Information

  • Document No.

  • Client / Site

  • Add location
  • Address

  • Client Contact Name & Position

  • Conducted on

  • Prepared by

Systems / Policies / Contact

  • Name of Person/s responsible for WHS on site (Name & Location on site)

  • Does the client have a documented WHS management system?

  • Does the client have an Injury Management policy/program?

  • Does the client have a Bullying & Harassment policy/program?

  • Does the Client have a Drug and Alcohol Policy in place?

  • Does the client have a Risk Management Program or Workplace Inspection Schedule in place?

  • Does the client have Hazard / Incident reporting forms or process? (EG: Accident, Injury, Near Miss forms, or reporting methods)

Consultation / Training

  • Does the client have WHS consultation arrangement in place? (EG OHS Committee / HSR / Other)

  • If WHS Committee is in place are minutes of meeting available to staff? (If possible sight and record location)

  • Are on hired staff put through client in house induction/training as well as Zoom induction? (If yes cite signed induction and list location)

  • Does the client have documented Safe Work Procedures (SWP) / Safe Operating Procedures (SOP) / Safe Work Method Statements (SWMS) or Work Instructions?

  • Do on hired staff sign a form after receiving necessary training required to perform task/job safely?

Injury / Incident / First Aid

  • Is there a dedicated Client contact who will report / inform Zoom of any Injuries / Incidents or Near Misses? (List name & direct contact number if possible)

  • Is there a person trained First Aider onsite? (List name & Location)

  • Are First Aid kit / kits available and are they efficiently stocked?

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  • Are First Aid kits checked - service / maintained / refilled on a regular basis? (If yes list by whom)

  • Is there a First Aid register onsite for recording injuries / illnesses? (If yes list location)

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Amenities

  • Are toilets clean and well stocked with toilet paper & soap?

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  • Are lockers or a safe areas provided for storing personal belongings?

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  • Is there access to clean drinking water?

  • Is there a dedicated lunchroom / kitchen or area for on hired staff to use during breaks? (If yes list)

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  • Are facilities for storing / heating food available? (EG Fridge / Microwave)

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Storage / Enviroment

  • Is there sufficient lighting?

  • Is environment temperature comfortable for on hired staff to complete work in? (EG Not overly hot or cold)

  • Are all walkways / isles / passageways clear of slip / trip / fall hazards? (EG Cords / Stock / Uneven Surfaces)

  • Are all walkways / aisles / passageways free of any protrusions or obstructions at head height?

  • Is there adequate storage for plant, materials & stock onsite?

  • Does storage allow for safe retrieval of plant, materials & stock?

  • If ladders are used onsite are they Safety / Platform types?

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Emergency Provisions

  • Is there a building emergency evacuation plan available & displayed? (If yes list location)

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  • Are Emergency / Evacuation procedures available & displayed? (If yes list location)

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  • Do all emergency exits open outwards and are they kept unlocked?

  • Are all emergency exits clear of obstructions both inside & out?

  • Are all emergency exits clearly marked? (EG lights / floor markings etc)

  • Is there sufficient fire fighting equipment? (EG Extinguishers, Hose, Fire Blankets ETC)

  • Are fire extinguishers appropriate for the risks? (EG Water, Foam, Dry Chemical)

  • Are fire extinguishers stored with clear access and correct signage?

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  • Are fire extinguishers tested and tagged regularly? (Every 6 months) - (If yes list last tag date)

  • Are evacuation drills conducted? (If yes how often)

  • Are emergency telephone numbers listed & displayed? (If yes where are they displayed)

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Manual Handling

  • Does the client have a policy on maximum load a single person may lift? (If yes list maximum weight policy)

  • Will the maximum weight manual handled ever exceed 25kg and be a single man lift? (If yes please list max weight and item)

  • Are mechanical aids available which would minimise manual handling? (EG Trolleys, Pallet Jacks, Rollers) (If yes list)

  • Are loads moved over short distances only?

  • Are items / loads manually handled easy to get an adequate grip on?

  • Is there a need to handle bulky / awkward / slippery or unusual items? (If yes please list type or size)

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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

  • Is there a requirement for on-hired employees to drive/operate a forklift?

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  • Are the forklifts onsite owned by client?

  • Are the forklifts onsite leased by client? (If yes list leasing company)

  • What is there a service schedule on forklifts - EG Weekly / monthly / quarterly etc? (Please list schedule & approx. last month service was completed)

  • Are daily pre-operation checks conducted & documented on forklifts? (If yes sight where possible)

  • Is the workplace designed to separate pedestrians from forklift work areas? (If yes list how EG lines / barriers)

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  • Are warning devices such as flashing lights, beepers fitted on forklifts and are operational?

  • Is a roll bar fitted to forklift?

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  • Are seatbelts fitted to forklifts?

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  • Are forklifts speed limited? (If no are traffic management speed control signs in place)

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  • Are order-pickers (LO) forklifts used on this site?

  • Is order-picker forklift platform fully enclosed?

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  • Are safety harnesses provided & worn when order-picker is in operation?

Chemicals

  • Are chemicals other than household cleaners used / stored on site?

  • 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?

  • Are chemicals decanted in their designed containers? (As opposed to food or drink containers like coke bottles)

  • Are MSDS / SDS for all chemicals displayed or easily accessed by staff? (If yes list where)

  • Is all required PPE for safe handling of chemicals available / supplied to on-hired workers?

  • Are flammable materials stored in fireproof cabinets and approved containers?

  • Are flammable materials stored away from corrosive and oxidisers?

  • Are combustible stored in containers with metal lids?

  • Are spill kits available and well stocked?

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  • If corrosives are handled, is there an eyewash and safety shower readily accessible?

  • Is there a chemical register, listing the chemicals used onsite?

Personal Protective Equipment - PPE

  • Is PPE required on site? (If yes check below items)

  • Hi-Visibility top (Vest / Shirt / Jacket ETC)

  • Steel Toe / capped safety footwear

  • Protective clothing (Overalls / Long sleeves & pants)

  • Hand Protection (Gloves)

  • Cold Temperature PPE provided (jackets, gloves etc)

  • Eye Protection

  • Head Protection (Hard Hats ETC)

Hearing Protection

  • is Hearing Protection required to be worn onsite? (If yes please list type EG buds, muffs, headphones)

  • Is hearing protection supplied and easily available to staff? (If yes list where it is store/available)

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  • Have noise surveys been conducted of site?

  • 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?

  • Are hearing assessments completed every 2 years for workers in areas where they have to wear hearing protection?

Plant & Machinery

  • 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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  • Will On-Hired staff be given training on Plant / Machinery?

  • If training is given, is training documented? (Sight where possible)

  • Are SOP / SWP available for Plant / Machinery? (If yes list location)

  • Have adequate measures been put in place to eliminate or minimize hazards during Plant / Machinery usage? (If Yes please list)

  • Are Machines well guarded? (If yes list types of guards EG light curtain, sensor doors, manual guarding)

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  • Are guards fitted to all hazardous moving parts / trapping spaces & in good working order?

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  • Is area around Plant / Machinery clear, clean and free of trip/slip hazards?

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  • Are emergency stop buttons or lanyards fitted to machines?

  • Are emergency stops buttons easily identified and within clear reach of operator?

  • Will On Hired staff be required to operate machinery / equipment in isolation?

  • If Yes is there adequate provisions made for contact in case of emergency? (List)

Signatures

  • Client Company Representative

  • Person Whom Completed Workplace Safety Assessment

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.