Prepared by:

(Name & signature)

Checked by:
(Name & signature)
Approved by:
(Name & signature)
Date: Date: Date:




REFERENCE: ASSESSMENT DATE: .
WORKPLACE OBSERVATION

ITEM

CHECKLIST

COMPLIANCE
NC

NA

A MACHINERY
B SCAFFOLD
C SIGNAGES & NOTICES
D HOUSEKEEPING
E ILLUMINATION & LIGHTING
F FIRE PROTECTION
G BARRICADES FOR HAZARDOUS AREAS
H ELECTRICAL SAFETY
I PREVENTION OF FALLING OBJECTS
J HAZARD IDENTIFICATION RISK
ASSESSMENT & RISK CONTROL
(HIRARC)

K PERIMETER HOARDING
L TRAFFIC MANAGEMENT
M FIRST AID
N WELFARE
O ENVIRONMENT
P MATERIAL MANAGEMENT
Q INCIDENT REPORTING