Title Page

  • Conducted on

  • State date and time checked

These checks are to be completed on a monthly basis to ensure the below workplace areas are satisfactory. If there is any non conforming items a picture must be taken at the end of this report, and then logged in the Corrective Action Log located within the Shared Drive.

  • What site are you at?

  • What is at site?

Toilets & changing rooms used by staff

  • Note down any issues in the space provided below, log on the corrective action log and take a picture using the media tool below if applicable.

  • General Decor

  • Walls/Floor

  • Lighting

  • Heating/Ventilation

  • Sanitary units

  • Cubicle condition

  • Cubicle locks

  • Toilets/Urinals

  • Hand dryers

  • Hot water supply

  • Soap Dispenser

  • Drinking water/hygiene

  • Signs

STAFF ONLY AREAS

  • Note down any issues in the space provided below, log on the corrective action log and take a picture using the media tool below if applicable.

  • Lockers/Rail

  • General Decor

  • Carpet

  • Furniture

  • Lighting

  • Equipment storage areas

  • Bins

  • Plant rooms

  • DM completion signature

  • GM Sign off

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.