Title Page

  • Site conducted

  • Department

  • Month

  • Date

  • Prepared By

  • Location

Fire Safety

  • Fire Extinguishers/Alarms/Hose reels are not obstructed and demarcated

  • Fire Extinguisher are checked and report up to date

  • Photo of Fire Fighters Updated (Department)

  • Fire Register Marked Daily (including managers)

  • Exits/ pathway are open and not obstructed

  • Running man stickers / exit directions adequate and not damaged

  • All emergency equipment are demarcated

  • Exit Board are lighting and Exit boards available

  • At least two team members nominated as Fire Fighters/ Shift

First Aid

  • First Aid Box available

  • First Aid demarcation, signage and notice available

  • At least two team members nominated as First Aiders/ Shift , Photos available

  • First Aid Checklists updated

  • Contents of First Aid Box displayed

  • First Aid box completely filled

  • No evidence of Expired Medicine

Personal Protective Equipment

  • All employees are wearing relevant PPE

  • Employee wear PPEs properly

  • All PPEs are stored properly and required storage available

Electrical Safety

  • Flexible cords and cables free of splices, frayed wiring or deteriorated insulation

  • Electrical enclosures (i.e. switches, receptacles, junction boxes, etc.) are provided with tight fitting covers or plates

  • Flexible cords are not arranged in a way which can result in tripping

  • No extension cords used

  • No cartons/ fabric stacked along plug points and panels

  • Adequate signage of electrical hazards

  • Rubber carpets available under electrical panels

Fall Protection

  • Cartons stacked at max 6ft

  • Cartons stacked in safe manner

  • Provided ladders are safe to use

  • All racks are floor mounted and secured

  • All racks are visible with maximum load

  • All mezzanine floors are visible with maximum load and signage / Handrailing / Toe Guard

  • Helmets available and used when required

  • All staircases are safe to use

  • No sharp edges present

Machine Safety

  • All Machine have adequate guarding

  • All machine guards being used

  • Required signages are displayed

  • All employees trained on machine safety

  • Machine handovering inspection has conducted (update)

  • All stand machines are floor mounted

  • All hoisting and lifting machines are safe to use and operators are trained (Fork Lift competency license)

  • All machines safe to operate

Employee Awareness

  • Employee aware of what to do during a fire

  • Employee aware of operating emergency doors

  • Employee aware of the ESH committee Member

  • Employee aware of the nearest Fire alarm/ call point

  • Employee aware of the fire fighters and first aiders

  • Employee aware of the near-miss and incident reporting mechanism

  • Employee aware of the machinery safety, work environment safety

Chemical Safety

  • All chemicals are labelled with HMIS Tags and label

  • Secondary container available with capacity marked

  • Secondary container is clean and free from chemical residue

  • Chemical inventory is maintained and updated and MSDS available

  • Spill Kits filled and instruction displayed with checklist

  • Chemical store in proper place

  • Emergency eye washer available (No obstruct / Signage / Clean / Check List update)

  • No eating drinking and Smoking board displayed

Other

Additional Details

  • General Comments/Recommendations

Completion

  • Completed By : (Name & Signature)

Emergency Respond

  • Emergency respond plane is established

  • Notification Mechanism established

  • Awareness about the employee

  • CCTV monitoring established

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.