does outside storage have a bund or spill containment?

  • Are appropriate signage posted on flammable and combustible material storage?

Ventilation, Illumination & Noise

  • Are all excessive heat/warm surface areas complete with sufficient control?

  • Are all excessive dust areas complete with sufficient control?

  • Are all exposures to toxic or irritating fumes complete with sufficient control?

  • Are all excessive noises with proper control measures?

  • Is all ventilation maintained properly at the working area?

  • Is all lighting sufficient within the working area?

Fire Protection System

  • Are fire extinguishers serviced, maintained, and tagged yearly?

  • Are extinguishers free from obstruction?

  • Are hose reels and hydrants in good condition (hose, valve, nozzle)?

  • Is the fire alarm panel in good condition with no faulty indication?

  • Are fire doors are in good condition and closed at all time?

  • Are all break glasses are in good confition?

First Aid, Safety Equipment & Emergency Response Plan

  • Is the first aid box is available and well equipped?

  • First aid box checklist been checked?

  • Emergency contact number displayed?

  • Available emergency shower tag filled and checked?

  • Available Lock Out and Tag Out equipment on site?

Personal Protective Equipment

  • Is the level of compliance with general PPE acceptable? (Safety shoes, glasses, safety helmet w/ chinstrap, safety jacket)

  • Protective equipment adequate for the work (WAH, HE & General Work)?

  • Employees trained in the correct use of PPE?

  • Adequate maintenance and clean storage available and utilized for PPE?

  • Respirators and masks being used when needed? (Harmful dust, asbestos, sand blasting, welding lead, paint and galvanized zinc or cadmium)

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.