Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Inspected By:
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Contractor Name:
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Store # and Location:
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Inspection Date:
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Project Name:
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Overall Inspection Score (Good, Acceptable, Unacceptable):
1. Competent Site Supervision
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1.1 Competent site supervisor
- N/A
- OK
- Not OK
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1.2 Competent acting site supervisor
- N/A
- OK
- Not OK
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Action:
2. Site Access
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2.1 Clean, clear workspace
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2.2 Adequate ramps
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2.3 Adequate Stairs
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2.4 Adequate Ladders
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Action:
3. Protective Equipment
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3.1 Hard hats worn?
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3.2 Foot protection worn?
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3.3 Fall protection worn?
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Action
4. Guardrails, Barricades
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4.1 Located where required?
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4.2 Properly constructed & secured?
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Action:
5. Ladders/Scaffolding
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5.1 Secured & tied off (extension ladders)?
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5.2 Proper angle (extension ladders)?
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5.3 Proper size & type?
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5.4 Safe, usable condition?
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Action:
6. Hoarding
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6.1 Secure & in good condition?
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6.2 Located where required?
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Action:
7. Fire Protection
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7.1 Extinguishers (by contractor)?
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Action:
8. Housekeeping
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8.1 Clear walkways & doors?
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8.2 Clear work areas?
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8.3 Garbage & debris in controlled piles or bins?
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Action:
9. Fall Protection
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9.1 Unprotected openings & edges?
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9.2 Workings from scaffolds?
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Action:
10. Extension Cords
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10.1 General condition of casing, ends, and connections
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10.2 Tripping hazard?
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Action:
11. Worker Education
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11.1 Worker education?
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11.2 Basics of fall protection?
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11.3 Electrician's C of Q card?
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11.4 Gas filters license?
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11.5 Others (as required)?
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Action:
12. First Aid Requirements
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12.1 First aid kits (by Contractor)?
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Action:
13. Elevating Work Platform
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13.1 Properly used (tied off to platform)?
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Action:
14. Signs and Print Material
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14.1 OH&S Act & Regulations?
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14.2 WSIB form 82 poster?
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14.3 MSDSs
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14.4 H&S policy & program (Contractor)?
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14.5 Emergency response procedure?
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14.6 MOL reports/documents?
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Action:
15. Temporary Electrical Panels
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15.1 Panel in good condition?
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15.2 Panel properly mounted/secured?
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Action:
16. Adequate Work Place Lighting
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16.1 Adequate lighting provided?
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Action:
17. Adequate Ventilation?
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17.1 Work area free of fumes & smoke?
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17.3 Hepa-filter used to vent work area?
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17.2 Fumes & smoke properly/safely vented to the outside of building?
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Action:
18. Other Comments/Concerns
Final Scoring
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Scoring Guide:
G (Good) - 1 or less contraventions observed.
A (Acceptable) - 3 or less contraventions observed, excluding Inspection Section 1 - Competent site supervision.
U (Unacceptable) - 3 or more contraventions observed, one of which is Inspection Section 1 - Competent site supervision. -
Select date
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Contractor's Name:
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Contractor's Signature:
