Title Page
Header
-
Date
-
Truck Number
-
Location
-
Risk assessment complete (both sides) and reviewed by all employees
-
Photo of front RA
-
Photo of back RA
-
Vehicle pretrip done, signed, dated.
-
Drivers log bookfilled out, signed, dated
-
Wheel chocks used
-
Confined space permit filled out
-
Work area protection adequate
-
Lock out tag out in place
-
Corrective actions for any NO answer above
PPE
-
CSA Approved hardhat worn properly
-
CSA Approved safety glasses with side shields
-
CSA Approved safety boots for electrical work, laced and tied
-
Hearing protection available/worn
-
Leather gloves worn/available
-
CSA Approved body belt properly worn, employee trained
-
CSA Approved fall arrest worn properly, employee trained
-
CSA Approved lanyard worn properly, employee trained
-
Climbers, gaffs & guards in place/worn
-
Rubber Insulating gloves worn properly, up to date
-
CSA Chainsaw chaps available and/or worn if needed
-
CSA Approved chain saw boot protectors worn/available
-
Respiratory protection worn if required, employee trained
-
Is flame retardant clothing required & worn if necessary
-
Is reflective clothing/ overalls worn
-
Corrective actions to any NO answers above
Tools and Equipment
-
What hand tools being used?
-
Good condition
-
What power tools being used?
-
Good condition
-
Extention cords not frayed, prongs not damaged
-
Lasher used/available
-
Are lights on truck not damged and operational?
-
Are ladders not damaged, 3 points of contact
-
Are scaffolds erected as per manufactures spec
-
Is a manhole being worked in? If so is a confined space plan in place?
-
Are power actuated tools being used, safe condition, employee trained
-
Is a confined space entry equipment required?
-
Are hazardous materials stored properly with labels & and does supervisor have up to date MSDS binder? Employees trained?
-
Is guard in place on chainsaw?
-
Are proper rigging practices being followed? Employees trained?
-
Is vehicle in a safe operating position? Are vehicles backed in to parking area?
-
Are items secured on vehicles?
-
Is general house keeping in good condition in vehicles and on site?
-
Corrective actions to any NO answer above
Safety Equipment
-
Has voltage tester been tested to ensure battery works?
-
Are enough traffic cones available, reflective tape on them and cones not damaged?
-
Back up warning device wofking on vehicle?
-
Corrective actions to any NO answer above
Emergency Equipment
-
Is a functioning communication device in place for the crew?
-
Is a complete enviromental spill kit on the vehicle? Do employees know where it is?
-
Is an up to date and complete vehicle binder in place?
-
Is the fire extinguisher - full, inspected, secured, and in designated place with decal?
-
First aid kit - full - who is trained, secured, designated location with decal
-
Pole top rescue kit - complete with sheath on knife.
-
Bucket evacuation kit - complete
-
Bucket rescue kit - complete
-
Corrective actions for any NO answer from above
Documents and certificates
-
MVI inspection up to date
-
Registration up to date
-
Vehicle insurance up to date
-
Drivers log book in vehicle and completed properly
-
Does supervisor have up to date MSDS? Do employees know what chemicals are on their vehicles?
-
Corrective actions for any NO answer from above.
Trailers
-
Fenders & mud flaps in good condition?
-
Light cord & socket working and in good condition
-
Do lights work properly?
-
Breakaway connections work?
-
Battery charged and working?
-
Tires, wheels, & nuts secured with good thread?
-
Safety chains & hooks available & in good condition.
-
Hitch in place & not damaged
-
Crank down legs in place & not damaged?
-
Bunks, supports & straps in place & not damaged
-
Arbours & saddles in place & not damaged
-
Collars & pins in place & not damaged
-
Corrective actions to any NO answer from above
Signatures
-
Observers signature
-
Employees/contractors signature
-
Employees/contractors signature
-
Employees/contractors signature
-
Employees/contractors signature
-
Employees/contractors signature