• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Task Description

  • What activity will you be performing?


  • Are you fit to perform the required task?

  • Do you understand the job - has it been explained sufficiently?

  • Are you competent to do the work and familiar with the equipment?

  • Are the tools and equipment in a safe condition?

  • Have you informed others who may be affected by your work?

Risks - Assess if any of the following are risks to your task

  • List the risks & what controls you will use to reduce the risks in the text box if different to the defaults provided

  • GRAVITY - falling objects, working at height, slips, trips

  • *Dropping equipment: Wear safety boots, perform lift with at least 2 people.

  • MASS - pulling, pushing, sliding, being hit by vehicles/objects

  • *Moving equipment: Use a trolley, plan route; *Sliding equipment pinch points: take care when folding handles down, wear suitable gloves to protect fingers

  • HUMAN MOVEMENT - bending, lifting, carrying

  • *Back Injury: Stretch before starting lift, plan the lift, perform lift with at least 2 people.

  • ELECTRICAL - electrocution, damaged cables

  • *Low voltage cable risk: Inspect all cables before use; seek permission to power on equipment.

  • MECHANICAL - cutting, crushing, entanglement

  • *Sharp rail/cardboard box edges: Wear suitable gloves.

  • NOISE/VIBRATION - A/Cs, computer equipment, other machinery

  • *Data Centre Background Noise: Wear suitable ear protection if working in DC for extended period, perform work remotely outside room where possible.

  • ISOLATED WORKER - Working unaccompanied

  • *Check in with Supervisor every 1 hr via agreed method

  • THERMAL - hot, cold

  • PRESSURE/VACUUM - lifting floor tiles

  • STORED ENERGY - spings, flywheels, counterweights

  • RADIATION - UV sunlight

  • FIRE/EXPLOSION - ignition sources, flammable waste, packaging

  • ASPHYXIATION - lack of oxygen, fire suppresents

  • ENVIRONMENTAL - earth/air/water impacts, heat, cold, exposure

  • DESIGN - Hazards/impacts associated with design of products

  • VEHICLES - vehicle > vehicle / vehicle > person collisions

  • Other

Equipment - Will you need any of the following

  • Ladders

  • General Tools - Screw Drivers, hammers, extensions?

  • Other

Personal Protective Equipment

  • Which of the following PPE will be required?

  • Safety Boots

  • Gloves

  • Glasses

  • Ear plugs

  • Correct PPE Clothing

  • Harnesses

  • Hard Hats

  • Respirator

Sign Off

  • I have considered all elements of this Work that needs to be done!

  • Cleaning Manager

  • Operator/Cleaner

  • Operator/Cleaner

  • Safety Officer of site

  • Select date

  • Please send this assessment to and to the Safety Officer of the site you are working at!for filing

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.