Information

Health and Safety Rep Observation Report (Complete Monthly)

  • Date:

  • Completed By:

  • Lead Journeyman On Site:

  • Employee(s) Observed:

  • Job Site:

  • Is the General Contractors Safety Board on site

  • Provide picture of Safety Board

1. Personal Protective Equipment

  • 1.1 Proper head protection

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.2 Proper foot protection

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.3 Proper eye protection

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.4 Proper hearing protection

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.5 Ear plugs not just set in outer ear

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.6 Proper hand protection (gloves)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.7 Proper respiratory protection

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.8 PPE in good condition

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.9 Harness worn correctly (straps, lanyards, snug enough, etc.)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.10 Harness CSA approved

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.11 Harness is in safe, usable condition

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.12 Tied off correctly to basket/platform of lift

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 1.13 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

2. Ladders

  • 2.1 The ladder is suitable for the task (step, extension, or platform ladder)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.2 The ladder can accommodate the weight being moved up or down, or being held on it

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.3 The ladder length will position the worker so they do not have to reach

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.4 The ladder has been maintained and is in safe working condition and used per the manufacturer's guidelines

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

Extension / Portable Ladders:

  • 2.5 Is secured at the top and bottom

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.6 Is set up at a safe angle (1:4)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.7 Is set up with side rails against supporting surface (not the rung against the surface)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 2.8 If used for access/egress the length extends three rungs above the top of the supporting surface

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

Workers working on ladders

  • 2.9 Are trained in ladder safety

  • Provide steps taken to correct the issue, includes pictures.

  • Add media

  • 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)

  • 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

  • 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

  • Provide steps taken to correct the issue, includes pictures.

  • Add media

  • 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)

  • Provide steps taken to correct the issue, includes pictures.

  • Add media

  • 2.14 Are standing below a height of 3 metres

  • Provide steps taken to correct the issue, includes pictures.

  • Add media

  • 2.15 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

3. Manual Material Handling / Safe Lifting

  • 3.1 Worker carrying load close to core

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.2 No stooping or twisting; bending at knees with back straight

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.3 Appropriate size of load

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.4 Proper grip of load

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.5 Using sufficient rest & recover time between loads

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.6 Choosing to push load rather than pull

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 3.7 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

4. Safe Position for Task

  • 4.1 Body positioned for task

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 4.2 Using proper PPE for specific task

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 4.3 Proper footing for task

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 4.4 Proper balance for task

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 4.5 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

5. Safe Behaviour (No Horseplay)

  • 5.1 Safety meetings are being held

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 5.2 No horseplay, rowdiness, practical jokes, fighting, running, sleeping

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 5.3 Does worker know & understand correct work procedure

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 5.4 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

6. Safe Use of Equipment

  • 6.1 Familiar with the safe use of equipment

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 6.2 Could worker spot damage

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 6.3 Properly trained to operate equipment

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

Ariel Work Platforms

  • 6.4 Are there Ariel Work Platforms on site?

  • 6.5 Is Lift Kit available

  • 6.6 Has Daily Scissor Lift Checklist been completed?

  • 6.7 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

7. Tools, Equipment, Materials

  • 7.1 Tools/Equipment right for the task at hand, used properly and in safe condition

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.2 Cords on small tools safe

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.3 Proper guards on equipment

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.4 Tagging necessary items as DEFECTIVE

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.5 Necessary PPE worn while using tools/equipment

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.6 Neatly and safely stacked

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.7 Flammable materials separated & stored in ventilated area

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.8 Materials properly stored & identified/labelled

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.9 Consumables are properly stored in containers

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 7.10 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

8. Electrical

  • 8.1 All employees have non-contact voltage tester and understand to check each circuit before starting work on it

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.2 Proper Lock Out/Tag Out is being used

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.3 Lock Out/Tag Out form is completed with each Lock Out/Tag Out occurrence

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.4 Can identify High Voltage area on job site

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.5 Working a safe distance from overhead conductors while on a ladder or other work platform

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.6 Moving material/tools by hand or using hoisting equipment a safe distance from overhead power lines or live electrical equipment

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.7 Markings on ground to identify location of underground power lines/utilities prior to excavation

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.8 Equipment/vehicles being operated a safe distance from overhead power lines

  • 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

  • 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)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.10 Generator is properly grounded

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.11 Electrical cords are properly grounded

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.12 Ground pins are not broken on electrical cords

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.13 Electrical cord connected power tools have double insulated casing

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.14 Equipment does not have any exposed electrical parts

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.15 Live switches and receptacles have necessary cover plates

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.15 Live switches and receptacles have necessary cover plates

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.15 Live switches and receptacles have necessary cover plates

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.15 Live switches and receptacles have necessary cover plates

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

Extension Cords

  • 8.10 Outdoor type is rated for over 300V

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.11 Safe condition of casing, ends, connections

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.12 GFCIs used where required

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 8.13 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

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9. Unrestricted / Uncongested Areas

  • 9.1 Steps are kept clean

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 9.2 No debris in walkways

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 9.3 Evacuation routes are clear

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 9.4 Individual job/work locations not interfering

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 9.5 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

10. Good Housekeeping / Orderly

  • 10.1 Cables and cords not tangled

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 10.2 Tools are not cluttering walkways

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 10.3 Equipment container used for specific equipment only

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 10.4 Work area kept clean

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 10.5 Clear access and landing

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 10.6 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

11. Scaffolds / Guard Rails

  • Are there scaffolds or guard rails on site?

  • 11.1 Can identify properly constructed guard rails

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 11.2 Can identify a safely built scaffold before use

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 11.3 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

12. Confined Spaces

  • Are there confined spaces on site?

  • 12.1 Can identify confined spaces

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 12.2 Understands to stay out of confined spaces

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 12.3 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

13. Trenches and Excavation

  • Are there trenches or excavations on site?

  • 13.1 Trench properly sloped where required

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 13.2 Excavated soil properly placed

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 13.3 Appropriate shoring used

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 13.4 Proper access to trench

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 13.5 Proper storage of materials in and above trench

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • 13.6 Other: (please specify)

  • 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

  • Recommended corrective action to be taken (please include pictures)

  • Add media

  • Signature of Inspector:

  • Copies to:

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.