Title Page

Site Information

  • Site Name

  • Site Address
  • Conducted on

  • Prepared by

Asset Protection Zones

  • Is there a neighboring building within 20m of site boundary?

  • Is adequate clearance maintained? (20m from building)

  • Is there an APZ (20m) from SWC Assets?

  • Is there a 1m APZ around boundary fence lines?

Powerlines

  • Are there power lines on site?

  • Type of Powerline?

  • Is adequate clearance maintained? (2m 415V, 4m 11kva)

Driveway

  • Is the driveway surface all-weather?

  • Is driveway clearance (4m High, 6m Wide) maintained?

Works Required

  • Does this site require FHR works?

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.