5
- Fire, Evacuation and First Aid
Are all exit signs visible?
Yes / No
Name of nearest First Aider? ...............................................................................................................................................
Where is the nearest first aid kit?........................................................................................................................................
Where is the nearest defibrillator?......................................................................................................................................
What is the alarm sound for an evacuation?..............................................................................................
Who is responsible for announcing an evacuation? ............................................................................................................
Where is the nearest fire extinguisher or hose? .................................................................................................................
Where is the assembly point in case of evacuation?...........................................................................................................
Name(s) of designated fire warden(s)? ...............................................................................................................................
6
- Slips, Trips, Falls and Hazards
Have all visible fall hazards been mitigated? Yes / No
Have all visible trip hazards been mitigated? Yes / No
Are all fire exits and egress routes are clear of obstruction?
Yes / No
All those operating equipment are trained to do so.
Yes / No
All other Health and Safety hazards not previously identified have been mitigated. Yes / No
7
- Other
8
- Declaration
I confirm that this event is safe to proceed and that all reasonable measures have been put in place to ensure the health, safety and wellbeing
of any person present (in attendance, adjacent to and working at the event). I understand what to do in the event of an injury, fire, evacuation
or other incident which may affect the health safety and wellbeing of any person during the event.
Name:............................................................ Date:.......................................... Time:...............................................
Signature: ......................................................