Health and Wellness Inspection Form
Health and Wellness Inspection Form
This form is meticulously designed to systematically assess and document various aspects of workplace health and safety. By conducting this inspection, we aim to promote a safe and healthy work environment for all employees of [Your Company Name].
Physical Environment
|
No. |
Area/Aspect |
Observation/Comments |
Action Required |
|
1 |
Ergonomic Setup |
[Chairs are properly adjusted] |
[None] |
|
2 |
Hazardous Substances |
||
|
3 |
Ventilation |
||
|
4 |
Lighting |
||
|
5 |
Cleanliness |
Workplace Practices
|
No. |
Practice/Procedure |
Compliant |
Comments |
Action Required |
|
|
Yes |
No |
||||
|
1 |
Proper PPE Usage |
|
|
[Employees wearing appropriate PPE.] |
|
|
2 |
Safety Protocols |
|
|
||
|
3 |
Emergency Response Preparedness |
|
|
||
Employee Health
|
No. |
Health Aspect |
Observation/Comments |
Action Required |
|
1 |
Illness Reporting |
[The company follows a standardized process] |
[None] |
|
2 |
Vaccination Status |
||
|
3 |
Accommodations for Health Needs |
Wellness Programs
|
No. |
Wellness Initiative |
Evaluation (Scale 1-5) |
Comments |
Action Required |
|
1 |
Fitness Programs |
[4] |
[Well-received by staff] |
[Consider expansion] |
|
2 |
Stress Management Programs |
|||
|
3 |
Mental Health Support Services |
Training and Education
|
No. |
Training/Education Program |
Comments |
Action Required |
|
1 |
Safety Protocols |
[The program incorporates major details but lacking in some aspects] |
[Include the emergency contact information] |
|
2 |
Emergency Procedures |
Acknowledgment
I, the undersigned, hereby acknowledge that I have completed the Health and Wellness Inspection on [January 15, 2055]. I have thoroughly assessed the workplace environment, practices, and employee health and wellness aspects. Any observations or comments have been duly noted to the best of my knowledge and ability
[Your Name]
[Your Position/Title]
