Annual safety assessment report checklist

Template Information

This safety assessment outlines a comprehensive study of your workplace and its operations to review safety processes and identify health and safety issues.

Category: education

Template Questions

  • Executive Summary • This section can be used to provide a brief summary of the report, to highlight the how the ASA was undertaken and to draw attention to any particular issues if required. • Be sure to direct the reader to: - Appendix 1: Summary Results of the Annual Safety Assessment and - Appendix 2: Action Plan. ENTER TEXT IN NEXT FIELD
  • Principal Signature:
  • Select date Date
  • Criterion 1: WORK HEALTH AND SAFETY POLICY
  • Criterion Indicators are rated from 1 - NOT MET to 5 - FULLY MET
  • Current strengths and things we do well:
  • Issues of concern and recommendations for future improvement:
  • Criterion 2: MANAGEMENT RESPONSIBILITY
  • Criterion indicators are rated 1 - NOT MET to 5 FULLY MET
  • Current Strengths and things we do well:
  • Criterion 3: PLANNING PROCESSES
  • Criterion 4: CONSULTATION
  • Criterion 5: RISK MANAGEMENT
  • Criterion Indicators are rated 1 - NOT MET to 5 - FULLY MET
  • Criterion 6: HEALTHY LIFESTYLE PROGRAM
  • Criterion 7: INFORMATION, INSTRUCTION AND TRAINING
  • Criterion 8: INJURY TREATMENT AND MANAGEMENT
  • Criterion 9: CLAIMS MANAGEMENT
  • Criterion indicators are rated 1 - NOT MET to 5 - FULLY MET
  • Criterion 10: INCIDENT RECORDING, INVESTIGATION, ANALYSIS AND REVIEW
  • Criterion 11: MEASURING AND EVALUATING WHS PERFORMANCE
  • Criterion 12: REVIEWING WHS PERFORMANCE
  • Criterion 13: REPORTING OF WHS
  • Location: Address
  • Safety Assessment compiled by:
  • SUMMARY RESULTS OF THE ANNUAL SAFETY ASSESSMENT 2014
  • Top 3 issues of concern with key actions to be taken:
  • Officer in Charge - signature and date:
  • Add signature