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Workplace inspection checklist and action report

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Document information
ByMinistry of Defenceharbor_tide_dc5146

A blank editable inspection form with 110 questions across 19 workplace safety areas, yes/no/n/a responses, comments, remedial action log, executive summary and manager sign-off.

Adapted edition

Workplace health and safetyWorkplace inspections
Document type
Checklist
Format
DOCX
Pages
5
Language
English
Version
1.0
Updated
2026-09-16
Category
Safety & operations
Licence
Open Government Licence v3.0
Description

Optional blank workplace inspection form adapted from Ministry of Defence Form 5020, which supports JSP 375 Chapter 4 in defence. Its checks refer to defence sites, internal JSP policy, MOD forms and specific facilities. Review and adapt the questions for your site and current local requirements; this adaptation is not a statutory compliance certificate.

Contents
  • Inspection details
  • Access and Egress
  • Asbestos
  • Building infrastructure
  • Chemicals
  • Electrical Safety
  • Emergency Precautions (inclusive of fire)
  • First Aid
  • Housekeeping
  • Lighting
  • Lifting, Manual Handling and Storage
  • Storage Areas
  • Machinery and Work Equipment
  • Noise
  • Space
  • Personal Protective Equipment
  • Temperature (working indoors)
  • Toilets and Washing Facilities
  • Ventilation
  • Other issues
  • Remedial action log
  • Executive summary
  • Manager sign-off
Source and licence
MOD Form 5020 - workplace inspection checklist / report

Ministry of Defence

Original source OGL-UK-3.0

AttributionContains public sector information from the Ministry of Defence, MOD Form 5020, published 19 December 2025, licensed under the Open Government Licence v3.0. Independent adaptation; no government endorsement.

ChangesAdapted 16 September 2026: rebuilt the published blank ODT as a neutral editable DOCX and readable PDF, preserving 110 inspection questions, 19 hazard areas, answer choices, 13 action rows, executive summary and manager sign-off. Removed named Office editor metadata and source hyperlinks, including non-public MOD intranet links, while retaining their visible policy and legislation references. Condensed empty source spacer rows and regularised whitespace and field labels. Corrected exactly three source passages: Q16.1 printed 16OC/13OC, displayed as 16°C/13°C (HSE); First Aid printed JPS 375 Chapter 5, displayed as JSP 375 Chapter 5 (MOD); Space cited the Workplace regulations with missing parentheses, displayed as the Workplace (Health, Safety and Welfare) Regulations 1992 (HSE).

Version history
  • v1.016/09/2026
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