Title Page

  • Conducted on

  • Prepared by

  • Location

1. Office set up - ergonomics

  • An adjustable height and back rest, ergonomic chair with a five base used

  • Feet’s and lower limbs are supported by floor or footrest

  • Keyboard height allows shoulders to be relaxed

  • There is adequate working space on desk

  • Monitor approximately arm’s length from operator and eyes approximately level with top third of screen

  • Monitor screen is free from glare

  • Frequently used items are within close reach

  • Postural change occurs every 25 - 30 minutes

  • Repetitive twisting / bending of neck or back is avoided


  • The temperature is adequate / comfortable

  • Lighting and ventilation is adequate for the tasks required

  • Good vision can be obtained at entry and exit points

  • Walkways / traffic areas are clear of clutter

  • Furniture and trolleys are arranged to minimise disruption to walkways

  • Work surfaces are at an appropriate height

  • Traffic flow in area does not cause risk of collision or injury

  • Noise levels are not excessive within the department

  • There is appropriate drainage to ensure water doesn’t pool on the floor

  • Floors are even and have an appropriate slip resistance

  • Floors are free from gaps / holes / cracks

  • Stairways have adequate handrails, are clear of clutter and in good repair

  • The workplace amenities used by the staff are adequate and in a clean condition

3. Electrical

  • 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

  • Detail next expiry date

  • Electrical cords, extensions, plugs and switches are safely arranged and in good repair I.e. plastic covering intact

  • Electrical cords are secured to prevent trip injuries

  • Piggy back plugs (double adaptors) are NOT used in the department

  • Electrical equipment is not exposed to water

4. Personal Protective Equipment (PPE)

  • PPE and disposable gloves, glasses, aprons and ear protection are available for use and in good condition

  • Staff are wearing the required PPE

  • Detail ONE item of PPE worn :

  • Staff are wearing appropriate footwear I.e. non - slip rubber soled shoes

  • Radiation monitoring devices are worn by staff who have potential to be exposed to radiation

  • Radiation monitoring device records are kept by a designated person and any over exposure are reported

  • Lead aprons are in good condition stored appropriately and are tested as per radiation safety standards and records are kept of same

  • Radiation signage is in place where radiation is used

  • Laser safety protocols are in place where lasers are used

  • Laser safety signage is in place where lasers are in use

5. Equipment / Machinery

  • Safety steps or step ladders are available to enable access to all storage areas

  • Trolleys, beds and other wheeled equipment neatly arranged wheels and brakes are adequate and in good repair

  • Any damaged equipment has been removed from service until repair / replacement

  • All powered equipment and machinery is in good working order

  • All machinery and equipment is maintained and serviced as per the manufacture or suppliers guidelines. Observe service records and detail when the last service date was out of all of the equipment / Machinery

  • Date of last service

  • Out of service or danger tags are available to place on faulty / damaged equipment

  • Drip / monitor stands are easy to propel and do not over balance I.e. must have a 5 point base

  • Gazunda safety check including : emergency stop, charger, emergency backup bar & horn

6. Housekeeping

  • Wet floor signs are available and used

  • Equipment not in use is removed to storage or disposed of

  • The environment is free of trip / slip hazards

  • The floor is free from rubbish, debris and or spills

7. Emergency

  • Fire extinguishers and a hose reel are in close proximity, clearly marked and have been tested within the last 6 months

  • Detail when the fire extinguisher was last tested (will be displayed on the metal tag on the neck of the extinguisher)

  • Emergency exit signs are lit and are clearly marked and visible

  • Fire and smoke doors are clearly signed

  • Exit doors open and close and are free from obstructions

  • 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

  • Emergency wall plans are in place clearly showing, exits and firefighting equipment

  • Emergency procedure flip books are located next tto o every staff telephone

  • Staff are aware of emergency procedures and how to raise the alarm - DIAL 55

  • Ask FIVE staff members 1. 2. 3. 4. 5.

  • Smoke / detectors are free from damage / obstruction

  • All emergency alarms have been tested I.e. duress alarm

  • First Aid kit is available and fully stocked

  • Staff have received basic fire extinguisher training

8. Storage

  • Items stored on shelves are not stored too high. I.e. items on top shelves should be one box high

  • Are items stored appropriately I.e. Frequently used items and heavy items stored between knee and shoulder height

  • Materials are stored securely to prevent falling

  • Shelves are secured to the walls / floors to prevent falling

  • Gas cylinders are stored upright and are within a racking system or non - abrasive chain

  • Storage rooms are neat and tidy to allow a clear walking path and are free from rubbish

9. Chemicals

  • Safety data sheet (SDS) book is stored with the chemicals in the chemical storage / cleaners room

  • CheMical containers are labeled with the manufacture / suppliers label

  • Spill kits are available to clean up chemical spills (in bulk chemical storage areas)

  • Appropriate PPE is worn by staff working with chemicals

  • All chemicals are stored to prevent unauthorised access and storage areas are locked I.e. cleaners room

10. Manual handling

  • Staff follow correct patient manual handling and materials manual tasks procedures

  • Staff have received patient and materials manual handling training within the last year

  • Staff are not required to undertake tasks lifting excessive weight

  • Manual handling aids are available on the ward to reduce the need for manual handling I.e. slide sheets

  • A laminated patient mobility guide and risk assessment tool is located in the bedside patient care folder and in prominent locations in the clinical work areas (verify in patient files)

  • WeAring of lead aprons is minimised

  • Staff adhere to correct posture when wearing lead aprons

  • Object and patient manual handling is minimised and sliding(or low risk option) instead of lifting is utilised

  • For repetitive tasks, regular rotation is enforced for staff

  • Procedures are in place to minimise staff needing to sustain awkward postures during tasks

  • Large weights are separated when possible I.e. surgical tray and one set is handled at a time

11. Workplace Health and Safety Information

  • 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

  • Current Workplace Health and Safety Subcommittee Minutes are displayed in work area

  • Current monthly Safety reports are displayed in area

  • Injury Hotline poster displayed in work area

12. Policy and Procedure

  • Policy and Procedures are followed at all times and are up to date

  • Safe Operating Procedures (SOPs) are in place for all tasks and are up to date

13. Agency / Casual / Contractor Staff

  • All agency / casual / contractor staff have received the contractor orientation induction checklist and ward specific orientation handout

  • All agency / casual staff have signed the ward attendance register

  • All agency / casual staff are wearing appropriate ID badges

14. Security

  • Identity badges are visible and worn at all times, including agency, doctors, students and contractors

  • Designated areas are limited to authorised personnel at all times I.e. plant rooms, storage areas etc

  • Access / Entry to the department is controlled

15. Waste management

  • All waste is contained and disposed of in appropriate waste stream I.e. general, clinical confidential, cytotoxic

  • Total Number of Corrective Actions

  • Completed by

  • Department Manager Name

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