Title Page
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Document No.
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Checklist Title
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Client/Site Name
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Conducted on
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Prepared by
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Location
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Personnel
Floors
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Can water be walked on to smooth floors (e.g. Foyers) on rainy days?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any hard, smooth floors in wet or oily areas?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any fluid leaks on to the floor from processes or machines?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any transitions in floor surfaces that are not easily noticed? (Any ridge that is as large or larger than the sole of a shoe)
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is there any water or ice on cold room floors?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is the floor slippery when wet?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is there poor drainage causing pooling of fluids?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are any anti-slip paint, coating profiles or tapes worn smooth or damaged?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any isolated low steps? (Commonly at doorways)
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any trip hazards due to equipment and other objects left on floor?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any raised carpet edges or holes worn in carpets?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any tiles becoming unstuck or curling at the edges?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any holes or unevenness in the floor surface?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Stairs and Ramps
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Is the lighting insufficient for ramps or steps to be seen clearly?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is the lighting for ramps or steps creating glare?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do any steps have too small a rise or tread or an excessive tread edge (nosing)?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are any step edges (nosings) slippery or hard to see?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are the steps uneven or are there excessive variations in step dimensions?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are handrails inadequate on stairs?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are ramps too steep or too slippery?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are any step edges (nosings) slippery or hard to see?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Lighting
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Is there insufficient lighting in passageways, at flooring transitions, ramps or stairs?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Does the lighting throw distracting shadows or produce excessive glare?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is there insufficient lighting in passageways, at flooring transitions, ramps or stairs?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is there insufficient lighting in passageways, at flooring transitions, ramps or stairs?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Outdoor areas
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Is there a build up of moss or other vegetation on pathways?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any surface transitions not easily noticed? (Any ridge that is as high as a sole of a shoe/ footwear or higher)
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there potholes in footpaths or walkways?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Housekeeping
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Is there a build-up of polish on floors?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is there an excessive residue of detergent?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do workers or others have to walk on floors wet from cleaning/washing?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are "Wet Floor" signs not available or not used correctly?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do you need to provide information/training/advice to contractors regarding cleaning procedures?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are paper, rubbish, dirt or spills left on the floor?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are aisles halls/walkways poorly marked?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are aisles/halls/walkways cluttered?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are there any trip hazards due to equipment and other movable objects left lying on the ground?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do spills (wet or dry) occur regularly during work processes?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Is the cleaning method appropriate for the floor surface?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Tasks
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Do workers have to walk or work on greasy, oily or wet floors that are not adequately slip resistant?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do loads that are carried or pushed interfere with vision? (Clear line of site)
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are the loads to be carried excessive or likely to upset a person's balance?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do heavy trolleys / persons in wheelchairs have to be pushed up ramps / inclines?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are workers hurried due to time constraints?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do workers require training in the procedures for dealing with slip and trip hazards?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
Footwear
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Do the workers safety shoes / shoes lack grip?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Do workers require slip resistant footwear?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
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Are tread patterns on footwear clogged with dirt?
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DEFINE LOCATION:
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PERSON RESPONSIBLE:
