Keller Site Safety Assessment Report

• Conducted on

  Date

• Prepared by

• Job#/Site

• Location
  Address

• Personnel

1. Site Emergency Response

• 1.1 - Is site ERP posted for workers to reference?

  Yes

  No

  N/A

• 1.2 - Are emergency air horns located on site, how many?

  Yes

  No

  N/A

• 1.3 - Have fire extinguishers been inspected and within annual recertification? (Tags are to be initialed and updated)

  Yes

  No

  N/A

• 1.4 - Are first aid supply levels correct?

  Yes

  No

  N/A

• Equipment available on site:

  Select First Aid Kit Emergency Blankets (3) Water Eye Wash (spot use) Eye Wash Station (15 minute) Cell Phone(s) Two-Way Radios Advanced First Aid Station Stretcher

  • First Aid Kit
  • Emergency Blankets (3)
  • Water
  • Eye Wash (spot use)
  • Eye Wash Station (15 minute)
  • Cell Phone(s)
  • Two-Way Radios
  • Advanced First Aid Station
  • Stretcher

• 1.5 - Are First Aiders identified?

  Yes

  No

  N/A

• 1.6 - Have emergency procedures been tested?

  Yes

  No

  N/A

2. Site Mobilization and Set-up

• 2.1 - Is the appropriate company signage in place?

  Yes

  No

  N/A

• 2.2 - Muster Point has been identified and correct?

  Yes

  No

  N/A

• 2.3 - Is proper fuel storage location established and identified? (signage, containment, vented)

  Yes

  No

  N/A

• 2.4 - Site fencing is in place, secured to prevent upset, with established opening for access/egress?

  Yes

  No

  N/A

• 2.5 - Safety wall established to post required daily/weekly/monthly safety documentation?

  Yes

  No

  N/A

• 2.6 - Is Keller Safety Manual, Provincial OHS Guide and site SDS binder placed for open review by workers on site?

  Yes

  No

  N/A

3. Site WHMIS

• 3.1 - Sites SDS binder and documentation in place?

  Yes

  No

  N/A

• 3.2 - Materials are stored properly?

  Yes

  No

  N/A

• 3.3 - Are properly rated spill kits in place?

  Yes

  No

  N/A

4. Documentation

• 4.1 - Has Daily Safe Work Permit established?

  Yes

  No

  N/A

• 4.2 - Has Job Safety Analysis been established and has it been updated?

  Yes

  No

  N/A

• 4.3 - Have workers completed a Hazard Assessment for their task?

  Yes

  No

  N/A

• Additional Checklists and Permits Posted:

  Select Hot Work Critical Checklist Working at Heights Critical Checklist Fall Protection Rescue Equipment Critical Checklist Shallow Excavation, Boring, Drilling Critical Checklist Deep Excavation Critical Checklist Confined Space Checklist Tankfield Sump Entry Critical Checklist Critical Lifting Critical Checklist Heavy Equipment Lifting Critical Checklist Lock-Out/Tag-Out Critical Checklist Integrity of Critical Control Systems Critical Checklist Vacuum Truck Critical Checklist

  • Hot Work Critical Checklist
  • Working at Heights Critical Checklist
  • Fall Protection Rescue Equipment Critical Checklist
  • Shallow Excavation, Boring, Drilling Critical Checklist
  • Deep Excavation Critical Checklist
  • Confined Space Checklist
  • Tankfield Sump Entry Critical Checklist
  • Critical Lifting Critical Checklist
  • Heavy Equipment Lifting Critical Checklist
  • Lock-Out/Tag-Out Critical Checklist
  • Integrity of Critical Control Systems Critical Checklist
  • Vacuum Truck Critical Checklist

• 4.4 - Is Near Miss reporting promoted and posted in order to capture critical reporting?

  Yes

  No

  N/A

• 4.5 - Is weekly site inspection posted for workers to reference and review? (Date of inspection____________)

  Yes

  No

  N/A

• Select date

  Date

• 4.6 - Is weekly toolbox talk posted for workers to reference and review? (Date of meeting_____________)

  Yes

  No

  N/A

• Select date

  Date

• 4.7 - Can orientation of workers be confirmed and certifications kept as part of orientation records?

  Yes

  No

  N/A

• 4.8 - Is Weekly Reporting being sent in for review by Keller Safety department?

