Title Page

  • Council Group

  • Sub Group

  • Conducted on

  • Leadership walk conducted by

  • Interviewee Name

Safety and Culture Conversations

  • Instructions:
    1. Please complete each question, they are designed to start a conversation around Health and Safety with staff.
    2. To add further detail or photo, tap on the paperclip icon on the right of each question.
    3. Complete the form entirely.
    4. Share your report by exporting as a PDF or by `share report'.
    5. Load your completed form into Vault or send to your assistant to load.
    6. Ensure any issues are followed up and updated as required.


  • For ELT member Were you appropriately inducted to the site?

  • Request if there are any hazards that you should be made aware of whilst visiting the site?

Safety and Culture Conversations

  • Ask the worker "tell me about the work being undertaken on your site. What hazards have the highest risk; those that could harm you or others, or worse?" Was there a clear understanding of the hazards and associated risks?<br>

  • Make a judgement on the level of risk this may cause e.g. is there potential for immediate harm, in which case you might stop the work and contact the manager until you are satisfied that it is safe to continue or if it is low risk you might think about some future actions e.g team leader to provide training.

  • What controls are you using to manage the hazards? Are those controls in place?

  • Do you believe you have received the appropriate health and safety training to perform your role?

  • If not, what more do you require?

  • Can you show me the personal protective equipment you are required to wear, does it protect you? Do you have any other thoughts, good or bad around the use of PPE?

  • As an employee do you have a clear understanding of your health and safety role and responsibilities? Prompt below

  • If you could do one thing to improve health and safety here, what would that be?

  • Do you know who your health and safety committee representative is?

  • AQUATIC SERVICES - Megan Ferguson
    ARA TOI - Debbie Lancaster-Gordon
    PARS - Dani Flatt
    PROPERTY SERVICES - Hamish Black
    3 WATERS - Fiona Turner
    UNION REPRESENTATIVE - Nigel Wilkinson

  • Have you ever logged a near miss or new hazard in Vault?

  • Do you know what the outcome was and what corrective actions (if any) were implemented?

  • Why not?

Work Environment and Conditions

  • Housekeeping and layout, appears clear of obstructions, clean and tidy workspaces?

  • Add a photo of the area. If it is a matter of the area being untidy, then hold a conversation with the employee. If it is unsafe, hold a conversation with the manager of the area.

  • Worksite delineation, barricades and signage sited.

  • Add a photo of the area. If it is a matter of the area being untidy, then hold a conversation with the employee. If it is unsafe, hold a conversation with the manager of the area.


  • Please verbalise your appreciation for the level of commitment to health and safety and recognize the work they are doing and their contribution to it.

  • Add signature

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.