Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Fire Prevention

  • Evacuation plan displayed and understood by all employees?

  • Evacuation procedures discussed regularly? (>2 times a year)

  • Extinguishers in place and clearly marked?

  • Extinguishers recently serviced? (Check 12 monthly punch mark on tabs.)

  • Are drills conducted annually?

  • Exit doors easily opened from inside?

  • Exits clear of obstructions?

  • Fire alarm system functioning correctly?

  • Sprinkler system inspected and in good condition?

General Lighting

  • Good natural lighting?

  • Reflected light from walls & ceilings not causing glare to employees?

  • Light fittings clean and in good condition?

  • Emergency exit lighting operable?

Building Safety

  • Floor surfaces even and uncluttered?

  • Entry and walkways kept clear?

  • Walkways adequately and clearly marked?

  • Intersections kept clear of boxes etc?

  • Stair and risers kept clear?

  • Are liquid spills removed quickly?

  • Are railings in good condition?

  • Are fall preventive measures in place and used where gaps occur in railings?

  • Furniture in sound condition?

  • Loading area clean and tidy?

Work Benches

  • Clear of rubbish?

  • Tools not in use kept in safe place?

  • No damaged hand tools in use?

  • Damaged power tools removed from use?

  • Work height correct for the type of work and the employee?

  • Sharp edges protected?

Rubbish Removal

  • Bins located at suitable points around site?

  • Bins emptied regularly?

  • Oily rags and combustible refuse in covered metal containers?

Storage Design and Use

  • Materials stored in racks and bins wherever possible?

  • Storage designed to minimise lifting problems?

  • Floors around racking clear of rubbish?

  • General condition of racks and pallets?

Machines

  • Are they kept clean?

  • Are the floors around the machines kept clean?

  • Guards operational and in good condition?

  • Starting and stopping devices within easy reach of operator?

  • Adequate work space?

  • Is lighting adequate?

  • Noise levels controlled?

  • No bending or stooping required?

  • Operators trained/inducted into the operation of the machines?

  • Is the training recorded?

  • Do operators comply with the training?

  • Are lockout procedures implemented and followed?

  • Are gas bottles secured?

Electrical Safety

  • Safety switches installed?

  • Safety switches tested every 6 months and tests recorded?

  • Broken plugs, sockets or switches?

  • Walkways clear of cords and hoses?

  • Cords inspected for damage?

  • Portable power tools in good condition?

Chemical Safety

  • Safety Data Sheets available for all chemicals?

  • All containers labelled correctly?

  • Workers trained in the use of hazardous substances?

  • If required is PPE available?

  • Is adequate ventilation provided?

  • Are eye washes and showers easily accessed?

Ladders

  • Are all ladders Industrial strength? (Non Household rated, check label.)

  • Are ladders in good condition?

  • If used for electrical work are they non conductive? (Wood or fibre glass.)

  • Used according to instructions?

  • For extension ladders are ropes, pulleys and treads in a good state of repair?

First Aid Facilities

  • Cabinets clearly labelled?

  • Is there easy access to cabinets?

  • Employees aware of location of first aid cabinet?

  • Are emergency numbers displayed?

Office Hazards

  • Condition of chairs? (Five star bases.)

  • Chair/stool height adjusted properly?

  • Desks in good condition? (No damage.)

  • Screen Based Equipment adjusted to slightly lower than eye level and position to reduce glare from windows etc?

  • Tasks designed to prevent Occupational Overuse Syndrome? (Breaks included.)

  • Stable non-slip floor coverings in good condition?

Employee Training

  • Is safety training conducted with employees at least monthly?

  • List training topics covered recently:

Manager Training

  • Manager training takes place at least quarterly?

  • Training includes something like motivation, incident prevention, listening skills, disciple and more.

Written Programs (In place and Functional)

  • Respirator

  • HAZCOM/GHS

  • Lockout/Tagout

  • Machine Guarding

  • Forklift

  • Ergonomics

  • Emergency Procedures

  • Injury and Illness Prevention Program

  • Heat Illness Prevention Plan

Behavior Observations

  • Proper lifting and use of body mechanics?

  • Ladder Usage

  • Moving at safe speed?

  • PPE Usage?

  • Body Placement

  • Eyes on task

Sign Off

  • On site representatives

  • Chuck Vancura Director of Loss Control Leavitt Group Insurance Services

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.