Title Page

  • Document No.

  • Department / Area

  • Conducted on

  • Prepared by

  • Location
  • Personnel involed


  • Is there adequate ventilation?

  • Is the natural and artificial lighting adequate?


  • Are passages and walkways obstructed?

  • Are there any tripping hazards as a result of damaged carpets or tiles?

  • Rubbish disposal area clean and clear?

  • No smoking signs in position?

  • Housekeeping chemicals stored correctly under lock and key conditions?

  • Housekeeping chemicals labelled properly?


  • Are all electrical appliances and equipment tagged and tested?

  • Any damaged or frayed Leads?

  • Wall sockets overloaded?

  • Are distribution boards easy accessible and unobstructed?

Kitchen areas

  • Safety notices and warning signs in place? e.g. hot water

  • Microwave tag and tested sticker and service date in place?

  • Spillage procedure in place?

Toilet Facilities

  • Toilet facilities clean and tidy?

  • Adequate soap?

  • Hand towels/drying facilities in place and working?

  • Adequate toilet paper?

  • Sanitary disposal facilities in female toilets?

  • Walls and surfaces clean?

Fire Precautions

  • Routes clear of obstructions?

  • Fire doors easily opened?

  • Fire doors propped open?

  • Emergency lighting adequate?

  • Evacuation routes clearly signed?

  • Extinguishers in place and signs posted?

  • Extinguishers and hose reels serviced 6 monthly and punched?

  • Evacuation procedure and plan posted?

  • Fire panel free of obstruction and easily accessible?

Additional comments or Concerns

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.