Title Page

  • Conducted on:

  • Prepared by:

  • Site conducted

  • Is there any trip or slip hazards in the area?

  • All chemicals stored correctly and locked with a padlock?

  • Is the area clean and tidy?

  • Is there sufficient lighting and all lights working?

  • Are safety barriers and guards in place where required?

  • Is everyone wearing their PPE correctly?

  • Anyone undertaking any unsafe manual handling movements?

  • Are the emergency exits clear to see and free from any obstructions?

  • Fire extinguishers present and not obstructed ?

  • PPE stations full with PPE and in good working condition?

  • Ask operator if they have any H&S concerns in their area.

  • Ask the operator if they have any H&S improvements for the area.

  • Is there any open outstanding H&S concerns in the area?

  • Have any H&S actions been raised by the operator but not actioned?

  • Any actions captured on LIA?

  • Completed Time and Date

  • NAME & SIGNATURE

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.