Repeat for each area. Each one asks:
Area name or location*Short answer
For example Ground floor gents, Level 2 tea point, Loading bay 3.
Area typeChoose one
Floors clean, free of debris and stainsChoose one
Surfaces and touch points clean (handles, switches, handrails, lift buttons)Choose one
Bins emptied, liners fitted, not overflowingChoose one
- CheckSo far as is reasonably practicable, waste materials must not be allowed to accumulate in a workplace except in suitable receptacles. Regulation 9(3) of the 1992 Regulations.
Shown when “Bins emptied, liners fitted, not overflowing” is “Fail”
Glass, mirrors and partitions free of smearsChoose one
Toilets, urinals, basins and taps cleanChoose one
Shown only when the answers above make it relevant
Soap available at every basinChoose one
Shown only when the answers above make it relevant
Paper towels or hand dryer workingChoose one
Shown only when the answers above make it relevant
- WarningSoap or drying missing. Washing facilities must include soap or other suitable means of cleaning, and towels or other suitable means of drying. Workplace (Health, Safety and Welfare) Regulations 1992, regulation 21. On a construction site the same applies under Schedule 2 of the Construction (Design and Management) Regulations 2015.
Shown only when the answers above make it relevant
Toilet roll stocked in every cubicleChoose one
Shown only when the answers above make it relevant
- CheckSanitary conveniences and the rooms containing them must be kept in a clean and orderly condition. Workplace (Health, Safety and Welfare) Regulations 1992, regulation 20.
Shown when “Toilets, urinals, basins and taps clean” is “Fail”
Kitchen or tea point clean: sink, worktops, fridge, microwaveChoose one
Shown only when the answers above make it relevant
Walkways and exit routes clearChoose one
- CheckRegulation 12(3) of the 1992 Regulations. So far as is reasonably practicable, every floor and traffic route must be kept free from obstructions and from any article or substance which may cause a person to slip, trip or fall.
Shown when “Walkways and exit routes clear” is “Fail”
No trailing cables across walkwaysChoose one
- CheckHSE guidance on trailing cables. People trip over cables and wires, particularly on pedestrian routes. Permanently wire equipment to avoid trailing cables, or use cable covers. Where necessary, restrict access so people do not have to cross them.
Shown when “No trailing cables across walkways” is “Fail”
No spillages, and no wet floor left without a signChoose one
- WarningSpillage or wet floor. HSE guidance is to remove spillages promptly, and to leave smooth floors dry after cleaning or keep people off them until they are dry. Use warning signs while the floor is wet, and remove them once it is clean and dry.
Shown when “No spillages, and no wet floor left without a sign” is “Fail”
What was done about it before you left?Notes
Shown when “No spillages, and no wet floor left without a sign” is “Fail”
Storage tidy, no clutter or items stacked unsafelyChoose one
Items checkedWorked out by the form
Items passedWorked out by the form
Items failedWorked out by the form
Area score (%)Worked out by the form
Shown only when the answers above make it relevant
Counts as below standardWorked out by the form
- CheckBelow the pass mark. This area scored under the pass mark set on page 1.
Shown only when the answers above make it relevant
Overall standard of this area (1 unacceptable to 5 excellent)Rating 1 to 5 (Unacceptable to Excellent)
1 is unacceptable, 5 is excellent.
Photos of the failuresPhotos
Shown only when the answers above make it relevant
What was foundNotes
Shown only when the answers above make it relevant
Action neededNotes
Shown only when the answers above make it relevant
General photos of the areaPhotos
Walk Cam: this areaWalk Cam video with voice-to-text
Optional. Film this area on the SiteSurvey app; each clip keeps its spoken note.