Installation Health & Safety Issue

Work order number.

Full Address Details

Customer contact details

Health & Safety Comment box

Work order type

Have you gained access?

Health & Safety reason

photo Health & Safety issue
Date of Survey.
Customer Name & Signature
Surveyor Name & Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.