Page 1: Initial questions

  • Todays Date

  • Person doing this report

  • Location

Page 2: Main checklist

  • Who is on site today?

  • Please list who the other people on site are

Emergency Plans

  • Who is your first aid rep on site today?

  • Where is your first aid kit located?

  • Have you talked about your emergency plan today? <br>***3 long blasts on any vehicle horn warning everyone to immediately stop and head to the emergency assembly point***

  • STOP what you are doing and inform everyone of the emergency plan for this site. Mark yes when this has been done.

  • Where is your emergency assembly point on this worksite?

  • Where is your fire extinguisher located?

  • Is the correct PPE worn by everyone on site today?

  • Please provide details of who has a PPE issue, does it need to be repaired or replaced?

  • Is there any hazardous material on site today?

  • Is there a MSDS on site for the hazardous material?<br>Please fill in the Job Hazards section

  • Is the Hazard board and signage up to date?

  • What is the issue with it? Does it need repairing? Replacing? Or updating?

General Site Tidiness and Access Ways

  • Clear, safe access to work areas?

  • Who is going to resolve this and when?

  • Are the stairways and access ways clear

  • Who is going to resolve this and when?

  • Fencing and gates secure?

  • Who is going to resolve this and when?

Equipment in Use

  • Is there any damage you need to report about any tools or equipment?

  • What needs to be repaired or replaced?

  • Are all appropriate safety guards in place and in good condition?

  • PLEASE TAG OUT THIS EQUIPMENT/TOOL SO IT CAN'T BE USED

  • Are only trained users operating all tools and equipment

  • Who is helping the untrained user to use the tools/equipment

  • Job Hazards or Risks - Identify Hazards (ie trips or fall hazards)
  • Identified Hazard

  • Initial Risk Assessment (L, M, H)

  • Controls you can put in place

  • Level of Control (Minimise or Eliminate)

  • Residual Risk

  • Controls you can put in place?

  • Level of control

  • Residual Risk

  • Controls you can put in place

  • Level of control

  • Residual Risk

General Feedback

  • Any Feedback from the team

  • Feedback

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.