Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Assessment

  • Review this image before proceeding with your safety inspection

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  • Are floors free of water, ice, oil or other fluids?

  • Are floor surfaces even (eg no loose tiles or carpet that is torn or has ridges or holes)?

  • Is there a safety risk?

  • Mark clearly on this map where the risk has been identified

  • Supervisor has been automatically notified

  • Are walkways and doorways clear of boxes, extension cords and litter?

  • Are work areas, walkways and stairs well lit?

  • Are all lights working?

Final comments

  • Sign off

  • Supervisor sign off

  • Additional Comments - Is there anything else you would like us to know?

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.