• Document No.

  • Inspection category ( drainage, Bus Shelter eg.)

  • Address of hazard

  • Conducted on Month/ Date/Year

  • Prepared by

  • Location


  • Is there a defect

  • Type of defect ( blocked, broken, damaged eg)

  • Add media

  • Action required

  • Type of action required ( clear, repair replace eg)

Rating score of defect

  • High Medium Low

  • Work Instruction

Completion details

  • Action taken

  • Works completed by

  • Date of Works Completed.

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.