Title Page
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Client / Site
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Conducted on
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Prepared by
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Location
1. Signage (in compliance with AS 1319)
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Visitor Instruction
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Entrance/Exit
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Speed Limits
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Directional Arrows
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Caution Signs
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Specific Identified Hazards
2. Line Marking
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Dock Edges
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Freight Areas
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Exits
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Access Areas
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Parking Locations
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Traffic Directional Marking
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Other Line Marking Needing Attention
3. Housekeeping
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Dock Area
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Stairs
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Freight Areas
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Equipment Parking
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Spill Areas Cleaned
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Grounds Clean (paper, plastic, etc.)
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Walkways Clear of Obstructions
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Cleanliness/Removal of Debris
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Mechanical Methods of Debris Removal
4. Building & Workplaces
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Floors (including ramps)
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Walls
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Docks
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Stairs
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Roof/Guttering/Downpipes
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Furniture
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Lighting Levels
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Sufficient Room to Work Safely
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Ventilation
5. Fire Precautions
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Fire Extinguishers (as per AS 2444)
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Fire Reels/Hoses
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Hydrants/Fire Water Lines
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Signs
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Regular Servicing of Fire Equipment
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Exits Clear of Obstructions
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Fire Alarm Working
6. Emergency Information
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Emergency Response Plan
7. First Aid Facilities
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First Aid Facilities Available/Contents
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Names/Location of First Aider(s)
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Contents Regularly Checked & Restocked
8. Personal Protective Equipment
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Observation - Is PPE being worn?
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Gloves
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Eye Protection
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Dust Protection
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Hearing Protection
9. Dangerous Goods/Hazardous Substances
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DG Storage Area (overall appearance)
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Condition of Concrete Bund
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Location of PPE
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Emergency Shower/Eye Washes
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Dangerous Goods Segregation
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Location of SDS's
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DG Storage Compatible with DME Licence
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What are the classes and UN numbers of DG are on site?
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DG/Hazchem Manifest
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Site Map of Dangerous Goods Area
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Register of Dangerous Goods/Hazardous Substances
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Securing of Gas Cylinders
10. Environmental
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Domestic Waste Management
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Liquid Waste Management (oil etc.)
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Spillage (oils, fuels, etc.)
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Drums/Containers Sealed & Regularly Removed
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Energy Use (observation)
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Noise Levels
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Dust Levels
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Air Temperature/Methods of Heating & Cooling
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Drainage is Adequate on Floor of Work Areas
11. Electrical
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Condition of Plugs and Outlets
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Condition of Leads (frayed/damaged)
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Portable Power Tools
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Items Tagged and Dated
12. Machinery/Equipment
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Forklifts
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Fork Attachments
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Vehicles
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Compressors
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LPG Installation
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Air Conditioners
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Warning Devices Working
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Hand Tools
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Access Equipment (steps, ladders, EWP)
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Plant Registration and Inspection Certificates
13. Manual Handling
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Manual Handling Aids are Available
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Manual Handling Aids are Servicable
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Manual Handling Aids are Used
14. Amenities
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Drinking Water Available
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Adequate Seating at Work Stations
Additional Comments
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Additional Comments
