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Company :

Area / Location :

Weekly
No Checklist Point Observations
1 2 3 4
1 Workplace Environment free from hazard
2 Hazardous or combustible materials

3 General housekeeping improvement is dust free


environment, chemical fumes
4 Lighting, temperature and ventilation workpalce

5 Proper Air circulation – Each department, storage


rooms, work places, general area, area where covered
by walls?

6 All required certificates like air emission, noise levels


etc… certificates are available?
7 Waste Management
8 Control Pollution Levels
9 Water Quality Sample
10 Spill oil / solar
11 MSDS (Material Safety Data Sheet)
Special Remarks By Observer:

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