Title Page
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Conducted on
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Prepared by
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Location
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Customer:
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Brief Scope of Work:
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Inspection performed by: Date:
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SITE AREAS INSPECTED:
SAFETY ITEM CHECKLIST
Safety Item
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1. Site Access
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Corrective action taken
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Details
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2. Transport
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Corrective action taken
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Details
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3. Fire Precautions
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Corrective action taken
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Details
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4. First Aid & Welfare
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Corrective action taken
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Details
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5. Site Conditions
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Corrective action taken
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Details
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7. Safety Signs and Barriers
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Corrective action taken
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Details
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8. Personal Protective Equipment
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Corrective action taken
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Details
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9. Workplace Access
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Corrective action taken
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Details
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10. Lifting Equipment
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Corrective action taken
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Details
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12. Portable Appliance in date
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Corrective action taken
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Details
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13. Electrical equipment fit for use
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Corrective action taken
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Details
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14. Machine Guarding
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Corrective action taken
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Details
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15. Abrasive Wheels & Discs
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Corrective action taken
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Details
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21. Permits to Work
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Corrective action taken
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Details
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22. Site Documentation
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Corrective action taken
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Details
23 other
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Description
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Corrective Action
Sign off
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Inspectors Signature:
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Time completed: