Health and Safety Checklist for agency workers form template

Assignment Details:

• Assignment/Job Name: ______________________________
• Client Name: ______________________________________
• Assignment Location: _______________________________
• Date: //____

Health and Safety Checklist:

1. Personal Protective Equipment (PPE):

   • Ensure you have been provided with appropriate PPE for the assignment.
   • Wear PPE as required, including safety goggles, gloves, helmets, or high-visibility vests.

2. Work Area Safety:

   • Familiarize yourself with emergency exits, evacuation routes, and assembly points.
   • Ensure work areas are clear of hazards such as trip hazards, spills, or obstructions.

3. Equipment Safety:

   • Inspect and test equipment before use to ensure it is in good working condition.
   • Follow manufacturer's instructions for safe operation of equipment and machinery.

4. Chemical Safety:

   • Handle chemicals and hazardous substances in accordance with safety data sheets and instructions.
   • Use appropriate containment measures and personal protective equipment when handling chemicals.

5. Fire Safety:

   • Identify fire extinguishers, alarms, and emergency exits in the work area.
   • Know how to raise the alarm and evacuate the premises in case of fire.

6. Manual Handling:

   • Use correct lifting techniques to prevent injuries when handling heavy objects.
   • Use mechanical aids or seek assistance for lifting heavy loads when necessary.

7. Electrical Safety:

   • Avoid overloading electrical outlets and extension cords.
   • Report any damaged or faulty electrical equipment to your supervisor immediately.

8. First Aid:

   • Know the location of first aid kits and trained first aiders on site.
   • Report any accidents or injuries to your supervisor and seek medical attention if necessary.

9. Emergency Procedures:

   • Familiarize yourself with emergency procedures, including evacuation routes and assembly points.
   • Follow instructions from supervisors or designated safety personnel in case of emergencies.

10. Additional Notes:

[Add any additional health and safety precautions specific to the assignment or client]

Worker Signature: ________________________ Date: //____

Supervisor/Manager Signature: ________________________ Date: //____

Note: This checklist is intended to ensure compliance with health and safety regulations and promote a safe working environment for all agency workers. It should be completed before starting any new assignment and regularly reviewed to address any changes or updates in safety procedures.