Title Page
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Conducted on
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Prepared by
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Location
1. Office set up - ergonomics
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An adjustable height and back rest, ergonomic chair with a five base used and is fully functional and undamaged
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Feet’s and lower limbs are supported by floor or footrest
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Keyboard height allows shoulders to be relaxed
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There is adequate working space on desk & frequently used items are within close reach
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Monitor approximately arm’s length from operator and eyes approximately level with top third of screen and free from glare
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Postural change occurs every 25 - 30 minutes
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Repetitive twisting / bending of neck or back is avoided
2.Environment
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The temperature is adequate / comfortable
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Lighting and ventilation is adequate for the tasks required
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Walkways / traffic areas are clear of clutter
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Work surfaces are at an appropriate height
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Noise levels are not excessive within the department
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Floors are free from gaps / holes / cracks
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The workplace amenities used by the staff are adequate and in a clean condition
3. Electrical
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Electrical appliances, cords, and equipment have been tested and tagged. Please check all items and advise when NEXT EXPIRY date is out of all of the items
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Detail next expiry date
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Electrical cords, extensions, plugs and switches are safely arranged and in good repair I.e. plastic covering intact
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Electrical cords are secured to prevent trip injuries
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Piggy back plugs (double adaptors) are NOT used in the department
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Electrical equipment is not exposed to water
4. Personal Protective Equipment
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PPE and disposable gloves, glasses, aprons and ear protection are available for use and in good condition
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Staff are wearing the required PPE
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Detail ONE item of PPE worn :
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Staff are wearing appropriate footwear I.e. non - slip rubber soled shoes
5. Equipment / Machinery
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Safety steps or step ladders are available to enable access to all storage areas
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Trolleys and other wheeled equipment neatly arranged wheels and brakes are adequate and in good repair, all chairs are in good repair - patients and visitor
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Any damaged equipment has been removed from service until repair / replacement
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All equipment and machinery is in good working order
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Out of service or danger tags are available to place on faulty / damaged equipment
6. Housekeeping
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Wet floor signs are available and used
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Equipment not in use is removed to storage or disposed of
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The environment is free of trip / slip hazards
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The floor is free from rubbish, debris and or spills
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Adequate bins are provided to dispose of rubbish
7. Emergency
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Fire extinguishers and a hose reel are in close proximity, clearly marked and have been tested within the last 6 months
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Emergency exit signs are lit and are clearly marked and visible
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Fire and smoke doors are clearly signed
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Exit doors open and close and are free from obstructions
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Emergency procedures (code red - fire, code orange - evacuation, code brown - ext emergency) are contained in the fire box at the emergency assembly points and are in date
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Emergency wall plans are in place clearly showing, exits and firefighting equipment
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Emergency procedure flip books are located next to every staff telephone
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Staff are aware of emergency procedures and how to raise the alarm - DIAL 55
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Ask FIVE staff members 1. 2. 3. 4. 5.
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First Aid kit is available and fully stocked
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Staff have received basic fire extinguisher training
8. Storage
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Items stored on shelves are not stored too high. I.e. items on top shelves should be one box high
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Are items stored appropriately I.e. Frequently used items and heavy items stored between knee and shoulder height
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Shelves are secured to the walls / floors to prevent falling
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Safety steps are available in all storage areas
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Storage rooms are neat and tidy to allow a clear walking path and are free from rubbish
9. Chemicals
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Safety data sheet (SDS) book is stored with the chemicals in the area
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Chemical containers are labeled with the manufacture / suppliers label
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Appropriate PPE is worn by staff working with chemicals
10. Manual handling
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Staff follow correct patient manual handling and materials manual tasks procedures
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Staff have received patient and materials manual handling training within the last year
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Staff are not required to undertake tasks lifting excessive weight
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Equipment is available (e.g. trolleys) to reduce the need for manual handling
11. Workplace Health and Safety Information
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The below policies are displayed in the work area and signed by the hospital executive. * Work Health and Safety * Manual Handling. * Zero Tolerance - Aggression & Violence * Return to Work & Rehabilitation
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Current Workplace Health and Safety Subcommittee Minutes are displayed in work area
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Current monthly Safety reports are displayed in area
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Injury Hotline poster displayed in work area
12. Policy and Procedure
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Policy and Procedures are followed at all times and are up to date
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Safe Operating Procedures (SOPs) are in place for all tasks and are up to date
13. Agency / Casual / Contractor Staff
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All agency / casual / contractor staff have received the contractor orientation induction checklist and ward specific orientation handout
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All agency / casual staff have signed the ward attendance register
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All agency / casual staff are wearing appropriate ID badges
14. Security
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Identity badges are visible and worn at all times, including agency, doctors, students and contractors
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Designated areas are limited to authorised personnel at all times I.e. finance, executive, HIS etc.
15. Waste management
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All waste is contained and disposed of in appropriate waste stream I.e. general, clinical confidential, recycle
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Total Number of CorrectiveActions
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Completed by
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Department Manager Name
