Information

  • Client Name

  • Address

  • Site Contact Name & Position

  • Contact Details

  • Conducted on

  • Prepared by

General

  • Describe task / role expected to be undertaken by on-Hired staff

  • Name & Contact of Person(s) supervising On-Hired staff

  • Will on-hired personnel be supervised at all times?

  • What type of training will be given?

  • Is there a person Trained in First Aid Onsite? (List name & Location)

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  • Is there a full / well stocked First Aid kit on site? (List location)

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  • Is there a First Aid register onsite to record injuries / illnesses? (List Location)

  • Is there a building evacuation plan that shows muster points on site?

  • Add media

  • Are all emergency exits clearly marked? (If Yes list how EG lights / floor markings)

  • Add media

  • Are all emergency exits clear of obstructions and unlocked?

  • Add media

  • Is there sufficient, risk appropriate fire fighting equipment onsite?

  • Add media

  • Does all fire fighting equipment have clear access and correct signage?

  • Is all fire fighting equipment tested & tagged regularly (Within the last 6 month)? (List last tag date)

  • Are the toilets clean & well stocked with toilet paper & soap?

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  • Is there a safe location staff & store personal belongings? (EG Lockers / Behind Desk - please list)

  • Is there access to clean drinking water?

  • Is there a dedicated lunchroom or area where staff can take breaks? (List Location)

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  • Are there facilities for storing / heating food On-Hired staff can use? (EG Fridge / Microwave - Please List)

  • Is the site free from chemicals? (Other than household cleaners - If no please list type(s) & location of MSDS)

Electrical, Ergonomics & Environment

  • Describe or picture work area / environment

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  • Is there sufficient lighting onsite for On-Hired staff to undertake duties required?

  • Is the work environment temperature comfortable / Controlled (Air conditioned) to undertake duties in? (Not overly hot or cold)

  • Is the work station (Desk) at a good height and has an height adjustable chair to be able to perform work duties in a correct posture?

  • Is the adjustable chair clean & in good working order? (EG Height adjustable lever working, Wheels / rollers working and in good order ETC)

  • Is there sufficient leg room under the desk?

  • Is the work environment free from Trip, slip hazards or uneven surfaces?

  • Are all plug sockets / switches and leads in good condition? (IE: Not damaged, Frayed or exposed wires showing)

  • Is electrical equipment / leads etc tested and tagged? (If yes please list tag date)

  • Are all electrical leads and wires organized in a neat and orderly fashion as to eliminate tripping hazards?

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Manual Handling - Other - Notes - Signature

  • Will on-hired staff AVOID lifting heavy / bulky or awkward items? (Heavy = What a person is capable of OR no more that 5kg from a seated position / 15kg from other positions)

  • Are most commonly used items easily accessible and stored between shoulder and mid thigh level?

  • If High shelving needs to be accessed is there appropriate equipment available for accessing those shelves? (EG Safety steps)

  • Is there a requirement for on-hired staff to work in isolation or remotely from other staff or workforce? (If YES please list below measures put in place for communication / Safety ETC)

  • Apart from general cleaning products are there any other chemicals stored onsite? (EG paint thinners / metholated spirits)

  • If yes are those chemicals stored in there correct containers & are the MSDS / SDS readily available for those chemicals. (List location of MSDS)

  • Please list: Risks Identified (If any) / Recommendations / Notes

  • Company Client Representative or Site Contact Signature:

  • Person Whom Completed Workplace Safety Assessment:

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.