HEALTH AND SAFETY CHECKLIST

Industry/Company:____________________ Date: ___________ Safety Representative: ________________

SECTION 1: GENERAL HEALTH AND

YES NO CORRECTIVE ACTION DATE
SAFETY
DESCRIPTION CORRECTIVE
1. Is the office well-lit and free from
any trip hazard?
2. Are employees encouraged to report
any health or safety concerns to the
management?
3. Are restrooms clean and adequately
stocked with hand soap and toilet
paper?
4. Are regular health and safety
inspections conducted by designated
personnel?
5. Are designated areas available for
employees to take breaks and rest?
6. Are the employees aware of the
company’s policy on health and
safety?
7. Does the worksite have a security
alarm system?
8. Does the worksite have a security
surveillance system of public areas?
9. Are regular pest control measures in
place to prevent infestations?
10. OTHER:

SECTION 2: ELECTRICAL YES NO CORRECTIVE ACTION DATE

DESCRIPTION CORRECTIVE
11. Are all office equipment and
electrical outlets in good working
conditions?
12. Are all air-conditioning system are
regularly checked?
13. Are plugs and electrical outlets in
good condition?
14. Is wiring insulated, and cords free
of fraying or deterioration?
15. Are computers and other office
appliances regularly checked?

SAFETY OFFICER’S SIGNATURE:

SUPERVISOR’S SIGNATURE:
 HEALTH AND SAFETY CHECKLIST

Industry/Company:____________________ Date: ___________ Safety Representative: ________________

16. OTHER:

SECTION 3: YES NO CORRECTIVE ACTION DATE

EMERGENCIES/FIRE/EVACUATION/FIRS
T AID
DESCRIPTION CORRECTIVE

17. Are all fire exit routes clearly marked

and unobstructed?
18. Is there an automatic fire alarm and
fire detection system?
19. Are there at least two emergency exits
from the work area or building?
20. Are emergency telephone numbers
for the worksite posted in a public
area (e.g fire, department, police,
hospital, poison control)?
21. Are fire extinguishers easily
accessible and regularly inspected?
22. Are emergency evacuation procedures
clearly communicated to all
employees?
23. Are there sufficient first aid kits
available and easily accessible?
24. OTHER:

SECTION 3: WORKPLACE SAFETY YES NO CORRECTIVE ACTION DATE

DESCRIPTION CORRECTIVE

25. Are computer workstations and

equipment sufficiently adjustable so
workers can make changes while
performing computer tasks?
26. Are all workstations ergonomically
design to prevent musculoskeletal
injuries?
27. Are employees provided with proper
training on handling office tools, such

SAFETY OFFICER’S SIGNATURE:

SUPERVISOR’S SIGNATURE:
 HEALTH AND SAFETY CHECKLIST

Industry/Company:____________________ Date: ___________ Safety Representative: ________________

as computers, physical phones, ID

badge, etc?
28. Is the office properly ventilated and
keep in an acceptable temperature?
29. OTHER:

Month/Year: _________________________________ Safety Representative: ________________________

Signature Over Printed Name

Supervisor: __________________________________ Safety and Health Committee:

Signature Over Printed Name
____________________________________________
____________________________________________
____________________________________________

SAFETY OFFICER’S SIGNATURE:

SUPERVISOR’S SIGNATURE: