Health & Safety Workplace Evaluation Form
Health & Safety Workplace Evaluation Form
|
Evaluation Date |
[January 1, 2050] |
|
Evaluator's Name |
[Your Name] |
|
Department/Section |
[Operations] |
General Information
-
Office
-
Warehouse
-
Production Area
-
Other:
Section 1: Workplace Environment
1. Lighting
-
Adequate
-
Inadequate
-
Comments:
2. Ventilation
-
Adequate
-
Inadequate
-
Comments:
3. Noise Levels
-
Acceptable
-
Excessive
-
Comments:
4. Cleanliness and Hygiene
-
Satisfactory
-
Unsatisfactory
-
Comments:
Section 2: Equipment and Machinery
1. Condition of Equipment
-
Good
-
Needs Maintenance
-
Comments:
2. Safety Guards in Place
-
Yes
-
No
-
Comments:
3. Emergency Shut Offs Accessible
-
Yes
-
No
-
Comments:
Section 3: Fire Safety and Emergency Procedures
1. Fire Extinguishers
-
Adequate Number
-
Insufficient
-
Comments:
2. Evacuation Routes
-
Clearly Marked
-
Not Clearly Marked
-
Comments:
3. Emergency Lighting
-
Functional
-
Non-Functional
-
Comments:
Section 4: Personal Protective Equipment (PPE)
1. Availability of PPE
-
Sufficient
-
Insufficient
-
Comments:
2. Usage of PPE
-
Always Used
-
Sometimes Used
-
Never Used
-
Comments:
Section 5: Training and Awareness
1. Safety Training
-
Regularly Provided
-
Not Provided
-
Comments:
2. Awareness of Safety Procedures
-
High
-
Moderate
-
Low
-
Comments:
Additional Observations
|
|
Evaluator's Signature:
Date: [Month Day, Year]
