Frequency:

Monthly

Date issued:

……/……/20..

Target for completion:

……/…../20..

Inspector:

Department:

Location:

Nr

Yes

No

Remarks

BUILDINGS

1

Clean and in good state of repair

2

No broken windows, doors or other openings?

FLOORS

3

Clean and free from slippery substances

4

No tripping or other obstruction hazards?

5

No holes, unevenness or structural damage?

VENTILATION

6

Sufficient natural or artificial ventilation?

7

All fans in working order?

8

Free from any dangerous gasses, dust, smoke etc.?

LIGHTING

9

Sufficient natural or artificial lighting?

10

All lights in working order?

11

No straining glares or contrasts?

12

No dark or shadowy spots?

POLLUTION

13

Adequate disposal system?

14

No air pollution?

15

Complying with all disposal standards and procedures?

HYGIENE

16

All toilets, urinals and change rooms clean and hygienic

17

Kitchens & eating places clean and hygienic?

18

No eating in places not so indicated?

DEMARCATION

19

Aisles and passageways demarcated?

20

Access and exit routes demarcated?

21

Fire equipment demarcated?

22

Electrical switchgear demarcated?

23

All demarcation lines clear and visible?

HOUSEKEEPING

24

Working area clean and tidy at all times?

25

Yard tidy and clean?

26

No redundant materials

27

Adequate storing space?

28

Stacking safe?

29

No obstruction in aisles?

30

Cupboards and shelves tidy and clean?

REFUSE AND WASTE

31

Adequate refuse bins and removal system?

32

Separate bins for specific materials as prescribed?

COLOUR CODING

33

All pipe work colour coded?

34

All electrical apparatus colour coded?

35

Hazardous machine parts colour coded?

36

Uniform colour coding system throughout?

MACHINE GUARDING

37

All hazardous machine parts adequately guarded?

38

All guards in good state of repair?

39

All guards in place and used according prescriptions?

ELECTRICAL SUPPLY AND EQUIPMENT

40

No installation defects

41

Regular inspections as prescribed?

42

No abuse?

EMERGENCIES

43

First Aid Boxes in place, demarcated, secured?

44

First Aid Boxes contents correct?

45

First Aiders trained with valid certificates?

46

Emergency Procedure understood by all and displayed?

47

Alarm System working?

38

All guards in good state of repair?

39

All guards in place and used according prescriptions?

ELECTRICAL SUPPLY AND EQUIPMENT

40

No installation defects

41

Regular inspections as prescribed?

42

No abuse?

EMERGENCIES

43

First Aid Boxes in place, demarcated, secured?

44

First Aid Boxes contents correct?

45

First Aiders trained with valid certificates?

46

Emergency Procedure understood by all and displayed?

47

Alarm System working?

44

First Aid Boxes contents correct?

45

First Aiders trained with valid certificates?

46

Emergency Procedure understood by all and displayed?

47

Alarm System working?

Recommendations:

………………………………………………………………………………………………………………

______________________ ______________

Signature of representative Date