Site Name and address?
Inspection Date
Hygiene Facilities

Change rooms

Toilet and kitchen

Occupational Hygiene Conditions

Noise zoning

Adequate venitalation



Water management

Waste management


Safety devices

Lock out

Earth leakage

DB Boards


Machine guarding

Guards in place

Clean and secured

Fitted with handles

Critical equipment and stores

Pressure vessels

Gas, Fuel and HCS stores

Dust suppression systems

Water supply

Demarcation and Signage

Correct symbolic signs

Labeling on electrical

Fire fighting and first aid equipment

Storage areas

Restricted areas

Road signs

Smoking areas

Tools and portable equipment

Tools numbered and inspected

No defective tools

Persons competent and authorized to use tools.

No self made tools.

Tools in safe place

Tools in good condition

Buildings and floors

Walkways and grating

Stairways and floors

Stacking and storage

Emergency Equipment

Fire Extinguishers

Assembly point

Emergency alarms

First aid box and stretcher

Escape routes


Labels and signage

Register and log books

Lifting operations


Not damaged

Stored neatly in locked container

Proper issue register

Working at hights

Safe work platforms

Safety harnes

Trackless mobile machinery

Road signage

Operator competency and autherisation

Seat belts

Pre start checks

Brake test

Key control

Vehicle permit

Lights and reflective strips

Two way radio

Chock blocks


Hooter and reverse alarm


Fire Extinguisher

First aid kit available

Cellphone usage

Blind spot id


PPE appropriate for task

Employee trained to use PPE

Used in line with MSDS

PPE in Good order

Site supervisor name and Signiture
Site Agent name and Signiture
GKC manager name and signiture

Scan barcode of site or device inspected