Information
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Date
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Branch
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Job Site
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Location
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Safety Professional
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Foreman
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Superintendent
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Consultant/GC/Architect
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Crew Member Attending
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Reported on Site With
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Business Card/Contact Information Left Onsite
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Last Evaluation Date
Job Details & Specific Details Of The Job At Time Of Evaluation
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Details
Distribution
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Doug Flynn
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Regional VP
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Branch Manager
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Department Manager
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Superintendent
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Health & Safety Department
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Foreman & Crew
Fire Prevention/ Fire Safety
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Hotwork Permit on Site
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Workers Trained in Extinguisher Use
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Fire Extinguishers Fully Charged
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Adequate Chemical Extinguishers
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Torch Operators Trained
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Other
Safety Response
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First Aid Trained Persons On Site
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First Aid Kits
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Emergency Plan
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Worker Aware Of Emergency Plan
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Evacuation Muster Point
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Emergency Phone List
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Other
Vehicle Compliance (Applies to Commercial Vehicles & Trailers Onsite)
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Vehicle Clean
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Pre-Trip Inspection Complete (Circle Check)
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Log Book Completed Properly
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Valid Driver's License
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Valid Insurance Card
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Vehicle Registration <br>
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Valid Commercial Vehicle License
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Valid Inspection Sticker<br>
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Valid TDG Training
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TDG Shipping Document Complete
Fall Protection
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Guard Rails Properly Constructed
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Guard Rails At Ladder Area
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Guard Rails At Hoist Area
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SRL Condition/Certification
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Perimeter Warning System in Place
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Openings Guarded or Secured Properly
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Anchors Adequate for Current Use
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Swing Fall Hazard
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Lanyard Condition
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Lifeline Condition
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Use of Travel Arrest/Restraint
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Fall Pro Emergency Plan
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Other
Site Access
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Clean Level Ground
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Adequate Access/Egress
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Other
Housekeeping
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Clear Walkways
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Clear Work Areas
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Garbage & Debris Cleaned Up
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Clear Access & Landing
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Other
Personal Protective Equipment
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Head Protection
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Foot Protection
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Eye & Face Protection
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Hearing Protection
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Hand Protection
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Hi-Vis Outerwear
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Other
Ladders
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Properly Secured Top & Bottom
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Proper Angle 1:4
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Proper Size & And Type
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Safe Usable Condition
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Properly Used
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Other
Power Hand Tools & Equipment
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General Condition
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Proper Guards
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Use Defective Tags
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Other
Hoisting/Lifting Equipment
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Manufacture's load capacity & operating instructions posted on equipment
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Daily And Annual Inspections Done
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Verify Operator Training
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Sufficient Counterweights Properly Secured
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Lift Zone Controlled
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Verify Two Way Communication
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Other
Worker Equipment Training
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Suspended Access Equipment Training
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Scissor Lift Training
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Zoom Boom Training
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JLG/Genie Lift Training
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Forklift Training
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Power/Manual Suction Cup Training
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Spyder Crane Training
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Other Lift Equipment
Daily Equipment Checklists
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Swing Stage
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Scissor Lift
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Zoom Boom
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JLG/Genie Lift
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Scaffold
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Power/Manual Suction Cups
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Spyder Crane
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Hoisting Equipment
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Forklift
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Other
Material Storage
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Safely Stacked and Secured
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Properly Bundled or Containerized
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Properly Located
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Properly Labeled (WHMIS)
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Other
Worker's Education
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Other
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WHMIS Trained (site specific)
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Flynn Canada Orientation
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Aware of H&S Committee and Worker Representative
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Orientated on Injury/Hazard Reporting
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Oriented on Provincial Construction Regulations
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Supervisory Training
Site Collateral Material
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Provincial Construction Regulation On Site
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MSDS Sheets On Site/Worker Access
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Safety Manual On Site
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Warning Signs
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FLRA Completed
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Material Securement Checklist
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Injury Passport
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Washroom/Lunch Area Cleanliness
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Weekly Safety Talk
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Work Site Hazard Assessment
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Other
Public/Worker Protection
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Covered Where Required
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Proper Delineation - Public/Other Trades
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Proper Protection Around Equipment/Materials
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Proper Lighting Where Required
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Ground Setup Isolated (Fencing)
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Other
First Aid Requirements
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Adequate First Aiders On Site
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Adequate Number of First Aid Kits
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Adequate Contents in Kits & Reports
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Other
Electrical Hazards
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Ladder/Work Access Proper Distance From Power Lines
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Tools & Equipment Proper Distance From Power Lines
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Other
Totals
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Red Category - Major Issue
- 0
- 1
- 2
- 3
- 4
- 5
- 6
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Yellow Category - Moderate Issue
- 0
- 1
- 2
- 3
- 4
- 5
- 6
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Blue Category - Minor Issue
- 0
- 1
- 2
- 3
- 4
- 5
- 6
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Follow-up Required
Review
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Site Supervisor/Forman
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Health & Safety
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Superintendent
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