HVC Work Site Inspection

• Document No.

• Department:

• Conducted on

  Date

• Prepared by

• Location
  Address

• Job description

• Employees at work site:

• Supervisor:

PPE Requirements

• All employees in work area wearing the proper gloves for their job?

  Safe

  At Risk

  N/A

• All employees in the area wearing the appropriate eye protection?

  Yes

  No

• All employees in the area wearing the proper steel toe boots?

  Yes

  No

• All employees in the area wearing the proper Hi-vis clothing?

  Yes

  No

• Any employees wearing respirators?

Employee respiratory protection

• Respirator required?

  Safe

  At Risk

  N/A

• Employee fit tested?

  Safe

  At Risk

  N/A

• Proper cartridge for the job hazard?

  Safe

  At Risk

  N/A

Vehicles and Mobile Equipment

Fire extinguisher

• Vehicle fire extinguisher

Fire extinguisher

• Inspection Current?

  Yes

  No

  N/A

• Appropriate type for hazard?

  Yes

  No

  N/A

• Mounted with ease of access in mind?

  Yes

  No

  N/A

Logbooks

• Vehicle logbook

Vehicle/Equipment Logbook

• Logbook present in vehicle/Equipment

  Yes

  No

  N/A

• Filled out for Date of Audit?

  Yes

  No

  N/A

• Repair requests followed up?

  Safe

  At Risk

  N/A

• Consistent use?

  Yes

  No

  N/A

Wheel Chocks

• Wheel Chocks for vehicles over 7000kg GVW

Vehicle/equipment wheel chocks

• Wheel Chocks present for vehicle/equipment?

  Yes

  No

  N/A

• Parked vehicle has Chocks in place?

  Yes

  No

  N/A

• Chocks are appropriate for vehicle size?

  Yes

  No

  N/A

Presence Indicators

• Presence indicators

Amber lights and buggy whips

• Amber light in place?

  Yes

  No

• Amber light functional?

  Yes

  No

• Buggy whip present?

  Yes

  No

  N/A

• Buggy whip flag conforms to HVC requirements?

  Yes

  No

  N/A

General work area

• Work area status?

Worksite

• Location Description

• Fire extinguishers in area inspected?

  Yes

  No

  N/A

• Travel/walk ways clear of tripping hazards?

  Safe

  At Risk

  N/A

• Acess/Egress of work area clear?

  Safe

  At Risk

  N/A

Materials Storage

• Sprays cans/Flammables in use?

Spray cans/fuels/WHMIS

• Flammables and spray cans stored appropriately?

  Safe

  At Risk

  N/A

• Decanted products have workplace labels?

  Safe

  At Risk

  N/A

• Fuel containers stored and labeled appropriately?

  Safe

  At Risk

  N/A

• MSDS Sheets available for products on site?

  Safe

  At Risk

  N/A

Lifting devices and rigging

• Slings in use?

Slings

• Inspection tags present?

  Yes

  No

• Obvious wear or damage?

  Safe

  At Risk

  N/A

• Lifting devices in use?

Lifting devices

• Rating stamped/marked on device?

  Safe

  At Risk

  N/A

• Obvious damage to device?

  Yes

  No

  N/A

• Device engineered/designed for purpose?

  Safe

  At Risk

  N/A

Electrical Safety

• Extension cords in area/use?

Extension Cords

• In good condition?

  Yes

  No

• Used for permanent wiring?

  No

  Yes

Barriers

• Control zones/guarding in place?

Control Zones

• Hazard area/ control zone marked appropriately?

  Safe

  At Risk

  N/A

• Barrier conforms to policy 4.23?

  Yes

  No

• Barrier tags are in place?

  Yes

  No

  N/A

Tools

• Hand tools in use?

Hand tools

• Tools in good condition?

  Yes

  No

• Required guards in place?

  Safe

  At Risk

  N/A

• Any obvious modifications to tools?

  Safe

  At Risk

  N/A

Confined Space

• Confined space entry in progress?

Confined space entry

• Entry space on current registry?

  Yes

  No

• Permit in Place?

  Yes

  No

• Employees trained for entry?

  Yes

  No

• Gas Detection appropriate for entry?

  Safe

  At Risk

  N/A

• Rescue plan in place?

  Safe

  At Risk

  N/A

• Rescue plan achievable?

  Yes

  No

  N/A

• Security notified of entry?

  Yes

  No

• Ventilation system appropriate for entry?

  Yes

  No

  N/A

• Barrier in place when space unoccupied?

  Yes

  No

Fall Protection

• Fall protection required?

Fall Protection equipment

• Pre-use inspection completed?

  Yes

  No

  N/A

• Employee trained in use?

  Yes

  No

• Equipment appropriate for job?

  Safe

  At Risk

  N/A

• Rescue plan in place?

  Safe

  At Risk

  N/A

Lock Out

• Lock out in use?

Energy Source Lockout

• Supervisor locked out on source?

  Safe

  At Risk

  N/A

• All employees on job Locked out?

  Yes

  No

  N/A

• Employees are aware of procedure?

  Safe

  At Risk

  N/A

• Employees have individual tags?

  Yes

  No

• Lock out tags conform to mines code requirements?

  Yes

  No

Excavations

• Active or present excavation?

Trenching and Excavations

• The manager shall ensure that no person enters any
  excavation over 1.2 m in depth unless
  (1) the sides of the excavation are sloped to a safe
  angle not exceeding 3 horizontal to 4 vertical
  
  4.17.10 A ladder shall be kept in the immediate area of persons
  working in any excavation over 1.2 m deep.

• Escape Ladder in place near employees?

  Safe

  At Risk

  N/A

• Trench walls appear to be at a slope ration of 3:4 or better?

  Yes

  No

Hot Work

• Hot work in progress?

Hot work area

• Fire watch person present?

  Yes

  No

• Extinguishing equipment available and in good shape?

  Yes

  No

• All area combustibles removed or guarded?

  Yes

  No

  N/A

• Permit in place?

  Yes

  Waiting for Supervisor

High Risk Activity

• Any high risk activity?

Work Area

• Overhead Hazards?

  Safe

  At Risk

  N/A

• Parts stored securely?

  Safe

  At Risk

  N/A

• Potential energy sources secured?

  Safe

  At Risk

  N/A

• Are there any activities that could affect persons in area not working on this job?

  Safe

  At Risk

  N/A

FLRA

• Is a full FLRA required for this job?

FLRA

• Full FLRA completed and signed off by supervisor?

  Yes

  No

  N/A

• All employees aware of hazards and controls?

  Yes

  No

• Are controls effective?

  Yes

  No

  N/A

Pocket FLRA

• Is a pocket FLRA required for this job?

Pocket FLRA

• Pocket FLRA filled out?

  Yes

  No

• Are controls effective?

  Yes

  No

  N/A

• Has supervisor signed pocket FLRA?

  Yes

  Waiting for Supervisor

General Comments