  Yes

  No

  N/A

5. Site Personnel

• 5.1 - Are workers using the proper PPE

  Yes

  No

  N/A

• Basic PPE Required:

  Select Hard Hat (CSA/ANS Approved) Safety Glasses / Overs / Side-shields (CSA Approved) Hi-vis Vest Gloves Work Boots (CSA Approved)

  • Hard Hat (CSA/ANS Approved)
  • Safety Glasses / Overs / Side-shields (CSA Approved)
  • Hi-vis Vest
  • Gloves
  • Work Boots (CSA Approved)

• Additional PPE and Safety Equipment Required (Tasked Based)

  Select Hearing Protection (85db Threshold) Sealed Eye Wear / Goggles 1/2 Mask Respirator (FIT Tested) Full Face Respirator (FIT Tested) Supplied Air Respirator (FIT Tested) Air Monitor Rescue Tripod Tyvek Clothing FRC Clothing

  • Hearing Protection (85db Threshold)
  • Sealed Eye Wear / Goggles
  • 1/2 Mask Respirator (FIT Tested)
  • Full Face Respirator (FIT Tested)
  • Supplied Air Respirator (FIT Tested)
  • Air Monitor
  • Rescue Tripod
  • Tyvek Clothing
  • FRC Clothing

• 5.2 - Are workers working safely? (Tool use / Handling materials)

  Yes

  No

  N/A

• 5.3 Have any Planned Job Observations been completed on any workers in the last 7-10 days?

  Yes

  No

  N/A

6. The Work Area

• 6.1 - Is the job site neat and organized? (Housekeeping/Material Storage)

  Yes

  No

  N/A

• 6.2 - Are site conditions for Slip / Trip / Falls being managed?

  Yes

  No

  N/A

• 6.3 - Is rebar on site protected properly? (Horizontal - mushroom caps / Vertical - impalement protection systems)

  Yes

  No

  N/A

• 6.4 - Are proper barricades/control zones erected with additional signage for hazardous work areas. (Trenches, overhead work, dust, noise)

  Yes

  No

  N/A

• 6.5 - Is there adequate base illumination for site, do workers have additional lighting as required for task?

  Yes

  No

  N/A

• 6.6 - Is there a safe location for workers to take a break?

  Yes

  No

  N/A

• 6.7 - Is drinking water available on site?

  Yes

  No

  N/A

• 6.8 - Are there clean and acceptable washroom facilities on site?

  Yes

  No

  N/A

7. Tools & Equipment

• 7.1 - Are tools in good condition and stored properly (guards in place, safe from damage)

  Yes

  No

  N/A

• 7.2 - Are tools being used as expected by manufacture? (Proper safe use, guards and aids in place)

  Yes

  No

  N/A

• 7.3 - Are proper documented equipment inspections being completed?

  Yes

  No

  N/A

• Equipment On Site:

  Select Aerial Work Platform Skid Steer Telehandler Mini Excivator Excivator Mobile Crane Vacuum Truck Other Heavy Equipment

  • Aerial Work Platform
  • Skid Steer
  • Telehandler
  • Mini Excivator
  • Excivator
  • Mobile Crane
  • Vacuum Truck
  • Other Heavy Equipment

• 7.4 - Are properly rated ladders used on site?

  Yes

  No

  N/A

• 7.5 - Are ladders properly erected, braced & anchored and extend 1 meter pas point of access/egress?

  Yes

  No

  N/A

• 7.6 - Are workers using ladders properly?

  Yes

  No

  N/A

• 7.7 - Are scaffolds tagged and within it inspection dates?

  Yes

  No

  N/A

• 7.8 - Are all expected scaffold components being used? (Sill plate, base secured, cross braces, pins, brackets, planks, toe boards, mid-rails, hand rails, ladder, anchors / outriggers)

  Yes

  No

  N/A

8. Underground Hazards

• 8.1 - Are valid First Calls / Locates in place for all activities taking place onsite?

  Yes

  No

  N/A

• 8.2 - Do equipment operators have copies of located with them in equipment?

  Yes

  No

  N/A

• 8.3 - Are all hazards marked and flagged?

  Yes

  No

  N/A

• 8.4 - Are proper excavation techniques used when digging around any underground line? (Hand expose / Hydrovac)

  Yes

  No

  N/A

• 8.5 - Are proper controls / cutback for sloping and ventilation in place?

  Yes

  No

  N/A

• 8.6 - Are establish access / egress points in place?

  Yes

  No

  N/A

• 8.7 - Are workers trained and certified for tasks involving ground disturbance?

  Yes

  No

  N/A

9. Confined Space

• 9.1 - Are valid rescue plans and equipment in place?

  Yes

  No

  N/A

• 9.2 - Is there proper ventilation and atmospheric testing in place?

  Yes

  No

  N/A

• 9.3 - Are proper control zones and signage in place?

  Yes

  No

  N/A

• 9.4 - Are workers properly trained and certified for Confined Space Entry and Monitor?

  Yes

  No

  N/A

Assessment Review Notes:

• Superintendent:

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• Site Safety Designate:

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• Add signature

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• Add signature

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