Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

Communication of Health and Safety Policy and Information

  • Are policies, procedures and guidelines easily accessible to staff?

  • Are staff aware of OH&S policy statement?

  • Is general OH&S information available?

Allocation of Responsibility/Accountability for Health and Safety

  • Are OH&S duties allocated to appropriate staff?

  • Are staff aware of duty statements allocating OH&S responsibilities?

  • Do staff discuss health and safety issues?

Purchasing Controls

  • Are purchasing policies, procedures and guidelines accessible to relevant staff?

  • Are staff aware of OH&S standard purchasing requirements?

  • Are products purchased with attention to OH&S features?


  • Are procedures in place to ensure that contractors maintain OH&S standards?

  • Are OH&S issues discussed with contractors before commencing work?

  • Is OH&S information available about contractual agreements?

Health and Safety Consultation

  • Is there a qualified workplace health and safety officer at your workplace (if you have thirty or more staff)?

  • Has/have a workplace health and safety representative(s) been elected (if requested by staff)?

  • Is there a workplace health and safety committee or other forum to deal with health and safety issues?

Risk Management

  • Are staff aware of the risk management process?

  • Are workplace risks assessed and controlled, e.g. is appropriate signage displayed to identify potential risks?

  • Are DOEM policies, procedures and guidelines on risk management accessible to staff?

Manual Tasks

  • Are there procedures to determine risks associated with manual tasks?

  • Are there procedures for safely performing manual tasks?

  • Are staff trained to safely perform manual tasks?

Hazardous Substances

  • Are DOEM policy and procedures on hazardous substances accessible to staff?

  • Have material safety data sheets been obtained for all hazardous substances?

  • Are there procedures for the safe use and storage of hazardous substances?


  • Have written procedures for the safe use of plant and equipment been developed?

  • Are manufacturers’ manuals/instructions accessible to staff?

  • Are plant and equipment used and maintained according to manufacturers’instructions?

Workplace Environment

  • Is information on safe and healthy environmental conditions available to staff?

  • Have environmental hazards been assessed and controlled, e.g. noise, UV radiation?


  • Have all staff received OH&S induction training?

  • Do staff receive OH&S training relevant to their job?

  • Are appropriate training records kept?

Accident Reporting and Investigation

  • Are there written procedures for reporting, recording and investigating accidents and incidents?

  • Are on-site records of all accidents and incidents kept?

  • Are accidents and incidents investigated?

Emergency Planning

  • Has a site plan been developed?

  • Are there written and displayed emergency procedures for situations such as fire, medical emergency, bomb threat, evacuation, natural disaster, chemical spill, and occupational violence at the workplace?

  • Are staff and students trained in the emergency procedures?

First Aid

  • Does the workplace have first aid facilities, e.g. first aid kit and first aid room?

  • Are there written first aid procedures?

  • Are there trained first aid personnel with first aid certification at least?

Infection Control

  • Is infection control information available to staff?

  • Are there written infection control procedures?

  • Do staff practise the infection control procedures?

  • Are sources of biohazards in the workplace identified?

Occupational Rehabilitation

  • Are the department’s occupational rehabilitation policy and procedures accessible to staff?

  • Has an accredited workplace rehabilitation coordinator been appointed (if your workplace has thirty or more staff)?

  • Are rehabilitation plans documented and regularly monitored?

Workplace Stress

  • Are consultative decision-making processes practised in the workplace?

  • Do staff know who their district employee adviser is?

  • Are staff provided with information on stress management?


  • Recommendations

  • Full Name and Signature of Inspector

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