Safety Sample Checklist

• Site

  Select
• Location
  Address

• Date / Time

  Date

• Site Manager Name

• Assessed By

• Safety sampling seeks to identify and correct the unsafe acts and conditions that if allowed to continue will eventually lead to accidents. Designated person(s) conduct safety samples in all areas of the site (this should not take more than 15 minutes for each area). They record all safety defects that they see during the sample using the following checklist. On completion the checklist is passed to the relevant manager(s) who will plan and commence actions.

• Please click the '+' on the relevant areas of your site from the list below.

First Aid

• First Aid box is in place and is correctly stocked.

  Yes

  No

  N/A

• All persons know who the designated first aider(s) are.

  Yes

  No

  N/A

• De-defibrillator is in place and unobstructed.

  Yes

  No

  N/A
Fire Safety

• Fire Alarm system tested weekly.

  Yes

  No

  N/A

• All persons know the fire evacuation procedure.

  Yes

  No

  N/A

• Designated fire marshal on site.

  Yes

  No

  N/A

• Fire exit doors are unobstructed and open fully.

  Yes

  No

  N/A

• Escape routes are unobstructed.

  Yes

  No

  N/A

• Fire exits signs are visible above each fire exit.

  Yes

  No

  N/A

• Directional fire exit notices visible where required.

  Yes

  No

  N/A

• Fire extinguishers correctly positioned & unobstructed.

  Yes

  No

  N/A

• Fire extinguishers are full, in good condition & in test.

  Yes

  No

  N/A

• Alarm points are unobstructed.

  Yes

  No

  N/A
Contractors

• Contractors on site are approved.

  Yes

  No

  N/A
Driving Range / Practice Area

• Lighting (natural and artificial) is good.

  Yes

  No

  N/A

• A reasonable working temperature is maintained.

  Yes

  No

  N/A

• All floors & surfaces are in as good as condition as practicable.

  Yes

  No

  N/A

• All floors are clean and free from slip & trip hazards.

  Yes

  No

  N/A

• Pedestrian walkways and stairways are unobstructed.

  Yes

  No

  N/A

• Tables, chairs, and other equipment are in good condition.

  Yes

  No

  N/A

• Aircon and ventilation are in good condition.

  Yes

  No

  N/A

• Ceilings are clean and in good condition.

  Yes

  No

  N/A

• Waste bins are clean and in good condition.

  Yes

  No

  N/A

• Housekeeping is good.

  Yes

  No

  N/A

• All areas are clean to AG hygiene standards.

  Yes

  No

  N/A

• All electrical appliances are in good condition and with an in date PAT test.

  Yes

  No

  N/A

• All electrical boxes / cabinets are secure.

  Yes

  No

  N/A

• Electric / Gas cut-off switches are unobstructed.

  Yes

  No

  N/A

• Hazardous substances are stored correctly.

  Yes

  No

  N/A

• Relevant safety information displayed.

  Yes

  No

  N/A

• Equipment has warning and caution decal displayed.

  Yes

  No

  N/A

• Storage is in defined areas, waste oil stored safety etc.

  Yes

  No

  N/A

• All fixtures and fittings are secure and in good condition.

  Yes

  No

  N/A

• All staff are trained for the task(s) being performed.

  Yes

  No

  N/A

• Pre-use equipment checks are carried out.

  Yes

  No

  N/A

• All guards and safety devices are in place and secure.

  Yes

  No

  N/A
Restaurant / Bar / Kitchen

• Lighting (natural and artificial) is good.

  Yes

  No

  N/A

• A reasonable working temperature is maintained.

  Yes

  No

  N/A

• All floors & surfaces are in as good as condition as practicable.

  Yes

  No

  N/A

• All floors are clean and free from slip & trip hazards.

  Yes

  No

  N/A

• Pedestrian walkways and stairways are unobstructed.

  Yes

  No

  N/A

• Tables, chairs, and other equipment are in good condition.

  Yes

  No

  N/A

• Aircon and ventilation ducts are in good condition.

  Yes

  No

  N/A

• Ceilings are clean and in good condition.

  Yes

  No

  N/A

• Waste bins are clean and in good condition.

  Yes

  No

  N/A

• Housekeeping is good.

  Yes

  No

  N/A

• All areas are clean to AG hygiene standards.

  Yes

  No

  N/A

• All electrical appliances are in good condition and with an in date PAT test.

  Yes

  No

  N/A

• All electrical boxes / cabinets are secure.

  Yes

  No

  N/A

• Electric / Gas cut-off switches are unobstructed.

  Yes

  No

  N/A

• Hazardous substances are stored correctly.

  Yes

  No

  N/A

• All tools including cutting tools are in good condition.

  Yes

  No

  N/A

• Relevant safety information displayed.

  Yes

  No

  N/A

• Equipment has warning and caution decal displayed.

  Yes

  No

  N/A

• Storage is in defined areas, waste oil stored safety etc.

  Yes

  No

  N/A

• All fixtures and fittings are secure and in good condition.

  Yes

  No

  N/A

• All staff are trained for the task(s) being performed.

