Small Business Health and Safety Checklist Form
Complete this checklist to document your workplace health and safety review. Ensure all key safety measures are in place and note any actions required.
Business Name
*
Location/Address
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Workplace Health and Safety Checklist
*
Fire exits are clearly marked and accessible
First aid kit is stocked and accessible
Electrical cords and equipment are in good condition
Emergency contact information is posted
Work areas are clean and free of hazards
Personal protective equipment (PPE) is available and used where required
Other (please specify below)
Issues Found (if any)
Follow-up Actions Required
Person Completing the Checklist (Name)
*
Role/Position
Next Review Date (if scheduled)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: