Title Page

  • Site/ Department conducted:

  • Conducted on:

  • Conducted by:

  • Location
  • 1. Appointed 16.1?

  • 2. SHE Rep trained and appointed?

  • The status of all items on this checklist should be indicated as conforn, non conform or not applicable. All non conform items must be given a written explanation and remedial action captured on action list

1. ACCESS (This section include the access, exits walkway, pontoon walkway, pathway, …to access the building/plant/area)

  • 1.1. Is there a board/ signage presenting the specific risks, precautions and PPE required to <br> access the area/plant ?

  • 1.2. Is there a color code board at the entrance?

  • 1.3. Are exits properly marked and exit lights working?

  • 1.4. Are the entrances obstructed?

  • 1.5. Are entrances properly lighted/illuminated? <br> (Check all lights, bulbs, fluorescent tubes are clean and working)

  • 1.6. Are unsafe areas barricaded and signposted?

  • 1.7. Are the walkways clear and unobstructed?

  • 1.8. All incidents reported and investigated within 24 hours?

2. HYGIENE and SANITATION (Look at toilets, change rooms, tea rooms, cantines and hand washing facilities)

  • 2.1. Are tea rooms (cantines), change rooms and ablution facilities cleaned and sanitized ?

  • 2.2. Are ablution facilities equipped with toilet papers and water?

  • 2.3. Are ablution facilities equipped with hand wash bassin and soap?

  • 2.4. Are ablution facilities for male and female separate and sign posted?

  • 2.5. Is the ablution inspection sheet in place and up to date?

  • 2.6. Are ablution facilities (including sewage treatment plant) part of the maintenance program?

  • 2.7. Is the Sewage Systems operational?

  • 2.8. Are employees/contractors only eating on authorized and designated area?

  • 2.9. Are tea rooms (cantine) equipped with waste bins?

  • 2.10. Ask an employee if he/she is feeling safe using the ablution facilities and tea rooms (cantine) ?

3. Open shelves, container storages,…

  • 3.1. Are the floors, gratings, stairways and aisles… free of debris and obstruction?

  • 3.2. Are the floors, gratings, stairways and aisles… free of oil and grease?

  • 3.3. Is cleaning done to prevent accumulation of unnecessary dust, chemicals, wastes…on <br> the workplace?

  • 3.4. Are individual work stations kept clean, organized and orderly?

  • 3.5. Are pipelines, machinery and equipment free of drippings oil or grease?

  • 3.6. Is there a dedicated and barricaded place to temporarily store unsused materials/scraps <br> until they are removed from site?

  • 3.7. Are staking of material stable and not creating obstruction and risk of fall of obect?

  • 3.8. Are staking on shelves storage respecting load limits?

  • 3.9. Is the stacking of materials safe to avoid risk of fall of object to the operator/slinger?


  • 4.1. Are lifting equipments and accessories checked and tagged according to the current color code and logged into a register?

  • 4.2. Are working at height equipments (safety harnesses, lanyards, anchore points, portable <br> ladders, …) checked and tagged according to the current color code and logged into a <br> register?

  • 4.3. Are confined space equipments, checked and tagged according to the current color <br> code and logged into a register?

  • 4.4. Are portable electrical equipments checked on monthly basis and logged into a register?

  • 4.5. Are lifting, working at height, confined space equipments, portable electrical equipments <br> stored appropriately while not in use?

  • 4.6. Is a physical (pre-use) inspection performed before using these type of equipments?

  • 4.7. Are pipelines coded in term of color coded standard?

  • 4.8. Are wall plugs, switches and other switchgear checked and labelled?

  • 4.9. Are unsafe equipments being red tagged and quarantined?


  • 5.1. Are employees wearing properly their basic and specific PPE while performing their job?

  • 5.2. Do supervision carry out regular inspections on their team to ensure that their PPE are in <br> good condition?

  • 5.3. Are employees with long hair respecting the agreed precaution to secure their hairs <br> inside the hard hat?

  • 5.4. Are employees having prescription glasses equipped with side shields? Otherwise, are <br> overprotection used?

  • 5.5. Are mosquito repellent products available on the workplace for employees to use? (if <br> applicable)


  • 6.1. Soils contaminated with oil, or other chemicals disposed off into hazardous waste container

  • 6.2. Is there adequate labelled bins per type of waste in the workplace according to the <br> waste volume of the plant?

  • 6.3. Is there no waste placed outside the bins?

  • 6.4. Are waste bins kept closed ?

  • 6.5. Is the waste segregation done according to Waste Management Procedure?

  • 6.6. Are all used oil drums sealed?

  • 6.7. Is the condition of the bund in compliance: no cracks, no deterioration, no direct <br> release to the environment? (bunding around generator, compressors, fuel storage <br> areas, Oil/ paint storage or baths)

  • 6.8. Is the net capacity of the bund posted and visible?

  • 6.9. Is there accumulated spillage, water or rain water within the bunded area?

  • 6.10. Is there enough spill kits for the quantity of chemicals present?


  • 7.1. Chemical, flammable materials

  • 7.2. Is there a register of hazardous chemicals ?

  • 7.3. Are the MSDS (material safety data sheets) available in the workplace so that users can <br> have access to them?

  • 7.4Are the involved employees trained on handling, storage, use and emergency procedures on the hazardous chemicals?

  • 7.5. Are the mandatory signage ‘’No open flames" and "No smoking" displayed in the vicinity of the flammable liquid store?

  • 7.6. Is the maximum storage capacity of the flammable liquid store prominently displayed at <br> the store entrance?

  • 7.7. Are gas cylinders, the pipes, cutting torches, regulators, flash back arrestors and <br> pressure indicators in good condition and safe to use?

  • 7.8. Are gas cylinders storage labels in place (Name of the gas and manufacturers plate)?

  • 7.9. Are gas cylinders kept upright and chained/strapped while stored or transported?

  • 7.10. Is there ventilated system for the storage of chemicals?

  • 7.11. Is there adequate fire-fighting equipment available in close vicinity of the flammable <br> liquid store?


  • 8.1. Are vehicles and mobile equipments clean (mainly interior,windows and lights?

  • 8.2. Are pre-use checklist completed and available?

  • 8.3. Are defects on vehicles and mobile equipments raised and adressed for repairs?

  • 8.4. Is there a separate parking for LDV and forklifts?

  • 8.6. Are loading areas demarcated and sign posted as no go zone for pedestria?

  • 8.6. All machine operators trained?

  • 8.8. Are designated staff trained on performing lock out?

  • 8.9. Proper equipment to perform lock out available?


  • 9.1. Are fire extinguishers fixed and located on easily accessible positions ?

  • 9.2. Are fire extinguishers labelled and safety seal in place?

  • 9.3. Is the fire extinguishing equipments returned on its dedicated place after use?

  • 9.4. Are fire extinguishing equipments tested, operational and inspections up to date?

  • 9.5. Is there trained first aider and on site fire fighter in the area?

  • 9.6. Is there a planned Fire drills for the area?

  • 9.7. Are the emergency alarms system operational? Provide monthly test certificate

  • 9.8. Are ERT training and drills updated on the area?


  • 10.1. All routine and non critical tasks are covered by Baseline Risk Assessment?

  • 10.2. Each critical task is covered by an approved Task Based Risk Assessment?

  • 10.3. Are the Critical Controls adhered to? (includes using chock blocks)

  • 10.4. Are team leaders of the area scheduling Planned Task Observation or critical audits for <br> Critical Tasks of their area?

  • 10.5. Are near misses reported, recorded and managed properly? (To be marked as NA until <br> Near miss campaign launched)

  • 10.6. Are all incidents rreported and investigated?


  • 11.1. SHE Policy awareness done to all employees, attendance kept in file?

  • 11.2. Appointments of people with SHE functions done and copies kept in file?

  • 11.3. Toolbox talks & Training records for employees kept in files? Including new employees

  • 11.4. SHE rep inspections done on monthly basis and actions addressed?

  • 11.5. Copies of updated Risk Assessments, and Take 5 kept in file?

  • 11.6. Are SHE monthly (quarterly) meetings and risk register review performed on the area?

  • 11.7. Incident Records and Recalls awareness in file?

  • 11.8. Emergency drills and fire test records done an in file?

  • 11.9. Check specific permits books (hot work, isolation, confined space, excavation) and identify gaps


  • 12.1. Is there a Planned Maintenance on equipment?

  • 12.2. Are emergency switch and/or equipment controls visible and operational?

  • 12.3. Are pressure vessels regulatory inspection up to date?

  • 12.4. Are guards in place for rotating equipments?

  • 12.5. Are equipment calibrations done and defective equipment tagged?

  • Hazards identified during the inspection which cannot be fixed immediately and require expert skills or equipment to be ordered should to be recorded in the table below. The page should then be photocopied and logged into the work area hazard file. Completed inspection forms are to be forwarded to the Head of Department for review, follow-up and filing

  • The Responsible Person *SHE Officer) is responsible for monitoring progress of the hazard log folder. At the end of each month the Responsible Person is responsible for updating progress to the hazard register and forwarding a list of outstanding actions to the Area Manager





  • Target Date

  • Reviewed by Head of Department

  • Signature:

  • SHE rep name:

  • Signature

  • Date

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