Title Page

  • Work Location

  • Conducted on

  • Personnel


  • Health & Safety notice boards available with relevant information

  • Emergency persons names / photos displayed i.e. Safety Reps, First Aid Attendants, emergency wardens

  • Facility Emergency Management Plan available containing correct information, staff have signed acknowledgement section

  • Emergency wardens have completed relevant training<br>

  • Incident reporting forms (Staff and Public) available

  • Fire extinguishers available, serviceable & correctly identified. Access to all fire extinguishers unobstructed

  • Entry & exits clearly marked with illuminated signs and unobstructed

  • Emergency equipment adequate and available; first aid facilities available with adequate amount of replenishments

  • All walkways clear from unnecessary obstructions

  • Materials stored correctly to ensure manual handling is minimized

  • Bins provided & emptied regularly

  • Electrical Equipment in good working order, tested and tagged

  • Floor surfaces secure ie carpet, tiles in good order.


  • Kitchen area clean and tidy

  • Toilets clean and tidy, hand wash, soap, paper towel is available

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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.