Title Page

  • Conducted on

  • Prepared by

  • Location
  • This inspection is to enhance safety awareness amongst the employees and must be conducted in a dialogue with the affected employees, thus to drive continuous improvement by active leadership in EHS.

  • Site Name:
  • Please mention as Site Name: City - Hospital / Customer name - Project

  • Description of the works - intervention:

  • Present subcontractor(s); company name(s): (enter "None" if no subcontractors are present)

  • In case questions can't be verified or checked; than please answer N/A

1. Organization, environment and execution of the works

  • 1.1. Is our safety plan available and followed through?

  • 1.2. Is our risk-assessment (incl. risk-assessment for subcontractors) available and followed through?

  • 1.3. Has a safety toolbox meeting been organized with the customer (and subcontractors) prior commencing the works?

  • 1.4. Is a work permit for hazardous activities (i.e. work at heights) and/or a hot work permit available and followed through?

  • 1.5. Is the work area properly demarcated and/or indicated with safety signage?

  • 1.6. Are the vehicles for loading and unloading properly parked?

  • 1.7. Are the works conducted safely?

  • 1.10. Is the work area arranged neatly and in order?

  • 1.11. Is generated waste removed and properly segregated?

2. Protective equipment

  • 2.1. Is a fire extinguisher available and accessible?

  • 2.3. Have the workers a high visibility vest and do they wear it when required?

  • 2.4. Have the workers safety shoes and do they wear them when required?

  • 2.5. Have the workers a safety helmet and do they wear it when required?

  • 2.7. Have the workers a dosimeter and do they use it correctly when required?

3. Work tools

  • 3.1. Is the scaffold properly set up (wheels locked), inspected (label) and suitable for the job?

  • 3.2. Is the (step)ladder properly set up, inspected (label) and suitable for the job?

  • 3.3. Are the used lifting devices and lifting equipment (i.e. pallet/material lifts, hoists, slings) properly set up, inspected (label) and suitable for the job (not exceeding their maximum load capacity)?

  • A hoist is a device used for lifting or lowering a load. Our hoists are manually operated and use chain as its lifting medium. The hoists couple to their loads using a lifting hook.

  • A sling is a flexible strap or belt used in the form of a loop to support or raise a hanging weight, it is used in a rigging system for lifting. Our slings are made of synthetic fiber.

4. Knowledge and qualification

  • 4.1. Do the workers understand the risks they are exposed to and the risks they are generating by their tasks?

  • 4.2. Do the workers know the assembly point in case of evacuation or can they show where to find this information quickly?

  • 4.3. Do the workers know the emergency number(s) or can they show where to find this information quickly?

  • 4.4. Do the workers know what to do when they are involved in a work-related accident or incident?

  • 4.7. Do the employees know the principle of LMRA (Last minute risk-assessment)?

  • 4.8. Are the workers that work with electricity certified for the job?

  • 4.9. Do the workers know who is responsible for the execution of the works from the Siemens side?

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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.