Title Page

  • Full name of Contractor observed

  • Exact Location (including postcode)
  • Type of work being undertaken

  • Prepared by

  • Job Title

  • Date Checklist Undertaken

Site Safe Systems

  • Appropriate barriers and site signage in place

  • Site tidy and materials are stored safely

  • Working areas and walkways are level and free from trip hazards & obstructions

  • Appropriate PPE being used e.g. safety boots, gloves, hardhat

  • Work area adequately lit

  • Flammable materials stored securely and separately

  • First aid provision available

Protecting the public

  • Work areas clearly and securely segregated

  • Adjacent public access areas are level and no trip hazards

  • Emergency escape routes are not compromised

  • Unattended plant, ladders & equipment are immobilised to prevent unauthorised use

Manual handling

  • Mechanical devices are used whenever possible


  • Ladders in good condition and appropriate for task


  • Valid certificate on scaffold

  • Guard rails and toe boards have been installed

Roof Work

  • Harnesses are available and used where appropriate

  • Adequate edge protection to stop people or items falling

  • Equipment such as MEWPs used by competent person(s) in an agreed location


  • RCDs are provided where mains voltage has to be used

  • Cables and leads. Or trailing

  • Portable electrical equipment tested and tagged and looks in good condition

Vehicles on Site

  • Pedestrian and vehicle routes are separate and clearly marked

  • Contractors' vehicles are parked in agreed locations

  • Completed forms to be returned to the appropriate Health and Safety Team:

    North Region

    South Region

    West Region

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.