Title Page
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Document No.
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Department / Area
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Conducted on
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Prepared by
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Location
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Personnel involed
Environment
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Is there adequate ventilation?
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Is the natural and artificial lighting adequate?
Housekeeping
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Are passages and walkways obstructed?
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Are there any tripping hazards as a result of damaged carpets or tiles?
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Rubbish disposal area clean and clear?
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No smoking signs in position?
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Housekeeping chemicals stored correctly under lock and key conditions?
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Housekeeping chemicals labelled properly?
Electrical
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Are all electrical appliances and equipment tagged and tested?
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Any damaged or frayed Leads?
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Wall sockets overloaded?
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Are distribution boards easy accessible and unobstructed?
Kitchen areas
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Safety notices and warning signs in place? e.g. hot water
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Microwave tag and tested sticker and service date in place?
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Spillage procedure in place?
Toilet Facilities
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Toilet facilities clean and tidy?
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Adequate soap?
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Hand towels/drying facilities in place and working?
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Adequate toilet paper?
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Sanitary disposal facilities in female toilets?
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Walls and surfaces clean?
Fire Precautions
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Routes clear of obstructions?
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Fire doors easily opened?
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Fire doors propped open?
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Emergency lighting adequate?
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Evacuation routes clearly signed?
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Extinguishers in place and signs posted?
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Extinguishers and hose reels serviced 6 monthly and punched?
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Evacuation procedure and plan posted?
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Fire panel free of obstruction and easily accessible?
Additional comments or Concerns