• Date:

  • Inspector:

  • Signature:

  • This checklist serves as a guide for the evaluation of Cubic workplaces (additional items and categories may be added to suit local needs, but none may be removed). If a NC is identified, corrective actions (CA) are to be determined in consultation with line managers and HSE personnel. The Summary of Actions table will identify those responsible for the implementation of corrective actions and must be populated once the inspection has been completed

Housekeeping and Environment

  • 1.1 Are areas free of rubbish, obstruction, slip and trip hazards?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.2 Are floor coverings in good condition?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.3 Is high storage avoided for heavy or frequent use items?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.4 Is stock or material stored appropriately and safely? (no chance of falling)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.5 Are filing cabinets and desk drawers closed when not in use?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.6 Are doors fully functional?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.7 Are stairs, steps and handrails in good order?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.8 Are all areas adequately lit?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.9 Are areas free from glare?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.10 Is there adequate ventilation?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.11 Are noise levels acceptable? (Can you be heard 1m away in normal conversation i.e. no shouting)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.12 Is the office temperature ok? I.e. not noticeably hotter or colder

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.13 Is kitchen clean and tidy?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.14 Are floors free of spills? (Duty of Care to mop up spills if present)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.15 Are toilets clean and tidy?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.16 Are empty photocopier cartridges in recycle bin?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 1.17 Is proper segregated recycling of items occurring i.e. paper / cardboard?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

2: Ergonomics

  • 2.1 Is all furniture fit for purpose?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 2.2 Is all furniture in good repair?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 2.3 Are all cords/wires out of the way? (clear under desks)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 2.4 Are workers stowing personal bags out of walkways to avoid trip hazards?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 2.5 Are Workstation ergonomics in place for:(Sample 3 x Workstations)

  • Chairs (back supported/knees 90degrees )

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Desks

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Monitors (arm’s length when sitting)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Keyboard (edge of desk when typing)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Mouse (beside keyboard)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Phone (easy reach / non-dominant side)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Work Layout

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

3: Manual Tasks

  • 3.1 Are suitable trolleys available and in good condition?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 3.2 Are suitable ladders or safety steps available and in good condition?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 3.3 Frequently used items are within easy access between knee and shoulder height

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 3.4 Large/heavy objects stored on lower shelves

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 3.5 Filing cabinets are loaded with heaviest items in the bottom drawers

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 3.6 Can you only open one draw at a time? (If not the cabinet is faulty)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

4: Electrical

  • 4.1 Are electrical appliances tagged and within test date, where required?(Sample 5 items) (If an electrical appliance has not been tagged or is out of date remove it from service until it can be tested)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 4.2 Are all plugs, sockets, leads, cords and switches in good working order?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 4.3 Are electrical appliances kept clear of wet areas?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 4.4 Only power boards used, no double adaptors present?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 4.5 Are RCD’s (safety switches) installed where required?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 4.6 Is faulty equipment tagged out/removed from service?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

5: Emergency

  • 5.1 Is a first aid kit easily accessible and clearly labelled with current first aid officers name and contact details?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.2 Are the contents of the first aid kits clean and in-date?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.3 Do fire sprinklers have at least 500 mm of clear space beneath?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.4 Are fire extinguishers hanging, unobstructed and clearly marked?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.5 Are fire extinguishers clearly signed for type of fire?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.6 Does fire extinguisher hanging on wall match signage?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.7 Are fire extinguishers tagged every 6 months? (When were they last inspected?)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.8 Does the kitchen have a fire blanket mounted on the wall? (If applicable)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.9 Are fire exits clearly marked and unobstructed on both sides?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.10 Are exit doors easily opened from inside? (i.e. no damaged handles, door not sticking)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.11 Are exit signs illuminated?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.12 Are exit signs tested every 6 months? (sight records)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.13 Have hose reels been serviced and tagged in the last 6 months?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.14 Are emergency procedures current and displayed?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.15 Has emergency evacuation drill been conducted in last 12 months? (check records)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.16 Is the emergency evacuation plan orientated with regard to the direction of egress?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.17 Has the emergency evacuation plan been reviewed within the last 12 month

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 5.18 Does the visitor book clearly represent who is in the building at the time of the inspection?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

6: HSE Information and Security

  • 6.1 Are current policies displayed on Noticeboards?

  • Work Health and Safety

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Environmental

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Consultation

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Rehabilitation

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 6.2 Is current HSE information displayed on noticeboards?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 6.3 All “security pass - access only” areas are secured

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

7: Warehouse Facility

  • 7.1 Are warehouse storage racks loaded correctly i.e. nothing overhanging racks, items squarely located on pallets?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.2 Are pallets in good condition – no obvious damage?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.3 Are the storage shelves loaded correctly i.e. heavy items stored on lower shelves, nothing overhanging?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.4 Have forklift daily checks been completed? Has log book been signed by users? (Sight the records)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.5 Are chemical containers clearly labelled and stored correctly i.e. away from ignition sources?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.6 Are warehouse storage racks loaded correctly i.e. nothing overhanging racks, items squarely located on pallets?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.7 Are Safety Data Sheets (SDS’s) Australian variants (where required)?

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • 7.8 Are Safety Data Sheets (SDS’s) current? (dated within last 5 years)

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

8: Additional items, Hazards Identified, Observations

  • Item 1 - Please explain the additional issue found during your inspection

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Item 2 - Please explain the additional issue found during your inspection

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Item 3 - Please explain the additional issue found during your inspection

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Item 4 - Please explain the additional issue found during your inspection

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Item 5 - Please explain the additional issue found during your inspection

  • What were your findings?

  • What are your recommendations?

  • Please provide an image

  • Provide a copy of this completed inspection to the local HSE Team for record keeping purposes

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