Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Department:

  • Area:

  • Date:

  • Assessed by:

  • Participants:

  • Corrective Actions/Recommendations:

Pre-start Daily Safety Check & Communication

  • Does the work area have MPI approval to operate during alert level 3/4 and COVID-19 safety precautions in place?

  • Are workers travelling to / from work alone or with someone from their ‘bubble’?

  • Have all workers thoroughly washed their hands or used sanitizer before leaving home or upon arrival at work?

  • Have all essential workers been informed of the COVID-19 Returning to Work during Alert level 3/4 guidelines and attended the daily Safety Brief, prior to entering work area?

  • Has a COVID-19 Health Risk Screening Questionnaire been completed daily by each worker and their temperature checked prior to working?

PPE Requirements - All

  • Are all authorized workers wearing and complying with work area PPE requirements, and been issued a mask and gloves?

  • Are all authorised workers wearing PPE to undertake a task or interaction, which may put them within a 2m distance of another worker?

Working Environment - All

  • Are staff adhering to 2m distancing rules and are suitable risk mitigation methods in use, for those where only 1m distancing is possible (i.e. screens/full PPE)?

  • Is suitable signage in place reminding staff of social distancing and hygiene requirements in the production area?

  • Is suitable signage in place reminding staff of social distancing and hygiene requirements in the bathroom & smoking areas?

  • Are designated walkways clearly defined, and are staff adhering to their use?

  • Is there a cleaning schedule in place for suitable disinfectant of communal areas, shared spaces and machine centre consoles/screens/control panels?

Break Times

  • Are tearooms arranged in accordance with maintaining 2m social distancing? Are these distances being adhered to by staff?

  • Are stocks of sanitiser at the Café entry maintained and are staff sanitising on entry and exit to the Cafe’ & toilets?

  • Are staff maintaining social distancing in designated smoking areas and avoiding face-to-face positioning at all times?

  • Are staff adhering to not using social activity equipment (games) or the gym during their breaks?

Visitors

  • Are all Visitors to the work area authorised to be there and have they read the relevant guidelines and completed a Health Risk Screening Questionnaire?

Unwell Staff

  • Do all staff appear well and fit to work? If not please answer questions 2-4, otherwise go to “Other Measures”

  • If NOT, has their Shift Manager been notified, and called the Healthline on 0800 358 5453 to seek advice?

  • Has the employee had their temperature retaken after safety brief?

  • Has the work team isolated their machines, moved to their assembly point maintaining 2m distancing and notified the senior management?

Other Measures

  • Is relevant COVID-19 signage and information present in all areas of the plant, communal areas and facilities?

  • Are team briefings and information updates being issued by supervisors in a way that minimises physical interaction, and maintains min 2m social distancing?

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.