Safety Checklist Form Template

Instantly Create Your Checklist, Just enter your details

Chimney Work Safety Checklist

Use our Checklist creator tool to create customised workplace safety documents. Learn more about Chimney Work Safety Checklist Template below
50% off your first month Standard £4.99 · Pro £12.49 for month one — applied automatically. Ends 31 July Claim offer
Safety Checklist Creator
Guest

Loading Safety Checklist Creator

Please wait while we prepare your workspace

Checklist Questions

Every question is included by default. Untick any you want to leave out, or delete the ones you don't need.

Click Add Question to add your own custom checks. Click a row to edit its wording, and drag to reorder.

The Yes / No / N/A tick-boxes and comments space are added automatically on the exported PDF or Word document.

No questions added yet — add your first one below.

Logo, Branding & Sign-off

Custom Branding Not Available

Create a free account, then upgrade to add your company logo.

Sign to confirm you completed this checklist

Click to sign on behalf, or leave blank for on-paper approval.

Review & Export

Choose your page orientation, then export a print-ready checklist.

Preview Document

See exactly how your checklist PDF will look before downloading.

Download PDF

Print-ready PDF with Yes / No / N/A tick-boxes and a comments space.

Export to Word

An editable Word (.doc) version with Yes / No / N/A tick-boxes and a comments space.

Export to Excel

A spreadsheet version for digital tracking and filtering.

Important: The documents produced by this tool are templates only. They must be reviewed and approved by a competent person or your HSEQ representative prior to publication or circulation, in accordance with our Terms & Conditions.

PDF Preview

100%

Creating preview

Building your PDF preview…

Still Using Paper Sign-Off Sheets?

Once you've generated and saved your document, create a secure share link to distribute across any platform. Collect encrypted digital signatures from your team and generate professional sign-off reports.

Generate
Save
Share
Sign
Report
Try It Free

Increased Limits Available

Risk Assessment Description:

This chimney work safety checklist template from Health & Safety Zone helps bricklayers, roofers, plasterers and other building‑trade operatives ensure safe execution of chimney repair, maintenance and construction tasks at height.

It covers the essential checks across planning, competence, site conditions, task‑specific hazards, equipment, substances, personal protective equipment, collective measures, emergency provisions and completion steps. The checklist aligns with the Work at Height Regulations 2005 and the Construction (Design and Management) Regulations 2015.

The checklist reflects guidance from the Health and Safety Executive’s HSG33 ‘Health and safety in roof work’ and the HSE scaffolding information publications, ensuring best practice for working at height on chimneys.

Use this checklist for:

  • Pre‑start checks – confirm risk assessments, permits and safe access before work begins.
  • During‑work inspections – verify that the chimney, scaffold and protective measures remain safe.
  • Post‑work sign‑off – ensure the area is clear, tools are stored and the chimney is left stable.

Each item is answered Yes, No or N/A – any No answer must be addressed before work continues.

To use the checklist, tick Yes, No or N/A for each question as the work progresses. Any No response must be investigated and corrected before proceeding to the next stage, and records retained for inspection.

Fully editable and shareable – customise the questions to your site, download as a PDF and share with your team.

Compliant with: Work at Height Regulations 2005; Construction (Design and Management) Regulations 2015.

Sample PDF Document Image:

Checks covered in this Chimney Work checklist

This Chimney Work safety checklist template covers 26 checks. Customise the questions to your workplace, then download a professional, print-ready PDF with Yes / No / N/A tick-boxes and a comments space.

#Checklist item
1Has a risk assessment and method statement for the chimney work been completed and briefed to the operatives?
2Is a permit to work for work at height or hot work in place where required?
3Are all operatives trained and competent to work at height on chimneys?
4Is a competent supervisor or site manager overseeing the work?
5Is the access scaffold or tower ladder in good condition, with no damaged standards or decking?
6Is the scaffold erected on firm, level ground and secured against movement?
7Are edge protection and toe‑boards fitted to prevent falls from the scaffold?
8Are guardrails or edge protection installed around the chimney at the working height?
9Is the scaffold inspection tag current and displayed?
10Is the weather suitable – no high winds, rain or icy conditions that could affect stability?
11Is the chimney structure inspected for cracks, loose bricks or compromised mortar before work starts?
12Is the chimney stack securely supported and not at risk of collapse during work?
13Are tools and equipment (e.g., brushes, scaffolding fittings, lifting gear) inspected for damage and fitted correctly?
14Is a debris net or catch platform positioned to prevent dropped objects from striking persons below?
15Is dust control in place – wet methods or local extraction – to limit airborne particulate exposure?
16Are appropriate respiratory protective equipment (RPE) provided and worn where dust is generated?
17Are hard hats, safety glasses, gloves, high‑visibility clothing and safety boots being worn?
18Are exclusion zones and signage clearly displayed to keep unauthorised persons clear of the work area?
19Is a rescue plan for a fall from height documented and understood by the team?
20Are first‑aid kits and emergency contact details readily available on site?
21Is a competent person designated to monitor for falling masonry and ensure debris is captured?
22Is the scaffold tied to the chimney or building to prevent displacement?
23After work, has the scaffold been safely dismantled or secured and the chimney inspected for any new damage?
24Has all waste, debris and tools been cleared from the chimney and surrounding area?
25Has a competent person conducted a final safety inspection and signed off the chimney work before site reoccupation?
26Has the area been left tidy, with any temporary works removed and the site safe for normal use?

Frequently asked questions

Are these safety checklist templates really free to download?

Yes — completely free. Customise any checklist to your workplace and download a professional, print-ready PDF in minutes. No paywall, and no signup required for guests.

What format do the safety checklists download in?

Checklists download as a professional PDF, ready to print and complete on-site — each question has clear Yes / No / N/A tick-boxes and a comments space. You choose portrait or landscape at download. Word and spreadsheet formats are being added.

Can I customise the checklist questions to my workplace?

Yes — fully. Add your own questions, edit or remove any of the pre-written ones, and reorder them to suit your site, task or inspection before you download.

Are the safety checklists suitable for UK workplaces?

Yes. The checklists are written around UK health and safety good practice and HSE guidance, and are suitable for inspections, audits, toolbox checks and routine workplace monitoring.

Do I need an account to use the checklist templates?

No — guests can build and download a checklist for free without signing up. Register a free account if you want to save checklists to your dashboard and edit them later.

Can I add my company logo and branding to the checklist?

Yes — add your company logo, colours and details on Standard and Pro plans, so the exported checklist carries your own branding. Guests and Free downloads carry Health & Safety Zone branding.

How do I complete the checklist once it is downloaded?

The exported checklist is a blank, ready-to-use document: print it and tick Yes, No or N/A against each question and write any comments in the notes space, then sign and date it in the sign-off section.

What types of safety checklist can I create?

We are building specialist checklists across a wide range of subjects and industries — fire safety, workplace inspections, equipment and machinery checks, site inductions, vehicle checks, PPE, first aid and more. Browse by category to find the right one.

How often should safety checklists be completed?

It depends on the activity and your risk assessment — many checks are daily, weekly or monthly, while others are done before each task or shift. Completed, dated checklists provide a useful record of your monitoring.

Are the checklists a substitute for a risk assessment?

No. A checklist is a monitoring and inspection tool that complements your risk assessments and method statements — it helps confirm that controls are in place and working. Use them alongside your risk assessments.