ACE VEGETATION CONTROL SERVICE LTD. - Work Site HSE Inspection

• Crew #

• Site

• Supervisor

• Foreman

• Inspector

• Conducted on

  Date
• Location
  Address

• Instructions
  
  1. Answer questions provided below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Actions click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

Emergency Equipment

• First Aid Supplies

  Yes

  No

  N/A

• Eye Wash Solution & Bottle

  Yes

  No

  N/A

• Flare Kit

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

• Cell Phone

  Yes

  No

  N/A

• Signs & Cones

  Yes

  No

  N/A

• Forestry Fire Pack

  Yes

  No

  N/A

• Shovel, Pulaski

  Yes

  No

  N/A

• Muster Point

  Yes

  No

  N/A

• First Aid Identifier

  Yes

  No

  N/A

• Site Access / Egress

  Yes

  No

  N/A

• Emergency Contact Number

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hat

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Respirators

  Yes

  No

  N/A

• Rubber gloves

  Yes

  No

  N/A

• Adequate Foot Protection

  Yes

  No

  N/A

• Face Shield

  Yes

  No

  N/A

• H2S Monitors (calibrated, daily test)

  Yes

  No

  N/A

• Traffic Vest

  Yes

  No

  N/A

• Chainsaw Pants

  Yes

  No

  N/A

Storage & Cargo Securement

• Pesticide containers

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Hoses

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Spray Guns

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Personal Gear

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Tools, Pumps, Gasoline, Oils

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Weed Whips

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Backpacks

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Hazard Labels (bins &containers)

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Food & Water

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

• Bins

• • Clean

  ✔

  ✕

• • Secured

  ✔

  ✕

Site Inspection & Tailboard Yes No Observations

• Did the contact issue a safe work permit?

  Yes

  No

• Did the crew visually check the work site forhazards?

  Yes

  No

• Did the crew document a work plan? (A signed tailboard plan)

  Yes

  No

• Can all crew members describe the emergency response plan?

  Yes

  No

• Are all crew members concerns addressed onthe tailboard?

  Yes

  No

• Limits of Approach Known By Crew

  Yes

  No

• Does the crew have a J.S.A.?

  Yes

  No

• Is the J.S.A. signed by clients?

  Yes

  No

• Does the crew have a copy of their last safety meeting?

  Yes

  No

• Does the crew have a copy of their last safety inspection?

  Yes

  No

Crew Certification

• Pesticide License (for province)

  Yes

  No

• First Aid

  Yes

  No

• H2s

  Yes

  No

• WHMIS

  Yes

  No

• TDG

  Yes

  No

• ATV or ORUV

  Yes

  No

• Client Orientation

  Yes

  No

• UTT or UTW

  Yes

  No

• Heavy Equipment Operator (Approved)

  Yes

  No

Motor Vehicles & Trailers

• Lights

  Yes

  No

• #

• Brakes

  Yes

  No

• #

• Emergency brake

  Yes

  No

• #

• Back Up Alarm

  Yes

  No

• #

• Windshield

  Yes

  No

• #

• Condition of the Tire Tread

  Yes

  No

• #

• Spare Tire/ Tire Wrench

  Yes

  No

• #

• Rotating Warning Light

  Yes

  No

• #

• Trailer hitch and chains

  Yes

  No

• #

• Trailer Dynamite Switch

  Yes

  No

• #

• Break Away Switch

  Yes

  No

• #

• Cab is Clean

  Yes

  No

• #

• Pumps

  Yes

  No

• #

• Regulator & Gauges

  Yes

  No

• #

• Hoses, reels, & Guns

  Yes

  No

• #

• Driver’s License

  Yes

  No

• #

• Registration/Insurance/Inspection

  Yes

  No

• #

• Clean Inside / Outside

  Yes

  No

• #

Herbicide Mixing

• Did the crew document the correct amount of herbicide before they decanted it into the tank?

  Yes

  No

• Are all pesticide containers labeled?

  Yes

  No

• Did the crew wear the required PPE when measuring and mixing?

  Yes

  No

• Did the crew measure the correct quantities of herbicide?

  Yes

  No

• Did the crew follow safe mixing procedures? (i.e.- not near water)

  Yes

  No

• Did the crew triple rinse empty herbicide containers?

  Yes

  No

• Did the crew clean up spills and dripping containers before putting them away?

  Yes

  No

• Did the crew follow correct procedures for mounting and dismounting the spray unit?

  Yes

  No

Environmental

• Are Club root Protocols Available if needed?

  Yes

  No

• Is equipment Cleaned Prior to arriving at site?

  Yes

  No

• Is a record available?

  Yes

  No

• Crew ensures that no chemical has gone off site?

  Yes

  No

• Is there a water body within 30 meters?

  Yes

  No

• Weather station available? (Kestrel)

  Yes

  No

Site Measurement

• Did the crew measure the site before mixing?

  Yes

  No

• Did the crew measure all aspects of the site?

  Yes

  No

• Did the crew draw the maps neat & accurate?

  Yes

  No

Spraying the Site

• Did the crew wear the required PPE?

  Yes

  No

• Was the crew aware of their surroundings and the hazards?

  Yes

  No

• Did the crew follow a logical pattern to ensure that they sprayed the entire site?

  Yes

  No

• Did the crew complete a calibration after spraying the site?

  Yes

  No

• Did the crew deliver good coverage?

  Yes

  No

• Did the crew achieve their application rate?

  Yes

  No

Spraying The Site

• Are there any leaks in the spraying system?

  Yes

  No

• Did the driver and the sprayer both watch for hazards when the truck was moved?

  Yes

  No

• Did the sprayer and his assistant communicate work plans together?

  Yes

  No

Paperwork

• Did the crew complete all the paper workneatly and accurately?

  Yes

  No

• Tailboard

  Yes

  No

• Chemical Record

  Yes

  No

• Maps, weather, herbicides, rates

  Yes

  No

• LSD Form

  Yes

  No

• Time sheet

  Yes

  No

• Pre-Trip

  Yes

  No

• Did the crew prepare for the next work site?

  Yes

  No

Packing Up

• Did the crew depressurize the gun before disconnecting it?

  Yes

  No

• Did the crew do this on the treated area so that any spillage would not cause off site damage?

  Yes

  No

• Did the crew follow procedures to shut down the spray system?

  Yes

  No

• Did the crew shut off the fuel switch?

  Yes

  No

• Did the crew lock all bins?

  Yes

  No

• Did the crew label the contents of the tanks?

  Yes

  No

• Did the crew leave the work site clean and tidy?

  Yes

  No

Customer Service

• Is the crew maintaining adequate contact with the client?

  Yes

  No

• Is the crew keeping the client up to date on their progress?

  Yes

  No

• Are the crew members friendly and responsive toward the client?

  Yes

  No

• Is the client happy with this crew?

  Yes

  No

Completion

• Results Discussed With Crew?

  Yes

  No

• Crew

  Sign

• Crew

  Sign

• Inspector

  Sign