Title Page
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Client / Site
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Location
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Conducted on
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Prepared by James Andrade
Job safety analysts
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Jsa
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Was it filled out correctly
Working Environment
Working Environment
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Is it too hot?
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Is it too cold?
Housekeeping
Housekeeping
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Inspection area tidy, clean and well organised?
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Access ways obstructed?
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Tripping hazards (including floor finishes)?
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All electrical cleaning equipment tested?
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All equipment stored under correct conditions?
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Rubbish disposal area clean and clear?
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Sharps removal procedure in place?
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No smoking signs in position?
Electrical
Electrical
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Is all portable equipment tested and labeled?
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Leads undamaged?
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Trailing leads?
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Sockets overloaded?
First Aid
First Aid
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First aid kit in truck?
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appointed first aid person displayed?
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Emergency telephone number displayed?
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Accident reporting procedure in place?
Fire Precautions
Fire Precaution
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Routes clear of obstructions?
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Evacuation routes clearly signed?
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Extinguishers in place?
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Extinguishers in date?
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Correct type?
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Identification label in place?
Fire instructions
Fire Instructions
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Posted up?
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Free from damage?
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Current and up to date?
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Weekly test undertaken?
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Annual evacuation undertaken?
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Evacuation chairs in place?
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Fire risk assessment completed?
Machinery
Machinery
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All guards in place?
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Kept clean of rubbish?
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All cords in good condition
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All tools in good working order
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Risk assessment in place?
PPE (personal protective equipment)
PPE
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Correct type gloves for hazard
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Good condition?
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Wearing all PPE
Eyewash Bottles/Cylinders
Eyewash Bottles/Cylinders
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Full?
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In date?
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Correctly stored/fixed?
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Correct pressure?
Completion
Completion
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Recommendations
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Full Name and Signature of the Inspector