• Please conduct this inspection every week and send report via e-mail to Facilities Manager

    Rating: 1= Legally and Company Compliant
    2 = Light Risk (1 Month Action)
    3 = Meduim Risk (1 Week Action)
    4 = High Risk. (24 Hour Action)
    5 = Critical Risk. (Immediate Action)

    Scoring: If score is higher than 2 please indicate action to be implemented, supplier/person to take action and expected date of completion

  • Document No.

  • Floor/Department Inspected

  • Conducted on

  • Prepared by


  • Clean

  • Not Damaged


  • Clean

  • Not Damaged


  • Clean

  • Not Damaged

Aisles, Walkways, Stairs

  • Not Obstructed

  • Clean


  • Handrails not damaged

  • Well lighted

  • Clean

Pest Control

  • Monthly Servicing

  • Is activities and infestations reported

HSE Sinage

  • Displayed

  • Correct for area

  • Legible

Tables and Chairs

  • Clean

  • Not Damaged

Doors and Locks

  • Clean

  • Not Damaged

  • In working order

Lights and Lightfittings

  • Clean

  • All working

  • Not Damaged

  • Not Loose


  • Clean

  • Serviced

  • Pot in order

  • Building Maintenance Representitive

  • Facilities Manager

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.