  Yes

  No

  N/A

• Pre-use equipment checks are carried out.

  Yes

  No

  N/A

• All guards and safety devices are in place and secure.

  Yes

  No

  N/A
Adventure Golf

• Lighting (natural and artificial) is good.

  Yes

  No

  N/A

• A reasonable working temperature is maintained.

  Yes

  No

  N/A

• All floors & surfaces are in as good as condition as practicable.

  Yes

  No

  N/A

• All floors are clean and free from slip & trip hazards.

  Yes

  No

  N/A

• Pedestrian walkways and stairways are unobstructed.

  Yes

  No

  N/A

• Tables, chairs, and other equipment are in good condition.

  Yes

  No

  N/A

• Waste bins are clean and in good condition.

  Yes

  No

  N/A

• All areas are clean to AG hygiene standards.

  Yes

  No

  N/A

• Housekeeping is good.

  Yes

  No

  N/A

• All electrical boxes / cabinets are secure.

  Yes

  No

  N/A

• Relevant safety information displayed.

  Yes

  No

  N/A

• Storage is in defined areas, waste oil stored safety etc.

  Yes

  No

  N/A

• All staff are trained for the task(s) being performed.

  Yes

  No

  N/A

• Pre-use equipment checks are carried out.

  Yes

  No

  N/A

• All guards and safety devices are in place and secure.

  Yes

  No

  N/A
Clubhouse

• Lighting (natural and artificial) is good.

  Yes

  No

  N/A

• A reasonable working temperature is maintained.

  Yes

  No

  N/A

• All floors & surfaces are in as good as condition as practicable.

  Yes

  No

  N/A

• All floors are clean and free from slip & trip hazards.

  Yes

  No

  N/A

• Pedestrian walkways and stairways are unobstructed.

  Yes

  No

  N/A

• Tables, chairs, and other equipment are in good condition.

  Yes

  No

  N/A

• Aircon and ventilation are in good condition.

  Yes

  No

  N/A

• Ceilings are clean and in good condition.

  Yes

  No

  N/A

• Waste bins are clean and in good condition.

  Yes

  No

  N/A

• Housekeeping is good.

  Yes

  No

  N/A

• All areas are clean to AG hygiene standards.

  Yes

  No

  N/A

• All electrical appliances are in good condition and with an in date PAT test.

  Yes

  No

  N/A

• All electrical boxes / cabinets are secure.

  Yes

  No

  N/A

• Electric / Gas cut-off switches are unobstructed.

  Yes

  No

  N/A

• Hazardous substances are stored correctly.

  Yes

  No

  N/A

• All tools including cutting tools are in good condition.

  Yes

  No

  N/A

• Relevant safety information displayed.

  Yes

  No

  N/A

• Equipment has warning and caution decal displayed.

  Yes

  No

  N/A

• Storage is in defined areas, waste oil stored safety etc.

  Yes

  No

  N/A

• All fixtures and fittings are secure and in good condition.

  Yes

  No

  N/A

• All staff are trained for the task(s) being performed.

  Yes

  No

  N/A

• Pre-use equipment checks are carried out.

  Yes

  No

  N/A

• All guards and safety devices are in place and secure.

  Yes

  No

  N/A
Maintenance Area / Golf Course

• Lighting (natural and artificial) is good.

  Yes

  No

  N/A

• A reasonable working temperature is maintained.

  Yes

  No

  N/A

• All floors & surfaces are in as good as condition as practicable.

  Yes

  No

  N/A

• All floors are clean and free from slip & trip hazards.

  Yes

  No

  N/A

• Pedestrian walkways and stairways are unobstructed.

  Yes

  No

  N/A

• Tables, chairs, and other equipment are in good condition.

  Yes

  No

  N/A

• Waste bins are clean and in good condition.

  Yes

  No

  N/A

• Housekeeping is good.

  Yes

  No

  N/A

• All areas are clean to AG hygiene standards.

  Yes

  No

  N/A

• All electrical appliances are in good condition and with an in date PAT test.

  Yes

  No

  N/A

• All electrical boxes / cabinets are secure.

  Yes

  No

  N/A

• Electric / Gas cut-off switches are unobstructed.

  Yes

  No

  N/A

• Hazardous substances are stored correctly.

  Yes

  No

  N/A

• All tools including cutting tools are in good condition.

  Yes

  No

  N/A

• Relevant safety information displayed.

  Yes

  No

  N/A

• Equipment has warning and caution decal displayed.

  Yes

  No

  N/A

• Storage is in defined areas, waste oil stored safety etc.

  Yes

  No

  N/A

• Work areas are set out ergonomically.

  Yes

  No

  N/A

• All fixtures and fittings are secure and in good condition.

  Yes

  No

  N/A

• All staff are trained for the task(s) being performed.

  Yes

  No

  N/A

• Pre-use equipment checks are carried out.

  Yes

  No

  N/A

• All guards and safety devices are in place and secure.

  Yes

  No

  N/A

Summary

• Assessor Signature

  Sign