Information
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Document No.
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Client / Site
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Address
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Client Contact Name & Position
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Conducted on
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Prepared by
Systems / Policies / Contact
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Name of Person/s responsible for WHS on site (Name & Location on site)
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Does the client have a documented WHS management system?
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Does the client have an Injury Management policy/program?
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Does the client have a Bullying & Harassment policy/program?
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Does the client have a Risk Management Program or Workplace Inspection Schedule in place?
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Does the client have Hazard / Incident reporting forms or process? (EG: Accident, Injury, Near Miss forms, or reporting methods)
Consultation / Training
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Does the client have WHS consultation arrangement in place? (EG OHS Committee / HSR / Other)
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If WHS Committee is in place are minutes of meeting available to staff? (If possible sight and record location)
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Are on hired staff put through client in house induction/training as well as Exacts induction? (If yes sight signed induction and list location)
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Does the client have documented Safe Work Procedures (SWP) / Safe Operating Procedures (SOP) / Safe Work Method Statements (SWMS) or Work Instructions?
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Do on hired staff sign a form after receiving necessary training required to perform task/job safely?
Injury / Incident / First Aid
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Is there a dedicated Client contact who will report / inform Exact of any Injuries / Incidents or Near Misses? (List name & direct contact number if possible)
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Is there a person trained First Aider onsite? (List name & Location)
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Are First Aid kit / kits available and are they efficiently stocked?
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Add media
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Are First Aid kits checked - service / maintained / refilled on a regular basis? (If yes list by whom)
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Is there a First Aid register onsite for recording injuries / illnesses? (If yes list location)
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Add media
Amenities
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Are toilets clean and well stocked with toilet paper & soap?
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Add media
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Are lockers or a safe areas provided for storing personal belongings?
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Add media
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Is there access to clean drinking water?
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Is there a dedicated lunchroom / kitchen or area for on hired staff to use during breaks? (If yes list)
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Add media
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Are facilities for storing / heating food available? (EG Fridge / Microwave)
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Add media
Storage / Enviroment
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Is there sufficient lighting?
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Is environment temperature comfortable for on hired staff to complete work in? (EG Not overly hot or cold)
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Are all walkways / isles / passageways clear of slip / trip / fall hazards? (EG Cords / Stock / Uneven Surfaces)
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Are all walkways / isles / passageways free of any protrusions or obstructions at head height?
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Is there adequate storage for plant, materials & stock onsite?
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Does storage allow for safe retrieval of plant, materials & stock?
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If ladders are used onsite are they Safety / Platform types?
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Add media
Emergency Provisions
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Is there a building emergency evacuation plan available & displayed? (If yes list location)
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Add media
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Are Emergency / Evacuation procedures available & displayed? (If yes list location)
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Add media
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Do all emergency exits open outwards and are they kept unlocked?
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Are all emergency exits clear of obstructions both inside & out?
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Are all emergency exits clearly marked? (EG lights / floor markings etc)
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Is there sufficient fire fighting equipment? (EG Extinguishers, Hose, Fire Blankets ETC)
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Are fire extinguishers appropriate for the risks? (EG Water, Foam, Dry Chemical)
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Are fire extinguishers stored with clear access and correct signage?
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Add media
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Are fire extinguishers tested and tagged regularly? (Every 6 months) - (If yes list last tag date)
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Are evacuation drills conducted? (If yes how often)
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Are emergency telephone numbers listed & displayed? (If yes where are they displayed)
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Add media
Manual Handling
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Does the client have a policy on maximum load a single person may lift? (If yes list maximum weight policy)
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Will the maximum weight manual handled ever exceed 25kg and be a single man lift? (If yes please list max weight and item)
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Are mechanical aids available which would minimise manual handling? (EG Trolleys, Pallet Jacks, Rollers) (If yes list)
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Are loads moved over short distances only?
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Are items / loads manually handled easy to get an adequate grip on?
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Is there a need to handle bulky / awkward / slippery or unusual items? (If yes please list type or size)
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Add media
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Will long periods of heavy / physical manual handling be required throughout a normal day? (Longer than 2hrs) (If yes list type & reason)
Forklifts
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Is there a requirement for on-hired employees to drive/operate a forklift?
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Add media
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Are the forklifts onsite owned by client?
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Are the forklifts onsite leased by client? (If yes list leasing company)
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What is there a service schedule on forklifts - EG Weekly / monthly / quarterly etc? (Please list schedule & approx. last month service was completed)
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Are daily pre-operation checks conducted & documented on forklifts? (If yes sight where possible)
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Is the workplace designed to separate pedestrians from forklift work areas? (If yes list how EG lines / barriers)
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Add media
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Are warning devices such as flashing lights, beepers fitted on forklifts and are operational?
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Is a roll bar fitted to forklift?
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Add media
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Are seatbelts fitted to forklifts?
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Add media
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Are forklifts speed limited? (If no are traffic management speed control signs in place)
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Add media
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Are order-pickers (LO) forklifts used on this site?
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Is order-picker forklift platform fully enclosed?
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Are safety harnesses provided & worn when order-picker is in operation?
Chemicals
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Are chemicals other than household cleaners used / stored on site?
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Are chemicals stored safely in a designated area on site?<br>
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Are all chemicals clearly labelled with appropriate warning signs displayed?
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Are chemicals decanted in their designed containers? (As opposed to food or drink containers like coke bottles)
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Are MSDS / SDS for all chemicals displayed or easily accessed by staff? (If yes list where)
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Is all required PPE for safe handling of chemicals available / supplied to on-hired workers?
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Are flammable materials stored in fireproof cabinets and approved containers?
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Are flammable materials stored away from corrosive and oxidisers?
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Are combustible stored in containers with metal lids?
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Are spill kits available and well stocked?
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If corrosives are handled, is there an eyewash and safety shower readily accessible?
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Is there a chemical register, listing the chemicals used onsite?
Personal Protective Equipment - PPE
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Is PPE required on site? (If yes check below items)
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Hi-Visibility top (Vest / Shirt / Jacket ETC)
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Steel Toe / capped safety footwear
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Protective clothing (Overalls / Long sleeves & pants)
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Hand Protection (Gloves)
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Eye Protection
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Head Protection (Hard Hats ETC)
Hearing Protection
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is Hearing Protection required to be worn onsite? (If yes please list type EG buds, muffs, headphones)
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Is hearing protection supplied and easily available to staff? (If yes list where it is store/available)
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Add media
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Have noise surveys been conducted of site?
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Are hearing initial assessments given to all workers that work in areas they have to wear hearing protection within the first 3 months of employment?
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Are hearing assessments completed every 2 years for workers in areas where they have to wear hearing protection?
Plant & Machinery
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Will On Hired staff be required to operate / work on Plant / Machinery (Other than Forklifts / Pallet Jacks / Trolleys)? (If Yes please list type & brand below)
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Add media
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Will On-Hired staff be given training on Plant / Machinery?
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If training is given is the training documented? (Sight where possible)
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Are SOP / SWP available for Plant / Machinery? (If yes list location)
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Have adequate measures been put in place to eliminate or minimize hazards during Plant / Machinery usage? (If Yes please list)
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Are Machines well guarded? (If yes list types of guards EG light curtain, sensor doors, manual guarding)
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Add media
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Are guards fitted to all hazardous moving parts / trapping spaces & in good working order?
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Add media
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Is area around Plant / Machinery clear, clean and free of trip/slip hazards?
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Add media
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Are emergency stop buttons or lanyards fitted to machines?
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Are emergency stops buttons easily identified and within clear reach of operator?
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Will On Hired staff be required to operate machinery / equipment in isolation?
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If Yes is there adequate provisions made for contact in case of emergency? (List)
Signatures
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Client Company Representative
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Person Whom Completed Workplace Safety Assessment