Title Page

  • Leadership walk conducted by:

  • Council Group:

  • Dept/Team:

  • Conducted on

  • Person involved:

  • Name:

  • Name & Company:

  • Location

Safety & 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.
    6. Ensure any issues are followed up and updated as required.


  • Were you appropriately inducted to the site (if required)?

  • Ask about any hazards that you should be made aware of whilst visiting the site?

Safety and Culture Conversations - Questions to ask

  • 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)?

  • Is there a clear understanding of the hazards associated with their work and associated risks?

  • 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

  • Tell me about the controls you are using to manage the hazards. Are those controls in place?

  • Why not?

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

  • If not, what more do you require?

  • Show me the PPE 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, what is your understanding of your health & safety role and responsibilities?

  • Should cover:
    Comply with H&S policies and procedures;
    Report all incidents, accidents, near misses or new hazards
    Ensure their own safety and that of others; and Stop any unsafe practices and/or advise manager

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

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

  • 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?

  • Take a photo. If the area is untidy then discuss with the employee. If it is unsafe then discuss with the team leader/manager of the area.

  • Worksite delineations, barricades and signage sited.

  • Take a photo. If the area is untidy then discuss with the employee. If it is unsafe then discuss with the team leader/manager of the area.


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

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.