Information
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Audit Title
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Date:
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Area Address:
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Employee Number:
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Employee Name:
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Supervisor Number:
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Supervisor Name:
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If item fails then add in the notes area whether it is to be Repaired or Replaced
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Head Protection<br>Equipment Identifier: Name<br>Verify: <br>Shell- No crack or contaminants (paint, oil, etc) in good repair<br>Suspension- No frays, in good repair, clips in good repair, adjusted correctly (1 1/4" between shell and head)<br>Liner (if equipped) - in good repair
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Eye Protection<br>Equipment Identifier:N/a<br>Verify: <br>Lenses should be clean and scratch free, not loose frames should be crack free, side shields should be intact. <br>Prescription eye glass frames to be plastic.<br>
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Foot Protection<br>Equipment Identifier: N/a<br>Verify:<br>Toe cap not exposed, no splinters, not oil soaked, good tread, in good repair. Boot laces in good shape. <br>Safety footwear, green patch/omega symbol<br>
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FR Clothing ( including FR Rainwear<br>Equipment Identifier: Name<br>Verify:<br>No rips tears or contaminant. No missing buttons or zipper teeth.<br>In good, clean repair.<br>
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High Visibility clothing ( traffic best)<br>Equipment Identifier: Name<br>Verify:<br>Velcro side tabs break freely, in good repair <br>
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Hearing Protection (muffs or plugs)<br>Equipment Identifier:N/a<br>Verify:<br>In good repair
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Rubber gloves ( all classes) and bag<br>Equipment Identifier: N/a<br>Verify:<br>Rubber gloves- no holes , cracks, wear spots or contaminants (oil, paint, etc)<br>
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Leather Gloves, Spray Gloves <br>Equipment Identifier: Name<br>Verify:<br>No tears, holes. In good repair. <br>Gloves should fit properly.<br>
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Spurs<br>Equipment Identifier:N/a<br>Verify:<br>Upper/lower strap and pad in good repair, spur guards in place, gaffs length, sharpness adequate <br>
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Carabiner(s)<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Climbing Belt<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Rope Lanyard<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Adjustable Nylon Lanyard<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Respirator<br>Equipment Identifier:N/a<br>Verify:<br>Meets requirements of SP 1143. ( Respiratory Protection Program<br>Filters clan , proper fit, in good repair
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Climbing Rope (skinning Rope)<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Safety Snap<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Full Body Bucket/man lift harness <br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Slick Line <br>Equipment Identifier:N/a<br>Verify:<br>line is in good repair, free of major nicks, knots and not fraud to the point it will not run properly
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Throw Ball<br>Equipment Identifier:N/a<br>Verify:<br>Free of holes. <br>Stitching and attachment of ring secure.
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Micro pulley<br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Pole Choker <br>Equipment Identifier:N/a<br>Verify:<br>Inspect as per HO 3019<br>
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Leg Protection chainsaw pants or chaps<br>Equipment Identifier:N/a<br>Verify:<br>Check for rips, stitching in good conditions and check to see approval label. <br>Reflective bands Are in good shape on chainsaw pants
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Chainsaw lanyard <br>Equipment Identifier:N/a<br>Verify:<br>Snap hooks are working properly, not cracked or bent, springs intact not missing and in working order , not bent. The locking guides not missing or be filled off. No more wear than 20% of the cross sectional area. The outside jacket, no cut or worn
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PFD /Survival/Floatations Suit <br>Equipment Identifier:Name <br>Verify:<br>Must bear a label stating that they are certified by the Canadian department of transport as D.O.T. Approved. A hydro one approved automatic inflatable PFD with thermal protection, a survival suit (a floater suit, coat , bib pants) when hypothermia is a factor. The PFD should not have any tears in stitching, that all buckles and / or zippers be function properly. Check manuals.
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Anti-Slip footwear <br>Equipment Identifier:N/a<br>Verify:<br>No excessive wear, rips, tears, or deformations<br>No parts of the footwear missing or broken.<br>
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Snowmobile Helmets<br>Equipment Identifier:N/a<br>Verify:<br>Must be DOT approved as per HO 4173 Safety and maintenance & Training Requirmwnts for off Road Personnel CRriers
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Employee Signature:
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Supervisors Signature: