Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Has the previous inspection report been reviewed?

  • Are there any outstanding actions?

  • Enter details

Regulation 5: Maintenance

  • Is there a maintenance schedule in place, and is it followed

  • Action required

  • Are high risk items of equipment checked at regular intervals?

  • Action required

  • Is faulty equipment removed from service until it is repaired?

  • Action required

Regulation 6: Ventilation

  • Is there a method of providing an adequate amount of fresh or purified air into the workplace?

  • Action required

  • Is recirculated air filtered and enhanced with a supply of fresh air?

  • Action required

  • Are mechanical ventilation systems (including air conditioning) cleaned regularly between services?

  • Action required

  • Are mechanical ventilation systems (including air conditioning) equipped with a method to alert of failure?

  • Action required

  • Are mechanical ventilation systems (including air conditioning) serviced on a regular basis?

  • Action required

Regulation 7: Temperature of indoor workplaces

  • Are indoor temperatures maintained at a reasonable level?

  • Action required

  • Can the work be conducted without the need for special clothing?

  • Action required

  • Do any of the methods of temperature control work in such a way that prevents fumes, gas or vapour from entering the workplace?

  • Action required

  • Are there a sufficient number of thermometers at all internal workplaces?

  • Action required

Regulation 8: Lighting

  • Is lighting sufficient to enable work without eye strain?

  • Action required

  • Is lighting sufficient to enable people to safely move from place to place?

  • Action required

  • Is there sufficient lighting in areas of pedestrian/vehicle interaction?

  • Action required

  • Is lighting positioned to be free from glare?

  • Action required

  • Is task specific local lighting available and in use?

  • Action required

  • Is there a a schedule in place for the cleaning of light fittings?

  • Action required

  • Are windows and skylights cleaned on a regular basis?

  • Action required

  • is there sufficient emergency lighting?

  • Action required

  • is emergency lighting powered by a source independent of normal lighting?

  • Action required

  • is emergency lighting tested and inspected on a regular basis?

  • Action required

Regulation 9: Cleanliness and waste materials

  • Is the workplace regularly cleaned?

  • Action required

  • Are wall and floor surfaces maintained to enable effective cleaning?

  • Action required

  • Are waste materials removed as soon as practicable from the working area?

  • Action required

Regulation 10: room dimensions and space

  • Is there enough space for people to move around freely?

  • Action required

  • Are all jobs carried out without restricted movement, so far as is reasonably practicable?

  • Action required

  • Taking equipment and furniture into account is there at least 11M3 space available for each person employed in a workplace?

  • Action required

Regulation 11: Workstations and seating

  • Are workstations arranged so that tasks can be carried out safely and comfortably?

  • Action required

  • Are workstation heights suitable for the tasks being carried out?

  • Action required

  • Are workstations and seating suitably arranged for persons with suitable needs?

  • Action required

  • Do workspaces have sufficient clear and unobstructed space to allow for freedom of movement, manoeuvring and positioning of materials?

  • Action required

  • Is the seating in use suitable for the task?

  • Action required

Regulation 12: Condition of floors and traffic routes

  • Are floors and traffic routes free from holes, slopes, uneven or slippery surfaces likely to cause a hazard?

  • Action required

  • Are all damaged surfaces marked conspicuously or guarded?

  • Action required

  • Are any uneven or sloped surfaces marked conspicuously?

  • Action required

  • Are there arrangements in place to tackle snow and ice?

  • Action required

  • Are spillages cleaned up or contained immediatly?

  • Action required

  • Are traffic routes kept clear of obstructions?

  • Action required

  • Are the open sides of staircases adequately fenced and do all staircases have a handrail?

  • Action required

Regulation 13: Falls or falling objects

  • Is every vessel containing a hazardous substance adequately fenced or covered to prevent a person falling into it?

  • Action required

  • Are all barriers sufficiently high, and filled in to prevent falls over or through the barrier?

  • Action required

  • Are all barriers constructed of a material sufficiently strong enough to restrain any person or object falling agaist them?

  • Action required

  • Are all covers capable of supporting all loads likely to be imposed on them and any traffic likely to travel over them?

  • Action required

  • Are all covers of a type that cannot be easily displaced or moved?

  • Action required

  • In the event of barriers or covers being removed are there alternative control measures in place?

  • Action required

Regulation 14: Windows and transparent or translucent doors, gates and walls

  • Are all windows etc. made from a material which is inherently robust, breaks in a safe manner or of adequate thickness?

  • Action required

  • Where the material used is "safety glass" is the British Standards Kitemark apparent on every pane?

  • Action required

Regulation 15: Windows, skylights and ventilators

  • Can all windows, skylights and ventilators be opened from floor level?

  • Action required

  • When they cannot be opened from floor level is there a safe means of access?

  • Action required

  • When opened , are people prevented from falling through windows, skylights and ventilators?

  • Action required

  • When opened , are people prevented from colliding with them?

  • Action required

Regulation 16: Ability to clean windows safely

  • Can all windows be cleaned from ground level or internally?

  • Action required

Regulation17: Organisation of traffic routes

  • Discounting pedestrians whose work requires an interface with vehicles. is there a physical barrier between pedestrians and vehicles?

  • Action required

  • Is there sufficient segregation between traffic routes and any doors or gates which may be used by pedestrians?

  • Action required

  • Are all traffic routes suitably indicated for reasons of health and safety?

  • Action required

  • Is there any soft or uneven ground on which a vehicle could overturn, shed its load or become stranded adequately signed?

  • Action required

  • Is there a prominent warning of limited headroom?

  • Action required

  • Has a site speed limit been set and is it appropriate?

  • Action required

  • Has the need to reverse been reduced so far as is reasonably practicable?

  • Action required

  • Where reversing is unavoidable is this carried out under the control of a banks man?

  • Action required

  • Where pedestrian routes cross vehicle routes is there a suitable indication of the route?

  • Action required

  • Are barriers in place, where appropriate, to prevent pedestrians entering a traffic route unobserved?

  • Action required

  • Do all pedestrians on, or near to a traffic route wear hi-vis clothing?

  • Action required

Regulation 18: Doors and gates

  • Do sliding doors or gates have a device to prevent it coming off its track?

  • Action required

  • Do powered doors or gates have a device to prevent it trapping a person?

  • Action required

  • Do all upward opening doors or gates have a device to prevent them falling back?

  • Action required

  • Do all doors or gates have that can be pushed open from either side provide a clear view when closed of the space into which it opens?

  • Action required

  • Can all doors required for escape in an emergency be opened easily, without the need for a tool or key, whilst the building is occupied?

  • Action required

Regulation 20: Sanitary conveniences

  • Are sanitary conveniences readily accesible?

  • Action required

  • Are sanitary conveniences adequately ventilated?

  • Action required

  • Are sanitary conveniences adequately lit?

  • Action required

  • Are there separate sanitary conveniences for men and women, or is there a separate room the door to which can be locked from the inside?

  • Action required

  • Is there an adequate number of sanitary conveniences?

  • Action required

Regulation 21: Washing facilities

  • Are there washing facilities in the immediate vicinity of sanitary conveniences?

  • Action required

  • Are there washing facilities in the immediate vicinity of changing rooms?

  • Action required

  • do all washing facilities contain a ready supply of clean hot and cold water?

  • Action required

  • do all washing facilities contain a ready supply of soap or other means of cleaning?

  • Action required

  • do all washing facilities contain an hygienic means of hand drying?

  • Action required

  • Are all washing facilities adequately ventilated?

  • Action required

  • Are all washing facilities well lit?

  • Action required

  • Are there a an adequate number of washing facilities?

  • Action required

Regulation 22: Drinking water

  • Is there a ready supply of wholesome drinking water?

  • Action required

  • Are drinking water taps situated where contamination is unlikely?

  • Action required

  • Are cups, beakers or glasses provided where the water is not supplied by a drinking fountain?

  • Action required

  • Where non-disposable cups, beakers or glasses are used, is there a means to wash them in the immediate vicinity?

  • Action required

Regulation 23: Accommodation for clothing

  • Is there sufficient secure accommodation for personal clothing not worn during working hours?

  • Action required

  • Is there sufficient accommodation for special clothing not worn home?

  • Action required

  • Is the accommodation dry and well ventilated?

  • Action required

  • Are there facilities to dry work clothing?

  • Action required

Regulation 24: facilities for changing clothing

  • Where there is a need to remove clothing other than outer clothing, has a changing room been provided?

  • Action required

  • Where clothing can become contaminated by a hazardous substance, is there a changing room which prevents the workers own clothging becoming contaminated?

  • Action required

  • Do Changing rooms contain adequate seating?

  • Action required

  • Are changing rooms directly connected to clothing accommodation and showering/bathing facilities?

  • Action required

  • Do changing rooms ensure users privacy?

  • Action required

  • Are the facilities large enough to allow the maximum number of people expected to use them at any one time to do so without overcrowding or delay?

  • Action required

Regulation 25: Facilities for rest and to eat meals

  • Do Facilities contain an adequate supply of seating for the maximum number of people expected to use them at any one time?

  • Action required

  • Are the facilities situated in an area that allows for rest and food breaks to be taken without the need to wear PPE

  • Action required

  • Are the facilities situated in an area that prevents discomfort from cigarette smoke?

  • Action required

  • Have suitable facilities been provided for pregnant women and nursing mothers?

  • Action required

  • Have suitable facilities been provided for disabled persons?

  • Action required

Sign Off

Sign Off

  • Final meeting and discussion held with local manaagment

  • Auditee's signature

  • Auditors 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.