• Location and Site

  • Address
  • Main Occupying Organisation

Activity conducted

  • Conducted on

  • Conducted by

Site/Premise introduction

Risk Matrix

  • Risk Matrix

    In order to prioritise the level of risk with each significant finding, each risk has been scored using the risk matrix below. Estates and facilities will prioritise funding based on the allocated score. It is important that risks are reviewed regularly to ensure there has been no material change that would affect the initial grading of the risk. Where a change to the risk score is identified, both estates and the Trust fire safety advisers should be informed.


General Health and Safety Management

  • Are staff made aware of the Trust's H&S policy?

Risk Assessment

  • Have significant hazards and risks been identified?

  • Have the significant hazards and risks been risk assessed?

  • Are staff informed of the findings of the risk assessment and actions to reduce risk?

  • If a work process/activity changes are risk assessments reviewed?

  • Are the risk assessments periodically reviewed? e.g. change of procedure/legislation/accident/incident/near miss.

Accident/incident/risk reporting

  • Are staff aware of the trust's system of reporting accidents/incidents?

  • Is there a healthy culture of reporting accidents/incidents?

  • Is there a risk register in place?

  • Are risks placed on the register being reviewed as required by review date?

  • Are risks escalated as required?

  • Are staff aware of the requirements of RIDDOR? E.g. 15 days/types of injury/7 day sickness

  • Do staff understand the procedure for reporting RIDDOR events?

  • Are accidents/near misses investigated as appropriate?

  • Are recommendations from incident investigations actioned within a target date?

  • Are accidents/incidents discussed at any management meetings/handovers?

Health and Safety Notice Board

  • Is there a H&S notice on the premises?

  • Does the notice board display the HSE 'What you need to know' law poster?

Health and Safety Meetings

  • Are H&S meetings held for the premises/ward/site?

  • Do the minutes previous meetings reflect that H&S issues are being discussed?

Management site inspections

  • Does the site/ward manager carry out periodic H&S inspections?

  • Does the site/ward manager ensure that any issues/actions arising from inspections are followed up?

Health and Safety Training/Updates

  • Do staff attend mandatory health and safety training i.e. 'Working Safely' or 'Risk Management Awareness'?

  • Do training records show staff attendance at health and safety training?

  • Are staff made aware of health and safety issues/changes following a period of absence?

Housekeeping/Welfare Provision

Kitchen Safety

  • Does the site/ward manager ensure hygiene standards within the kitchen are maintained?

  • Is the kitchen area e.g. cupboards/larders/floors/sinks etc of a high standard of cleanliness?

  • Are waste disposal arrangements satisfactory?

  • Are all appliances e.g. cooker/grill clean and in good state of repair?

  • Are all utensils e.g. pots/pans/cutlery clean and in good condition?

  • Are there 6 colour coded chopping boards?

  • Are the chopping boards in good condition and free from deep scoring?

  • Are the refrigerators and food storage arrangements to a high standard?

  • Is there suitable hand washing facilities within the kitchen area?

Office Safety/Ward Safety

  • Have all staff completed a DSE assessment of their workstation?

  • Is the condition of the DSE equipment i.e. keyboards/chairs/desks in good condition?

  • Are there sufficient electrical sockets present to ensure good cable management?

  • Is there adequate room available for staff to work? E.g. 11 cubic meters per person

  • Is lighting within the work environment apprropriate?

  • Are the floors free of slip/trip/fall conditions?

  • Is there adequate ventilation?

  • Have window restrictors been fitted as appropriate?

  • Are the window restrictors maintained?

  • Are staff aware how to check the window restrictor to ensure maximum opening (100mm)?

Management of gyms and gym equipment

  • Is the gym area clear of obstructions?

  • Has the gym equipment been inspected (as appropriate) by a competent person?

  • Is there an induction for the use of the gym area and equipment?

Welfare Provision

  • Are there suitable toilet facilities for male/female use?

  • Are the facilities in good clean order?

  • Are there facilities for staff to take a break from the working environment?

  • Are there facilities to enable staff to change into work clothes/uniform?

  • Is there an adequate supply of drinking water?

  • Are there adequate eating facilities?

Fire and Emergency Management

Fire Risk Assessment

  • Is there a current Fire Risk assessment for the premises/site/ward?

  • Have the recommendations of the current fire risk assessment been actioned?

  • Is the fire risk assessment available to staff?

Emergency Procedures

  • Are the evacuation procedures formalised in a fire emergency plan?

  • Is the fire emergency plan available to all staff?

  • Are emergency grab bags available?

  • Is the fire log book available and maintained up to date?

  • Are regular fire drills carried out to respond to a fire alarm?

  • Are the fire drills recorded?

  • Are there sufficient fire marshals for the premises/ward/site?

  • Are the fire marshals clearly identified to other members of staff on site?

Fire related training

  • Are staff trained in fire awareness?

  • Are the fire marshals appropriately trained?

  • Do staff receive refresher fire training as appropriate?

Fire and Emergency Management

  • Is the fire detection system/emergency lighting regularly maintained?

  • Is the maintenance of the fire detection/emergency lighting system recorded?

  • Is the fire detection system tested weekly using different call points?

  • Are the fire alarm call points clearly marked?

  • Is the location of fire fighting equipment clearly marked?

  • Is there adequate fire fighting equipment? (blanket within kitchen)

  • Are flammable items i.e. oxygen/calor gas stored correctly (cage/locked/upright/valves protected from damage or tampering)?

  • Are the portable extinguishers wall mounted or on floor stands as appropriate?

  • Has the fire fighting been serviced within the last year?

  • Are the fire escape routes free of obstructions?

  • Are all fire exits clearly identified?

First Aid Provision

  • Are there sufficient first aid qualified staff on site?

  • Are first aid trained staff clearly identified to other members of staff?

  • Are there sufficient and suitably stocked first aid kits/eyewash on site?

  • Is the contents of the first aid kits/eyewash within the expiry date?

Manual handling and Lifting equipment (LOLER)/Use of Work Equipment (PUWER)

Manual Handling Training

  • Have staff been trained to the relevant manual handling requirements?

Manual Handling Risk Assessment

  • Has a manual handling risk assessment been carried out for the premises/ward/site as appropriate?

  • Have staff been made aware of the findings of the assessment?

Lifting Equipment

  • Is lifting equipment subject to LOLER used on the site?

  • Is the equipment regularly inspected and maintained?

  • Is the lifting equipment examined by a competent person?

  • Has a certificate of thorough examination been issued?

  • Has equipment been issued to staff as a result of a manual handling assessment?


  • Is there a lift on site?

  • Is the lift regulary maintained?

  • Is there a means of raising the alarm should the lift malfunction?

  • Has the use of a lift within an inpatient environment been risk assessed?

  • Is there a safe system of work in place to ensure patient safety in an inpatient environment? E.g. tailgating/hanging ligature risks.

Management of Visitors and Contractors


  • Are visitors signed in and out of the premises/ward/site?

  • Are visitors given a safety brief as appropriate?


  • Do premises/ward/site manager understand the content of the 'Contractors Booklet on Health and Safety' ?

  • Are contractors signed in and out of the premises?

  • Are contractors given a safety brief by the premises/ward/site point of contact?

  • Is the contractors work activity subject to a check at the end of a working day/shift?

  • Are contractors made aware of any hazards present on site? E.g. patients that may pose risk/asbestos.

Site Safety

External areas

  • Are external areas free from holes or defects?

  • Are there appropriate arrangements to control vehicle/pedestrian movements?

  • Are the arrangements properly maintained i.e. lines on road surface/barriers etc?

  • Is there adequate lighting available?

Security Arrangements

  • Are there adequate measures in place to prevent unauthorised access?

  • Are wheelie bins either secured or stored away from the premises to prevent arson?

  • Are waste materials removed in order to minimise potential fire risk e.g. arson?

Control of Restricted Areas

  • Are areas of restricted access properly managed?

  • Are areas of restricted access properly maintained?

Hanging and ligature risks

  • Has the premises been subject of a hanging/ligature risk assessment?

  • Have the findings of the assessment been made known to staff?

  • Have the findings of the assessment been actioned?

  • Have any risks not actioned within a time frame been placed on the premises risk register?

Control of Noise

  • Has the premises been subject of a noise assessment?

  • Has the findings of the assessment been made known to staff?

  • Have measures been taken to reduce the risk of noise?

  • Has PPE been issued as a result of the assessment?

  • Is the PPE adequate ?

  • Is PPE being used by staff as instructed?

  • If noise protection zones have been identified, are they correctly signed?

Electrical/Gas/Water Safety

Electrical Equipment

  • Is the PAT testing within date on all electrical equipment on premises/ward/site?

  • Is the condition of the electrical equipment in good order? I.e. loose or damaged cables/damaged casings etc.

  • Is the management of electrical cable satisfactory?

  • Are there sufficient electrical sockets?

  • Is the inappropriate use of plug gangs I.e. evidence of 'daisy chaining' avoided on site?

  • Does the label on the main electrical intake confirm periodic inspection? (5 years)


  • Are gas appliance regularly checked and maintained ?

  • Do staff know how to isolate the gas supply in an emergency?

Water Management

  • Is the site manager aware of the contents of the 'Safe Water' policy?

  • Has the premises/ward/site been subject of a legionella risk assessment?

  • Is there evidence to confirm that temperatures at representative cold and hot outlets are checked monthly?

  • Are infrequently run hot and cold water outlets run for 2 minutes every week?

  • Are staff aware of the contents of the 'Bathing' policy?

  • If Thermostatic Mixing Valves (TMV's) are in place are they regularly maintained?

  • Is there a thermometer available for use in bathing areas?

Environmental Safety

Display Energy Certificates (DEC)

  • Is a Display Energy Certificate (DEC) displayed within the premises in a public area?

  • Is the DEC in date?


  • Are staff aware of the asbestos policy?

  • Has the premises/ward/site been inspected for the presence of ACM's?

  • Is there Asbestos on site?

  • Is the location of ACM's clearly labelled?

  • Is the location of ACM's contained within an Asbestos register?

  • Is there a plan of the location(s) of ACM available?

Pest Control

  • Is there evidence of pest control on site?

  • Are the pest control measures sufficient?

Waste Management/spillage management

  • Are the pest control measures adequate?

  • Is hazardous waste disposed of correctly e.g. bagged and sealed and/or disposed off via approved contractor?

  • Is hazardous waste stored appropriately prior to disposal e.g. not exposed to the elements/separately from other waste?

  • Are emergency procedures documented in case of leaks/spillages?

  • Are spill kits available?

  • Are wastes clearly labelled/packaged/disposed of?

  • Are staff aware of the waste management procedures?

  • Are sharps bins closed/sealed when not in use?


CoSHH Risk Assessment

  • Are CoSHH risk assessments available for the substances in use on site?

  • Have the manufacturers safety data sheets been obtained and referred to when making an assessment?

  • Has a safe system of work been established as a result of the assessment?

  • Has the assessment been carried out by a competent person?

CoSHH Storage/disposal

  • Is the storage of CoSHH adequate?

  • Are CoSHH items disposed of correctly?

CoSHH Inventory

  • Is there an inventory of CoSHH items?

  • Is the CoSHH inventory up to date and accurate?

CoSHH Training and information provision

  • Are staff using CoSHH trained or at least provided with adequate information?

  • Is PPE issued in relation to CoSHH and is it adequate?

  • Are staff trained or made aware how to use the PPE correctly?

Lone Working/Driving Activites

Lone Working Policy

  • Are staff aware of the content of the Lone Working policy?

Lone Working Risk Assessment

  • Is a risk assessment in place to manage the risk associated with lone working?

Lone Working Safe System of Work

  • Is a safe system of work in place to manage the risk associated with lone working i.e. outlook diary, supervisor awareness, buddy system/code word?

  • Is there an alarm system available for staff to use whilst lone working?

Driving for Work Policy

  • Are staff aware of the contents of the 'Driving for Work' policy?

Driving for Work Management Control

  • Are driving hours by staff managed by a supervisor?

  • Have relevant driving documents (Driving Licence/Certificate of Insurance for business purpose been checked?

PPE/Violence and Aggression


  • Do managers ensure that PPE is in good condition and clean?

  • Do managers ensure there are sufficient stocks of PPE?

Management of Violence and Aggression

  • Is there a risk assessment in place to control the risks associated with violence and aggression?

  • Is there a safe system of work in place to manage the risks of violence and aggression?

  • Are enough staff available to manage the risks of violence and aggression?

  • Do staff attend relevant training courses i.e. PMVA/Break Away ?

  • Do the training records show staff attendance at the relevant courses?

  • If systems such as the PIT alarm are in place, are staff aware of functions of the system i.e. pressing button on base of PIT alarm?

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.