Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Physical Condition

  • Building and Structures

  • Floor Surfaces

  • Road Surfaces

  • Work Surfaces

  • Stacking and Storage

  • General Housekeeping

  • Notices, signs and labels

  • Color coding (Fire, drain, fresh water, chevron, roadmarking etc)

  • Reception (Walk off mats, public seating and furniture etc.)

  • Eating Facilities / Storeroom / Dressing rooms

Electrical Appliances and Equipment

  • Permanent Installation (HT, LT, DB rooms/board, general condition)

  • Portable appliances

  • Standby Generator (Room clean, ventilated, acoustics, fuel tanks)

  • Earth Leakages

  • Bonding and earthing (Visual, copper strip - water pipes, gutters)

  • Cable penetrations/cut-offs - wall & slab<br>Openings through buildings elements sealed

  • Labeling<br>Is it adequate, still in force each switch & plug

  • Infra-red monitoring results<br>Tests by third party on electrical distribution boards

Mechanical Appliances and Equipment

  • Machines guards, restraints<br>All V-belt guards, moving parts, fences

  • Pressure vessels, boilers<br>Annual checks and 3 year testing

  • Gas cylinders and hoses<br>Signage, fire hazard

  • Lockout system<br>When working on electrical equipment

  • Hoisting/Lifting equipment<br>Maintenance, operator training

  • Scaffolds/ladders/stairs

  • Manual tools/Equipment<br>Condition and correct use

  • Transport/Vehicles<br>Regular maintenance and road worthiness

  • CCTV Cameras<br>Unobstructed, loose cabling

  • Smoke Detection<br>Smoke detectors, systems working

Occupation Hygiene and General Safety

  • Dangerous chemical and material locked.<br>Paint, thinners, cleaning material, pest control

  • Ventilation<br>Adequate for occupancy type, room use

  • Temperature<br>Too high or too low

  • Lighting levels

  • Ear and eye hazard contaminant<br>Noise, Light & dust

  • Pollution of environment<br>Chemical/biological waist, refrigerant gas

  • Basic hygiene (toilets etc.)<br>Cleaning, condition, functional

  • First aiders<br>One for 10 - 100 employees

  • First aid equipment<br>One box for 5 and more employees

PPE

  • All tasks evaluated<br>Require PPE or not

  • Correct type<br>Safety harness, hard hats and earmuffs

  • Issue and condition<br>Working order, issue records

  • Training done<br>Correct use of equipment

  • Storage when not in use<br>Accessibility and cleanliness

Fire Protection and Preparedness

  • Reduction/removal of fuels.<br>Storage areas, refuse room, garden refuse

  • Extinguishers/Hoses in position and Numbered

  • Last service date by third party<br>Not to exceed 12 months

  • Appointment of fire marshals<br>Available and up to date

  • Competence of fire marshals<br>Adequate training

  • Fire Plan<br>Available and displayed in appropriate areas

  • Hotwork permit records to date<br>Confirm use and effectiveness

Training and Preparedness

  • Anyone need training Fire, first aid, etc.

  • Do all know their duties<br>Fire marshals and safety representatives

Additional

  • Additional concerns, findings or comments to be listed below and dated.

Signatures

  • Inspectors Name and Position

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.