Information

  • Client / Site

  • Add media

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Area

  • Add media

  • Lighting adequate and operational?

  • Ventilation is adequate?

  • Electrical switches/sockets in good condition?

  • Furniture safe and undamaged?

  • Is the building secure?

Emergency

  • Add media

  • Access and egress paths clear?

  • Are first aid kits accessible?

Welfare areas

  • Add media

  • Drains (floor and sink) clear and free flowing?

  • Area free from pests or evidence thereof

Validation information

    Affected area / item
  • Add media

Scope

  • Works completed to date?

  • Additional works required, number of techs and timeframe?

Sign Off

  • On site representative

  • Add signature

  • Auditor's signature

  • Add signature

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.