Instructions

Inspection Template Information

Hazard Legend:

Type A Hazard: Imminent hazard that requires correction IMMEDIATELY
Type B Hazard: Urgent situation that requires correction ASAP
Type C Hazard: Non emergent hazard that needs correction WITHOUT DELAY

Reporting a safety hazard to WSI (A, B, C)

- Call 1-877-222-3112 (press 1 if urgent issue)
- Document description of issue
- Record Service Due Date
- Document work order number
- Unit Chief to follow progress

Reporting Info:

- Please document any hazards and action taken on "Summary" page
- When completed, select "export"
- Select "PDF" and "email"
- Report should me emailed to the station UC and Darlene.Clayton@bcehs.ca

A. Vehicle Bays

A1. Aisles clear

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A2. Bay doors complete with working safety bars

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A3. Bay door manual mechanism working

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A4. Drains maintained

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A5. Drop cords secure and pigtails (18" from floor)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A6. Fire extinguishers by exits (dated)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A7. Floors (non slip) maintained

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A8. Furnace room (clean and tidy)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A9. Ground faults working/ checked

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A10. No vehicle oil/ fluids found

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A11. Entonox storage- secure/ decal

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A12. Oxygen storage- secure/ decal

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A13. Oxygen storage (away from combustibles)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A14. Main oxygen upright- valve caps/ secure

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A15. Segregation of incompatible material

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A16. Exhaust ventilation system working

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A17. Stairs (if applicable) clear and well lit

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A18. Hand rails secure

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A19. Switch/ plugs with covert plates

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A20. Tire storage low to ground

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date
A21. Eyewash station (bottle full; mounted near sink)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI contacted at:

Work Order #

Service Due Date

B. Safety Administration

B1. MSDS sheets in binder (complete, current)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B2. WHMIS books

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B3. BCAS OSH Program manual

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B4. Safety Bulletin board

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B5. Copy of WCB regulations

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B6. Employee immunization records

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B7. Employee safety training tracking

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B8. Fleet management bulletin manual

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B9. Latest inspection posted

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B10. Minutes posted - DOSH committee (last 3 months)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B11. Safe work procedures (posted/ filed)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B12. Reporting forms (1130A, 2414, 2339, 2340, WCB)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
B13. Any asbestos listed/ marked

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

C. Station

C1. Electrical panel accessible

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C2. Electrical cords/ phone cords

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C3. Emergency lights

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C4. Fire extinguishers (dated) by exits

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C5. Floors maintained (non slip wax)

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C6. Furniture maintained

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C7. Handrails and stairwells illuminated

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
C8. Smoke/ heat detectors

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

D. Outside Building

D1. Exterior lighting

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
D2. Snow/ ice removal procedure

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
D3. Structure appears in good shape

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
D4. Walkways clear/ lighted

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

E. Storage Room

E1. Clean/ orderly

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
E2. No heavy storage over 6 feet

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
E3. Shelving bolted to walls

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

F. Other Storage Areas

F1. Lockers secure

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
F2. Separate storage of flammables

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
F3. Shelving secure

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
F4. Spare spineboard(s) in good order

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
F5. Stability of stored material

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
F6. Storage of hazardous products

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

G. General Conditions

G1. Electrical connectors

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G2. Electrical wires/ fixtures

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G3. General housekeeping & cleanliness

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G4. No tripping hazards

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G5. Outlet cover plates where required

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G6. Emergency exits with closures, marked/ visible

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G7. Fire evacuation procedures in place

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date
G8. Access/ egress unobstructed

Comments

Call WSI @ 1-877-222-3112 to report Hazard A, B or C
Document work order#, date and ETA below:

WSI Contacted at:

Work Order #

Service Due Date

H. Other Station Items

Please document any additional items requiring inspection below:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Report Summary

Electronic Signature
Electronic Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.