Information
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel involved
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Document No.
Personal Protective Equipment
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Safety Helmet
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Safety Boots
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Clothing
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Other
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Office Facilities
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Housekeeping
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Fire Extinguishers
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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MSDS File
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Entry /Access / Egress
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Electrical Tagging
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Signage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Workshop - General
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Housekeeping
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Fire Extinguishers
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Entry / Access / Egress
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Run off Control
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Floor Conditions
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Noise
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Pumps condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Ventilation
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Signage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Storage Area
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Spill Kit
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Eye Wash
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Electrical
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Earth Leakage Devices Functional
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Generator Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Power Lead Routing
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Tags Visible (Quarterly Inspection Completed)
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Compressed Air
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Blowdown nozzle fitted with shut off valve
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Coupling fitted with safety pins
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Routed safely and orderly
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Welding and Cutting
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Cylinder Storage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Cylinder secured
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Regulator, Hoses, Handset Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Flashback Arrestors Fitted
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Welding Machine Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Welding Leads
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Protective Screens
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Fire Extinguiishers
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Housekeeping
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
Steam Cleaning Facility
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Floor Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Run Off Control
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Solid Waste
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Bins
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Recycling Efficiency
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Service Truck
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General Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Signage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Fire Extinguisher
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Waste Control
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Pumps
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
Chemicals
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Storage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Signage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Fire Extinguishers
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
-
Eye Wash
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Housekeeping
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Bunding
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Ventilation
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
-
Floor Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Safety Information
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
Spill Equipment
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Absorbent Materials
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Cleanup Shovels / Brooms etc
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Location
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Access
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
-
Action required
Waste
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Drip Trays
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Comment
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Action required
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Waste Oil Reclamation
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Waste Water Control
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Waste Water Treatment
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
Yard
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Safety signs
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Haz Chem
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Emergency Information
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Surface Condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Housekeeping / Storage
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
-
Speed Limits
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
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Action required
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Wash down area condition
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required
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Wash down run off control
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
-
Comment
-
Action required