A health and safety program template is a document that puts forth a detailed guideline of the various safety measures to be followed and the health care techniques and precautions to be taken by individual or by some company to maintain the health standards of its employees and workers, etc. The template should contain relevant information regarding the various steps and measures to be adopted to ensure proper health and safety for all. This type of a template should be prepared by doctors and experts in the field of health and safety, to make sure that the best methods are adopted and the perfect possible procedures are conducted. This ensures that there is not even a small mistake in the execution of the plan.

You can Download the Free Health and Safety Program Template form, customize it according to your needs and Print. Health and Safety Program Template is either in MS Word, Excel or in PDF.

Sample Health and Safety Program Template:

Health and Safety Program Template

Download Health and Safety Program Template

________________________ [give a logo of the concerned organization here] 















Name of the organization: _____________________

____________________________________ [mention the name of the organization conducting the health and safety program]


Program undertaken by: _______________________

[mention the name of some special employee or department who have undertaken the responsibility of framing the program]


Document approved by: _______________________

[mention the name of the supervisor of the respective program]


Date: _____________ [mention the exact date of framing the program document]


Time period: ____________ to _______________ [mention the span of time for which the program plan will remain in effect]


Purpose:________________________________________________ [mention the basic objective behind framing the health and safety program]


Area of concern:

_______________________________________________ [mention if there exists some special areas or subjects that are to be included in the program]


Sl. No.


[mention the issues to be considered in the health and safety program]


[give description of the various processes involved and explain the procedures]

General rules and regulations of safety
Code of conduct and specifications in disciplinary actions
Possible accidents and necessary precautions
Health Care facilities
Management of environmental health hazards and violence
Laws and legislatures to safeguard health and safety
[include other issue that might be involved]
_______________________________ [signature of the respective officer]


______________________ [official seal of the organization]