Title Page

  • Conducted on

  • Prepared by

  • Location
  • Have you received induction training?

  • Do you know the company’s health & safety rules?

  • Are you familiar with how to report hazards & incidents?

  • Are there emergency facilities and an evacuation procedure/route for the site?

  • Do you have access to appropriate emergency and first aid equipment?

  • Have you asked the person in charge about all relevant hazards?

  • Do you have the correct procedures and equipment to do the work safely?

  • Is there appropriate separation of vehicles and people during the proposed work?

  • Is all required electrical/mechanical equipment in a safe condition?

  • Are hazardous/dangerous substances used and stored according to their safety data sheets?

  • Have you consulted with workers about the task and the safe way to do it?

  • Do you have all necessary PPE?

  • Have you got a safe way of getting in and out of your work area?

  • Have any manual handling risks been identified and accessed?

  • Site Specific notes

  • Sign off

  • Supervisor

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.