Print Form
Equipment checklist
Please indicate the appropriate response. A “No” answer means that the hazards should be assessed and control measures considered where
the assessment indicates it is necessary.
Date of inspection:
Address of premises:
Item Is the item Is the Is the item Is the item Comments/hazard report
suitable and in equipment easily easily completed
good order for easy to use? accessible? transported?
the task?
Vacuum cleaner
Bucket/Mop
Broom
Washing machine
Laundry trolley
Clothes dryer
Iron/ Ironing board
Step ladder
Food preparation facilities
Hot water system
Changing facilities/area
Page 1 of 3 – Equipment checklist
Personal equipment checklist
Date of last service Are there any defects, signs of Is the item being used
wear or other problems? correctly?
Bed
Manual wheelchair
Power wheelchair
Shower chair/trolley
Transfer devices:
• slide sheet
• grab rail/foot stool
Hoist:
• standing
• ceiling
• hydraulic floor
• electrical floor
• other
Page 2 of 3 – Equipment checklist
Workplace Health and Safety Queensland, Department of Justice and Attorney-General
Checklist – Working in peoples homes-
PN10975 Version 1 Last updated 31 March 2011
Electrical safety of equipment Yes/No Comments/hazard report completed
1. Is there regular testing and tagging of the electrical equipment that is
supplied by the organisation?
2. Is there an organisational procedure when faulty items are identified?
3. Have workers received training in electrical safety?
4. Is the safety switch tested and recorded every three months?
General notes
Page 3 of 3 – Equipment checklist
Workplace Health and Safety Queensland, Department of Justice and Attorney-General
Checklist – Working in peoples homes-
PN10975 Version 1 Last updated 31 March 2011