Third-Party Workplace Safety Assessment Form
Assess workplace safety conditions at a third-party site using a clear, professional form.
Site and Assessment Details
Site/Company Name
*
Site Address or Location
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Assessor Organization
*
Workplace Safety Review
Overall safety condition
*
Excellent
Good
Fair
Poor
Critical
Safety rating
Very unsafe
1
2
3
4
Very safe
5
1 is Very unsafe, 5 is Very safe
Observed safety areas or hazards
*
Housekeeping
PPE compliance
Fire safety
Equipment safety
Signage and labeling
Emergency readiness
Electrical safety
Slip, trip, and fall hazards
Chemical storage and handling
Ergonomics
Machine guarding
Other
Major hazards and findings
*
Follow-Up and Submission
Recommended Corrective Action / Summary Notes
*
Priority / Urgency Level
*
Low
Moderate
High
Critical
Expected Follow-Up Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: