Title Page

  • Conducted on

  • Prepared by

  • Date

  • Start time -

  • Divider wall-

  • Take 5 was conducted.

  • Light sensor checked-

  • Whiteboards clean?

  • If no, were whiteboards cleaned by a Utility Technician?

  • Markers and erasers checked?

  • Floors-

  • Trash bins-

  • Location -

  • Time EMS was checked -

  • Notes in EMS checked.

  • Attachments in EMS checked.

  • Setup Type -

  • Setup Count -

  • Additional requested tables - How many and where?

  • Additional requested chairs - How many and where?

  • Tables locked.

  • Rows of chairs/tables are straight and even.

  • All items from previous meeting removed.

  • Temperature is within normal limits on the thermostat and room is comfortable.

  • Blinds and sunshades are at a consistent level.

  • Tables locked.

  • Storage room(s) locked and closed.

  • Did you have any issues with information from EMS or last minute changes from the team member?

  • Extra chairs stored neatly, away from windows.

  • Extra tables stored neatly, away from windows.

  • If so, how was this issue resolved?

  • Was a team member present?

  • Was team member pleased with setup? (If present)

  • Picture of finished setup

  • Utility technicians present for setup -

  • End time -

  • How much time was spent on this setup? (Labor Hours)

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.