Information
Employee Work Habits Observations (Complete Weekly)
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Date:
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Completed By:
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Employee(s) Observed:
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Job Site:
1. Personal Protective Equipment
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1.1 Proper head protection
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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1.2 Proper foot protection
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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1.3 Task specific PPE (glasses, ear plugs, gloves, masks) are in good condition and used when necessary
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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1.4 Harness is in safe, useable condition and being used correctly
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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1.5 X-II high vis is being worn when around moving equipment
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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2. Ladders
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2.1 The ladder is suitable for the task (step, extension, or platform ladder)
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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2.2 Workers are trained in Ladder Safety and are using ladders safely
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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2.3 Are performing tasks that do not affect the ladder stability (ie: no forceful exertions or sudden forces, not using equipment such as hammer drills, not overreaching while pulling something such as cable through conduit)
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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3. Manual Material Handling / Safe Lifting
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3.1 Workers are applying safe, ergonomic lifting techniques when carrying load
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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3.2 Workers are using carts/equipment for loads over 50lbs
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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4. Safe Behaviour
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4.1 No horseplay, rowdiness, practical jokes, fighting, running, sleeping
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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5. Safe Use of Equipment
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5.1 Worker is safely operating equipment
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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Elevated Work Platforms: Are there Elevated Work Platforms on site?
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5.2 Worker is tied off / harness is being used?
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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5.3 Operating the EWP in a safe manner
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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5.4 Worker is aware of avoiding hazards (ie: Grates, trenches, rails, overhead cranes)
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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6. Tools, Equipment, Materials
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6.1 Tools/Equipment right for the task at hand, used properly and in safe condition
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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6.2 Broken equipment is reported and suspended from use until repair is made
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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6.3 Broken tools are reported and destroyed/thrown out
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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6.4 Flammable materials are labelled, separated & stored in ventilated area
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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7. Electrical
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7.1 All employees have non-contact voltage tester and understand to check each circuit before starting work on it
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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7.2 Proper Lock Out/Tag Out is being used
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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7.3 Lock Out/Tag Out form is completed with each Lock Out/Tag Out occurrence
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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7.4 Can identify High Voltage area on job site
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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7.5 Working a safe distance from overhead conductors while on a ladder or other work platform
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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Extension Cords
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7.6 Only grounded extension cords in safe working condition are being used
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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8. Unrestricted / Uncongested Areas
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8.1 Stairs, walkways and evacuation routes are being kept clear of debris
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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9. Good Housekeeping / Orderly
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9.1 Work areas are being kept clean
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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10. Confined Spaces
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10.1 Are there confined spaces on site?
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10.2 Can identify confined spaces
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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10.3 Understands to stay out of confined spaces
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Hazard Rating (this condition could result):<br>HIGH-in fatality, permanent disability, expensive loss to property<br>MEDIUM-in serious injury or illness resulting in temporary disability & property damage<br>LOW-in minor injury or illness non disabling, non disruptive property damage
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Recommended corrective action to be taken (please include pictures)
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11. Safe Job Procedures
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11.1 What job task was observed?
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11.2 Was the task completed as per the Safe Job Procedure
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11.2.1 Did you confirm with employee that the Safe Job Procedure was followed?
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11.2.2 Did you review/re-train the employee with the Safe Job Procedure immediately? Another observation will need to take place on this task
12. Other
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Other:
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Please specify:
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Signature of Inspector:
