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Special hazards check list
Inspections to be carried out at weekly/monthly intervals
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Location:
Carried out by:
Area/room number. Key
Date:
Audit (Initial and date)
Manager HSA Auditor
Place a tick () or cross () against each item for each area/room. Use key opposite to identify rooms.
= OK
= Needs attention
Item 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Item Passed Item Passed
Any item of concern to be dealt with immediately
If in doubt refer to a senior manager.
Outstanding items for action and details of action taken (continuation sheet)
Special hazards
Signed: Date:
