Ground Worksite Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Employee(s):

• The assessor(s) believe the information contained within this site risk assessment report to be correct at the time of printing. The assessor(s) do not accept any responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the assessors during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made.

• Information on the latest workers compensation and OHS laws can be found at the relevant province (WorkSafeBC or WorkSafeAB).

• Confidentiality Statement:
  In order to maintain the integrity and credibility of the risk assessment/hazard assessment process and to protect the parties involved, it is understood that the assessors will not divulge to unauthorized persons any information obtained during this risk assessment unless legally obligated to do so.

Documentation

• Pre-Trip

  Yes

  No

  N/A

• Hazard Assessment (Controls Implemented)?

  Yes

  No

  N/A

• Safety Tickets

  Yes

  No

  N/A

• Relevant Procedures

  Yes

  No

  N/A

• Relevant MSDS

  Yes

  No

  N/A

Supplies & Safety Equipment

• Equipment Grounded

  Yes

  No

  N/A

• All Hoses Pressure Tested, Stamped & Certified

  Yes

  No

  N/A

• Fluid Security (Ratchet Strapped, Cotter Pins, Velcro Straps)

  Yes

  No

  N/A

• Trailer Security (Weight Distribution, Ratchet Straps)

  Yes

  No

  N/A

• Spill Trays

  Yes

  No

  N/A

• First Aid Kits / Fire Extinguisher (Stocked & Readily Available)

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hats Worn As Required

  Yes

  No

  N/A

• Additional PPE Worn As Required

  Yes

  No

  N/A

Policies Understood / Communicated

• Radio Use & Emergency Communication Information Available

  Yes

  No

  N/A

• Emergency Evacuation Plan Communicated to Workers

  Yes

  No

  N/A

• Workers Have Partners or Following Working Alone Policy

  Yes

  No

  N/A

• Smoking in Designated Areas Only

  Yes

  No

  N/A