• Host Client

  • Address

  • Conducted on

  • Prepared by

  • Site Location
  • Attendees

Section 1


  • Is there a written safety policy statement, signed by the director/OHS Rep, and displayed?

  • Responsibilities for OH & S have been explained to workers and included in job descriptions?

  • Regular Consultation with workers on OHS issues, toolbox meeting / pre-start etc?

  • Through what means and frequency (toolbox/weekly)

  • JHA (Job Hazard Analysis) or JSA (Job Step Analysis) are developed and in writing where required?

  • Is there a OHS representative for site?

  • Safety Information is displayed on notice boards Eg. Safety Committee minutes, alerts, articles on safety?

  • Take image of notice board or similar

  • Safety posters used to promote safety in the workplace?

  • Adequate safety signage displayed on site?

  • A cost effective option is to print out images from the internet and laminate them.

  • What are the PPE requirements for site?

  • Is there appropriate signage indicating PPE requirements?

  • Is there a policy in place for Heat Stress?

  • What does it outline?

  • Is there a policy for Cyclone Evacuation?

Section 2


  • First Aid Kits are available on site and contents are within date?

  • First aid attendance is recorded?

  • List of First Aiders onsite and Emergency numbers displayed in prominent location?

  • All incidents/accidents/near misses are documented?

  • Take Image of Form

  • An appropriate injury reporting form is in place?

  • A system is in place for management to follow up to ensure corrective action has been implemented

  • Suitable duties are made available by management for employees for light or restricted duties?

  • Rehabilitation Policy and return to work programs are documented and displayed?

  • Have there been any workplace incidents in the last 12 months? Explain

Section 3


  • An induction system is in place with a general introduction to site pointing out general issues with an employee sign off sheet?

  • A formal induction system is in place conducted by WHS Rep or online company specific program with exam upon completion?

  • Please ask for copies of completed inductions to be supplied to Pindan/DFP

  • Is ongoing training provided to employees?

  • Is training documented in a training manual/matrix and kept up to date


  • Hazardous manual handling tasks have been identified, control measures put in place?

  • Is manual handling training provided or correct techniques discussed prior to manual labouring tasks?

  • Appropriate numbers of lifting aids available? Trolleys / fork lift?

  • Posters are displayed in the workplace showing correct techniques?


  • Do you have a plan/policy for workers whilst traveling on the road? I.e no driving after 6pm, GPS tracking?

  • Is there regular contact throughout the working day?

Section 4


  • Are safety inspections checklists undertaken to identify potential hazards

  • What frequency are they performed? Quarterly/weekly etc

  • Does the checklist include a follow up reporting system to ensure hazards are followed up on?

  • Does the employee have a mechanism to report hazards?

  • Via what medium? Take 5/other form


  • Fire equipment and exits are clear of obstructions and clearly marked?<br>(1m radius clear around obstructions, exit signs in working order/illuminated?)

  • Aisles/walkways are clear of clutter/trip hazards?

  • Floors are free from from oil & grease?

  • Pallets, racking, shelves in good condition?

  • Goods/Product are stored orderly?


  • Adjustable chairs provided & at correct height?<br>(knees at right angles, feet flat)

  • Computer workstation can be height adjusted?

  • Computer Monitor at the correct height? (top of screen level with eyes)

  • Adequate rest breaks are provided for and encouraged (5 minute break from intensive computer use each hour)?

Section 5


  • Fire extinguishers in place and clearly marked?

  • Have extinguishers been serviced in the last 6 months?

  • Evacuation Plan displayed in prominent location, showing muster points?

  • Emergency Exit / Muster Point areas clearly signed?

  • Take Photo of Evacuation Plan

  • Has an emergency drill been carried out in the last 12 months?


  • Residual Current Devices (RCD's) are installed and tested regularly?

  • Electrical equipment is inspected and tagged by licensed test and tag personnel?

  • Plugs and sockets are in good condition and not overloaded with double adapters?

  • Are electrical tools in good working order? No frayed cords etc?


  • MSDS's are available for all hazardous substances?

  • Workers are trained in safe handling, storage and disposal procedures

  • Appropriate first aid facilities nearby? Eg: Eye wash station?

  • PPE supplied and used as required?

  • Spill control kits and procedures are in place?

  • Containers are clearly labelled and not worn?

Section 6


  • Vehicles are well maintained and service history maintained and current?

  • Vehicles have current insurances?

  • Operational manuals are easily accessible for machinery?

  • Maintenance logs for plant & machinery maintained?

  • Are documented pre-starts conducted on plant/vehicles/machinery?

  • Are they instructed to conduct informal pre-starts prior to operating machinery?

  • Are hand tools kept in good condition? Sharp, clean and handles in good condition?

  • Are cranes, slings and lifting gear used?

  • Are rated capacities clearly marked?

  • Is lifting gear in good condition? Not frayed or worn?

  • Is lifting gear in good condition, not frayed or worn?


  • Are forklifts present on site?

  • Workplace is designed so that pedestrians and forklifts are separated?

  • Signs and mirrors are provided for forklift truck "blind spots" where people may be walking and working?

  • Forklift has an easily readable load chart, and loads do not exceed the rated capacity?

  • Are warning devices suck as reversing beeper, flashing lights fitted?

  • Protective structure on top of forklift to protect driver from falling objects and seatbelt fitted?

  • All personnel operating forklifts have a current high risk forklift licence?

FIxed Plant

  • Is there fixed plant on site?

  • What type of fixed plant is on site?

  • Specific on-site training has been given in regards to safe operation of this equipment?

  • Entanglement risks from hair, gloves, clothing has been eliminated by way of appropriate guards?

  • Laceration, crushing risks have been evaluated and eliminated?

  • Controls are clearly labelled and are within easy reach of the operator?

  • Emergency stops are highly visible?

Mobile Plant

  • Is there mobile plant on site?

  • What type of machinery is on site?

  • Are certificates required for this machinery or will the company VOC (verification of competency) on site?

Section 7


  • Are workers exposed to continual noise level exceeding 85dBA?

  • Is there a Noise Management or Hearing Conservation program in place?

  • Hearing protection available for use?

  • Hearing signs prominently located?

  • Photo of Hearing Signs


  • Air-conditioning system regularly cleaned and maintained?

  • Airborne contaminates kept at acceptable levels? Eg-construction site watering to keep dust minimized

  • Fume extraction provided where applicable? Eg. Welding/confined space/cooking areas?

  • Adequate Ventilation in work areas/factories?

  • Provisions are made for shaded work areas wherever possible? (moveable shade structures)

  • There are regular rest breaks provided In a cool well ventilated area for workers exposed to hot & humid environments?


  • Washrooms, toilets and lockers clean?

  • Meal areas clean and tidy?

  • Is there a supply of drinking water?

  • Are water coolers cleaned regularly and filters changed?


  • Are you aware that you cannot alter an on-hired workers duties without first notifying PLS/DFP?

  • Are you aware that you can not change an on-hired workers work location with out first notifying PLS/DFP?

  • Are you aware that we both share (the agency and the host client) the responsibility for the safety of the on-hired workers? and that ANY INCIDENT, no matter how small, needs to be documented and brought to the attention of PLS/DFP?

Sign Off


  • Pindan Labour Solutions Representative

  • Host Client Representative

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.