Checklist [Sample template]

• Welcome to the inspection experience on SafetyCulture!
  
  Everything you see in this sample template can be customized using the Template Editor.
  
  This page is the title page, which is the first page you see when you conduct a new inspection or view an inspection report.
  
  Title pages are a great way to capture essential details, giving you high-level context to inspection results.

• Conducted on

  Date

• Prepared by

• Site

• Location
  Address
Asset

• Have you received induction training?

  Yes

  No

  N/A

• Do you know the company’s health & safety rules?

  Yes

  No

  N/A

• Are you familiar with how to report hazards & incidents?

  Yes

  No

  N/A

• Are there emergency facilities and an evacuation procedure/route for the site?

  Yes

  No

  N/A

• Do you have access to appropriate emergency and first aid equipment?

  Yes

  No

  N/A

• Have you asked the person in charge about all relevant hazards?

  Yes

  No

  N/A

• Do you have the correct procedures and equipment to do the work safely?

  Yes

  No

  N/A

Checkbox section

• Is there appropriate separation of vehicles and people during the proposed work?

• Is all required electrical/mechanical equipment in a safe condition?

• Are hazardous/dangerous substances used and stored according to their safety data sheets?

• Have you consulted with workers about the task and the safe way to do it?

• Do you have all necessary PPE?

• Have you got a safe way of getting in and out of your work area?

• Have any manual handling risks been identified and accessed?

• Sign off

  Sign

• Supervisor

  Sign

• Yes

  No

  N/A