Title Page

  • Conducted on

  • Prepared by

  • Location

Location and Management of Facilities

  • Is the means of access safe?

  • Are consumable items, such as soap and toilet paper, replaced regularly?

  • Is broken or damaged infrastructure, such as plumbing, air-conditioning or lighting, repaired promptly?

  • Is equipment and furniture, like fridges, lockers and seating, maintained in good condition?

  • Are facilities cleaned regularly, at least weekly?

Work space

  • Is there safe entry to and exit from the workstation?

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  • Is there enough clear space, taking into account the physical actions needed to perform the task, and any plant and personal protective equipment that is needed?

  • Is there enough space in walkways and around cupboards, storage or doors, in addition to the clear workstation space?

  • Is the work space and facilities on the same level?

  • Are the steps in good condition?

  • Take a photo of the steps

  • Is a handrail installed and maintained in good condition?


  • Is adequate floor covering provided for workers who need to stand for long periods?

  • Are the floors maintained to be free of slip and trip hazards?

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  • Can the chair be adjusted for individual needs and is it appropriate to the type of work being carried out?

  • Does the chair have a 5 point base?

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  • Are all the wheels in good condition


  • Does the lighting allow workers to move about easily and to carry out their work effectively without adopting awkward postures or straining their eyes to see?

  • Does the working environment minimise the amount of glare, contrast or reflection?

Air Quality

  • Is the temperature between 20°C and 26°C ?

  • Are ventilation and air-conditioning systems serviced regularly and maintained in a safe condition?

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Drinking Water

  • Are drinking water outlets accessible to workers?

  • Are the drinking water outlets separate from toilet and washing facilities?

  • Is the water clean, cool and hygienically provided?

Hand Washing

  • Are there enough hand washing basins for all persons?

  • Are the hand washing facilities separate from work-related troughs or sinks, protected from weather and accessible from work areas, dining facilities and toilets?

  • Is hot and cold water, soap or other cleaning product provided?


  • Is hygienic hand drying provided that does not involve workers sharing towels?

  • Is there adequate toilet paper, hand washing facilities and soap, rubbish bins and sanitary disposal?

  • Are toilets cleaned regularly?

  • Do toilets have lockable doors, adequate lighting and ventilation?

Dining Facilities

  • Is a dining room or dining area?

  • Is there adequate protection from the elements, the work area, contaminants and hazards?

  • Are all fittings, appliances and any other equipment maintained in good condition?

Emergency response

  • Does the workplace have first aid facilities and emergency equipment to deal with the types of emergencies that may arise?

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  • Is the fire protection equipment suitable for the types of risks at the workplace (e.g. foam or dry powder type extinguishers for fires that involve flammable liquids)?

  • Is equipment easily accessible in an emergency?

  • Is there a suitable area for emergency assembly?

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  • Is there at least two points of access for emergency evacuation?

  • Nearest Doctors/Medical Facility?
  • Nearest Hospital?
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.