Information

  • Date

  • Branch

  • Job Site

  • Location
  • Safety Professional

  • Foreman

  • Superintendent

  • Consultant/GC/Architect

  • Crew Member Attending

  • Reported on Site With

  • Business Card/Contact Information Left Onsite

  • Last Evaluation Date

Job Details & Specific Details Of The Job At Time Of Evaluation

  • Details

Distribution

  • Doug Flynn

  • Regional VP

  • Branch Manager

  • Department Manager

  • Superintendent

  • Health & Safety Department

  • Foreman & Crew

Fire Prevention/ Fire Safety

  • Hotwork Permit on Site

  • Fire Extinguishers At Kettle - Two Per Kettle

  • Fire Extinguisher At Tanker - Two Per Tanker

  • Burn Kit At Kettle

  • Fire Extinguishers Fully Charged

  • Dry Powder Available

  • Water To Extinguish Fiber Board

  • Workers Trained in Extinguisher Use

  • Adequate Chemical Extinguishers

  • Extinguisher For Each Torch In Use (H2O)

  • Completed Fire Watch Forms Onsite

  • Heat Detector In Working Order

  • Torch Operators Trained

  • Other

Safety Response

  • First Aid Trained Persons On Site

  • First Aid Kits

  • Emergency Plan

  • Worker Aware Of Emergency Plan

  • Evacuation Muster Point

  • Emergency Phone List

  • Other

Vehicle Compliance (Applies to Commercial Vehicles & Trailers Onsite)

  • Vehicle Clean

  • Pre-Trip Inspection Complete (Circle Check)

  • Log Book Completed Properly

  • Valid Driver's License

  • Valid Insurance Card

  • Vehicle Registration<br>

  • Valid Commercial Vehicle License

  • Valid Inspection Sticker

  • Valid TDG Training

  • TDG Shipping Document Complete

Fall Protection

  • Guard Rails Properly Constructed

  • Guard Rails At Ladder Area

  • Guard Rails At Hoist Area

  • Guardrail At Garbage Chute

  • Perimeter Warning System in Place

  • Openings Guarded or Secured Properly

  • Anchors Adequate for Current Use

  • Swing Fall Hazard

  • Lanyard Condition

  • Lifeline Condition

  • Fall Pro Emergency Plan

  • Use of Travel Arrest/Restraint

  • Other

Site Access

  • Adequate Ramps

  • Adequate Access/Egress

  • Clean Level Ground

  • Kettle/Tanker Away From Air Intakes

  • Other

Housekeeping

  • Clear Walkways

  • Clear Work Areas

  • Clean Flynn Vehicle

  • Clear Access & Landing

  • Garbage & Debris Cleaned Up

  • Other

Personal Protective Equipment

  • Head Protection

  • Foot Protection

  • Eye & Face Protection

  • Hearing Protection

  • Hand Protection

  • Hi-Vis Outerwear

  • Other

Ladders

  • Properly Secured Top & Bottom

  • Proper Angle 1:4

  • Proper Size & And Type

  • Safe Usable Condition

  • Properly Used

  • Other

Power Hand Tools & Equipment

  • General Condition

  • Proper Guards

  • Use Defective Tags

  • Other

Hoisting/Lifting Equipment

  • Daily And Annual Inspections Done

  • Lift Zone Controlled

  • Sufficient Counterweights Properly Secured

  • Verify Operator Training

  • Verify Two Way Communication

  • Manufacture's load capacity & operating instructions posted on equipment

  • Other

Worker Equipment Training

  • Suspended Access Equipment Training

  • Scissor Lift Training

  • Zoom Boom Training

  • JLG/Genie Lift Training

  • Forklift Training

  • Power/Manual Suction Cup Training

  • Spyder Crane Training

  • Other Lift Equipment

Daily Equipment Checklists

  • Swing Stage

  • Scissor Lift

  • Zoom Boom

  • JLG/Genie Lift

  • Forklift

  • Scaffold

  • Power/Manual Suction Cups

  • Spyder Crane

  • Hoisting Equipment

  • Other

Compressed Gas Cylinders

  • Properly Located

  • Properly Secured/Guarded

  • Properly Lifted/Moved

  • Gauges, Hoses And Regulators Condition

  • Adequate Distance From Open Flame

  • Other

Flammable Liquids

  • Approve Containers

  • Properly Labeled (WHMIS)

  • Properly Stored

  • Other

Kettle/Tankers

  • Kettle Properly Set Up (Level & Stable)

  • Gauges, Hoses, Regulators, Burners, Condition

  • No Leaks On Hot Pipe And Fuel Line

  • Hot Pipe Discharge Secured Against Slipping

  • Lid Closing And Opening Properly

  • Tires, Towing Hitch And Chains Condition

  • Lid And Spigot Able To Be Secured At Night

  • Kettle Attended At All Times (While Operating)

  • Proper PPE - Face, Hand & Clothing

  • Located At Least 25 Feet From Combustibles

  • 2 - ABC Dry Chem Fire Extinguisher Located By Kettle

  • Fire Powder Readily Available

  • All Application/Dispensing Equipment In Good Condition

  • Roof Top Kettle Copy Safe Work Procedure

  • Other

Conveyors

  • Proper Setup

  • Maintain According To Manufacturer Spec

  • Trained Operators

  • Perimeter Guards In Place

  • Other

Material Storage

  • Safely Stacked and Secured

  • Properly Bundled or Containerized

  • Properly Located

  • Properly Labeled (WHMIS)

  • Other

Chutes

  • Adequately Constructed

  • Properly Fastened And Secured

  • Wheel Stop At Entrance

  • Other

Worker Education

  • Flynn Canada Education

  • WHMIS Trained

  • Aware Of H&S Committee And Worker Representative

  • Orientated With Injury/Hazard Reporting

  • Orientated On Provincial Construction Regulations

  • Propane Safety Training - Kettle Operators All

  • Supervisory Training

  • Other

Site Collateral Material

  • Provincial Construction Regulation On Site

  • MSDS Sheets On Site/Worker Access

  • Safety Manual On Site

  • Management Completed Site Inspection Form

  • Injury Passport

  • Washroom/Lunch Area Cleanliness

  • Weekly Safety Talk

  • Fall Protection Plan Complete

  • Work Site Hazard Assessment

  • FLRA Completed

  • Material Securement Checklist

  • Other

Re-Roofing Risk Management

  • Client Letter (Template)

  • Site Visit With Super - Client

  • Checklist Completed With Client C/W Photo

  • Verify Foremen Involvement In Process

  • Other

Public/Worker Way Protection

  • Covered Where Required

  • Proper Delineation - Public/Other Trades

  • Proper Protection Around Equipment/Materials

  • Warning Signs

  • Proper Lighting Where Required

  • Ground Setup Isolated (Fencing)

  • Other

First Aid Requirements

  • Adequate First Aiders On Site

  • Adequate Number of First Aid Kits

  • Adequate Contents in Kits & Reports

  • Other

Electrical Hazards

  • Ladder/Work Access Proper Distance From Power Lines

  • Inspection Of Underside Of Roof For Electrical Conduits

  • Tools & Equipment Proper Distance From Power Lines

  • A) Prior To Using Fasteners And Or

  • B) Cutting Roof Deck For Curbs/Cones Etc.

  • Other

Totals

  • Red Category - Major Issue

  • Yellow Category - Moderate Issue

  • Blue Category - Minor Issue

  • Follow-up Required

Review

  • Site Supervisor/Forman

  • Health & Safety

  • Superintendent

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.