Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Untitled Page

  • Date:

  • Location:

  • Inspected By:

  • Category

  • Hazard Rating

  • Action

General Workplace conditions (Main Office)

Floors (Walking and Working Surfaces)

  • Clean, orderly and sanitary condition

  • Free of slip, trip or fall hazards

  • Free of protrusions

  • Openings covered or barricaded

  • Are light fittings clean and in good condition

Aisles and Passageways

  • Clear and unobstructed

  • Desk areas and file cabinets not posing hazard


  • Sufficient exits for prompt escape

  • No locks or fastening restricting escape

  • Routes and exits are clearly marked

  • Exits adequately illuminated

  • More than one exit from work area

  • Approaches to exits unobstructed

  • Flammable kept out of exits


  • Good ventilation

  • Clean orderly and sanitary

  • Painted and well lighted


  • Fire Extinguishers inspected

  • First aid supplies and injuries monitored

  • Employees Working in a safe manner

  • Electrical outlets kept uncluttered

  • Desk heaters kept clear

  • Emergency Telephones list

  • Can exit doors be effortlessly opened

  • First aid and fire extinguishers signs posted

Plant and Factory

Mechanical Hazards

  • Mechanical power Transmission Belts guarded

  • Guard affixed to machines or secured to prevent displacement

  • Emergency Stop arrangements at all machines

  • Are hands tools in good repairs

  • Portable power hand tools provided with circuit breakers

Electrical Hazards

  • Are there broken or unsecured wires and cables

  • Switch boxes and distribution board covers and in good condition

  • Are all connections and electrical devices earthed

Hazardous Material and chemical Safety

  • Are all hazardous substances clearly and permanently labelled

  • Are all flammable liquids kept in covered and appropriate containers when not in use

  • Are no smoking signs posted in areas for storage and use of flammable, combustible materials

  • Are material safety data sheet available

Gas Cylinders

  • Are gas cylinders stored in upright position

  • Are gas cylinders secured from damage and being knocked over

  • Are valve protection caps provided and kept on gas cylinders

  • Do gas cylinders show obvious signs of defects like rusting

Walkways / Floors

  • Are floor surfaces even and uncluttered

  • Are Floor surface dry and clean

  • Are walkways clearly marked and free from obstruction

  • Are there unguarded / inadequately covered floor openings (e.g., stairways, floor openings.)

  • Are stairways in good condition with standard railing provided for every flight

  • Are working platform at higher levels provided with handrails and toe boards

Material Handling

  • Are all lifting appliances marked with their safe working load

  • Are wires, ropes and chains slings in good condition


  • Are ladders free from splinters, sharp and decay

  • Are Rungs of ladders uniformly spaced in good conditions

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.