• PPE supplies are readily available (what PPE supply areas did you inspect?)

  • Is PPE being worn as requested?
    (Who did you see wearing/not wearing the correct PPE? Do not use names)

  • Is PPE adequate for the job?
    (What task did you observe?)

  • Other information

  • Photo

Plant/Tools & Equipment

  • Are tools in good working condition?
    (List tools inspected)

  • All guarding is in place and not tampered with
    (What machine/s did you inspect)

  • Existing guarding is sufficient
    (What machine/s did you inspect?)

  • No hazards in the Plant/Equipment design?
    (What machine/s did you inspect)

  • Plant/Equipment working well and not breaking down frequently?
    (What machine/s did you inspect)

  • Other

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Chemical Management

  • Chemicals are stored appropriately and segregated according to type and class?
    (What storage areas were inspected)

  • Substances labelled appropriately?
    (What substance did you look at?)

  • Safe Transportation means for chemicals is available?
    (What are these methods)

  • Workers know where to find Safety Data Sheets (SDS)
    (Find two and provide the substance names)

  • Other observations?

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Walking/Working Surfaces

  • Work platforms are non-slip and free of debris and clutter?
    (Where did you inspect)

  • Railings/handrails in place where appropriate?
    (List some examples you looked at)

  • Fall protection is in place for working at heights?
    (What examples did you inspect)

  • Labels in place for access and working environment are clear and legible?
    (What signs did you look at)

  • Any working or floors surface is non slip even and clear of any items or debris
    (Where did you inspect)

  • Other information

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Emergency Response/Fire Protection

  • Fire Extinguishers are in place, inspected and tags marked 6 monthly
    (Where were the extinguishers identified?)

  • Workers are aware of where emergency evacuation points are located?
    (Who did you talk to? List at least 2 people)

  • Emergency Eyewash/Shower stations are in place and tested?
    (What did you inspect?)

  • Spill kits are available, stocked as required and in good condition?
    (Where are the spill kits you inspected?)

  • Emergency exits not blocked and identified by signage?
    (What exists did you look at?)

  • Other observations

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Mobile Equipment/Forklifts

  • Forklifts and other mobile plant are checked daily?
    (List checklist samples or equipment inspected details)

  • Mobile equipment including forklifts are in good working condition?
    (What items did you inspect?)

  • Traffic Management rules are appropriate and in place and no markings, bollards etc are worn out or damaged?
    (What areas did you observe?)

  • Other observations

  • Photo

Electrical Hazards

  • Electrical equipment is tagged within current test date as listed on tag?
    (What equipment did you inspect?)

  • Newly purchased equipment has been included in the preventative maintenance schedule (SAP)?

  • Areas where electrical items are used are clear from debris and suitable for task?
    (What items did you look at?)

  • High Voltage signs in place and visible?
    (Where are these signs located?)

  • Electrical leads are up off the floor and not obstructing walkways or work areas

  • Other observation

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Lockout Tagout (isolation)

  • Workers who conducted LOTO are trained and appropriately equipped?
    (Names of workers you spoke to)

  • LOTO procedures are in place and operating as intended
    (Isolation that you inspected)

  • Electrical isolations are locked and tagged
    (Isolation that you inspected)

  • Other observations

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Crane/Hoist Safety

  • Inspections are completed as required?
    (What crane/hoist did you inspect, when we're the inspection dates?)

  • Workers are not working under suspended loads?
    (What areas did you inspect?)

  • Are Safe Working Loads (SWL) listed on all equipment?
    (What lifting equipment did you inspect?)

  • Other observations

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General Safety and Housekeeping

  • Warden and HSR signs are up to date and in place as required
    (Name Warden and HSR that is listed)

  • Equipment is free of excessive dust, rust, oil or other contaminants?
    (What equipment did you inspect?)

  • General tripping hazards are not present
    (Where did you inspect)

  • Other observations

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