Physical Inspection Form

• Report Title

• Site

• Conducted on

  Date

• Prepared by

• Other personnel involved

RATING SYSTEM TO BE USED FOR ALL ITEMS

• 1 = Very Poor 2 = Very Poor 3 = Fair 4 = Good 5 = Excellent

Section 1: Machinery, equipment and guarding

• Must be clean and free of unnecessary material or hangings

• Must be free of unnecessary dripping of oil or grease

• Must have proper guards provided and in good condition

Section 2: Stock and material

• Must be properly piled and stored

• Chemicals must be properly labelled

Section 3: Tools and PPE

• Must be properly stored

• Must be free of oil and grease when stored

• Must be in safe working condition

Section 4: Aisles

• Must be provided to work positions, fire extinguishers, fire blankets and stretcher cases

• Must be safe and free of obstructions

• Must be clearly marked

Section 5: Floors

• Must have surfaces safe and suitable to work

• Must be clean, dry and free of refuse, unnecessary material, oil and grease

• Must have adequate number of receptacles provided for refuse

Section 6: Buildings and grounds

• Must have walls and windows that are reasonably clean for operations in the area and free of unnecessary hangings

• Must have lighting systems that are maintained in a clean and efficient manner

• Must have stairs/platforms that are clean, free of materials, well lit, provided with adequate hand rails and treads in good condition

• Must be in good order

Section 7: Electrical

• Must be in good order with proper controls and systems

Section 8: Substandard physical conditions

• ITEM 1

• Describe the substandard condition found and what will happen to correct it

• Take a photo of the substandard condition

  Media

• What is the hazard classification?

  A - Critical

  B - Serious

  C - Minor

• NOTE: An incident report or HIRA must be raised for any A or B hazards

• A = rectified immediately B = rectified within 1 week C = rectified within approp timeframe

• Has the substandard condition been fixed?

  Yes

  No

  N/A

• If 'No' then record action required, person assigned to action and date due

• ITEM 2

• Describe the substandard condition found and what will happen to correct it

• Take a photo of the substandard condition

  Media

• What is the hazard classification?

  A - Critical

  B - Serious

  C - Minor

• Has the substandard condition been fixed?

  Yes

  No

  N/A

Section 9: Closing the report

• The report can be closed when all items have been fixed and/or action plans have been determined.

• DC Manager to confirm report closure

  Sign

• Date of report closure

  Date