Information
Health and Safety Rep Observation Report (Complete Monthly)
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Date:
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Completed By:
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Lead Journeyman On Site:
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Employee(s) Observed:
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Job Site:
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Is the General Contractors Safety Board on site
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Provide picture of Safety Board
1. Personal Protective Equipment
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1.1 Proper head protection
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Proper eye protection
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Proper hearing protection
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Ear plugs not just set in outer ear
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.6 Proper hand protection (gloves)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.7 Proper respiratory protection
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.8 PPE in good condition
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.9 Harness worn correctly (straps, lanyards, snug enough, etc.)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.10 Harness CSA approved
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.11 Harness is in safe, usable condition
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.12 Tied off correctly to basket/platform of lift
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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1.13 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 The ladder can accommodate the weight being moved up or down, or being held on it
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 The ladder length will position the worker so they do not have to reach
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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2.4 The ladder has been maintained and is in safe working condition and used per the manufacturer's guidelines
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 / Portable Ladders:
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2.5 Is secured at the top and bottom
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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2.6 Is set up at a safe angle (1:4)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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2.7 Is set up with side rails against supporting surface (not the rung against the surface)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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2.8 If used for access/egress the length extends three rungs above the top of the supporting surface
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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Workers working on ladders
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2.9 Are trained in ladder safety
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Provide steps taken to correct the issue, includes pictures.
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2.10 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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Provide steps taken to correct the issue, includes pictures.
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2.11 Are climbing the ladder using both hands; facing the ladder
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Provide steps taken to correct the issue, includes pictures.
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2.12 Are standing keeping both feet on the ladder and able to receive or place materials/tools without reaching sideways beyond the side rails of the ladder, or below knee level, or lean backwards
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Provide steps taken to correct the issue, includes pictures.
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2.13 Are able achieve 3-point contact when standing and working on the ladder (ie: not holding large, awkward items that require both hands to hold)
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Provide steps taken to correct the issue, includes pictures.
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2.14 Are standing below a height of 3 metres
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Provide steps taken to correct the issue, includes pictures.
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2.15 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Worker carrying load close to core
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 No stooping or twisting; bending at knees with back straight
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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3.3 Appropriate size of load
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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3.4 Proper grip of load
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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3.5 Using sufficient rest & recover time between loads
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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3.6 Choosing to push load rather than pull
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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3.7 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Position for Task
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4.1 Body positioned for task
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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4.2 Using proper PPE for specific task
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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4.3 Proper footing for task
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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4.4 Proper balance for task
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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4.5 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Behaviour (No Horseplay)
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5.1 Safety meetings are being held
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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5.2 No horseplay, rowdiness, practical jokes, fighting, running, sleeping
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Does worker know & understand correct work procedure
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Safe Use of Equipment
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6.1 Familiar with the safe use of equipment
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Could worker spot damage
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Properly trained to operate equipment
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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Ariel Work Platforms
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6.4 Are there Ariel Work Platforms on site?
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6.5 Is Lift Kit available
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6.6 Has Daily Scissor Lift Checklist been completed?
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6.7 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Tools, Equipment, Materials
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7.1 Tools/Equipment right for the task at hand, used properly and in safe condition
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Cords on small tools safe
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Proper guards on equipment
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Tagging necessary items as DEFECTIVE
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Necessary PPE worn while using tools/equipment
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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7.6 Neatly and safely stacked
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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7.7 Flammable materials separated & stored in ventilated area
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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7.8 Materials properly stored & identified/labelled
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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7.9 Consumables are properly stored in containers
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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7.10 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Electrical
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8.1 All employees have non-contact voltage tester and understand to check each circuit before starting work on it
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.2 Proper Lock Out/Tag Out is being used
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.3 Lock Out/Tag Out form is completed with each Lock Out/Tag Out occurrence
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.4 Can identify High Voltage area on job site
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.5 Working a safe distance from overhead conductors while on a ladder or other work platform
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.6 Moving material/tools by hand or using hoisting equipment a safe distance from overhead power lines or live electrical equipment
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.7 Markings on ground to identify location of underground power lines/utilities prior to excavation
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.8 Equipment/vehicles being operated a safe distance from overhead power lines
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.9 Understands to stay clear of High Voltage area<br>(750V-150kV: stay 10' away; 150kV-250kV: stay 15' away; 250kV-550kV: stay 20' away)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.10 Generator is properly grounded
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.11 Electrical cords are properly grounded
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.12 Ground pins are not broken on electrical cords
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.13 Electrical cord connected power tools have double insulated casing
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.14 Equipment does not have any exposed electrical parts
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.15 Live switches and receptacles have necessary cover plates
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.15 Live switches and receptacles have necessary cover plates
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.15 Live switches and receptacles have necessary cover plates
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.15 Live switches and receptacles have necessary cover plates
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.10 Outdoor type is rated for over 300V
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.11 Safe condition of casing, ends, connections
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.12 GFCIs used where required
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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8.13 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Unrestricted / Uncongested Areas
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9.1 Steps are kept clean
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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9.2 No debris in walkways
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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9.3 Evacuation routes are clear
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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9.4 Individual job/work locations not interfering
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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9.5 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Good Housekeeping / Orderly
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10.1 Cables and cords not tangled
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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10.2 Tools are not cluttering walkways
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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 Equipment container used for specific equipment only
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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10.4 Work area kept clean
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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10.5 Clear access and landing
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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10.6 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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. Scaffolds / Guard Rails
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Are there scaffolds or guard rails on site?
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11.1 Can identify properly constructed guard rails
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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11.2 Can identify a safely built scaffold before use
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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11.3 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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12. Confined Spaces
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Are there confined spaces on site?
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12.1 Can identify confined spaces
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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12.2 Understands to stay out of confined spaces
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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12.3 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13. Trenches and Excavation
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Are there trenches or excavations on site?
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13.1 Trench properly sloped where required
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13.2 Excavated soil properly placed
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13.3 Appropriate shoring used
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13.4 Proper access to trench
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13.5 Proper storage of materials in and above trench
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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13.6 Other: (please specify)
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Hazard Rating:<br>HIGH-Condition resulting in fatality, permanent disability, expensive loss to property<br>MEDIUM-Serious injury or illness resulting in temporary disability & property damage<br>LOW-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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Signature of Inspector:
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