Liftow Monthly Workplace Safety Inspection - Rev.2.1 - 28-08-2020

• Site

• Conducted on (Date and Time)

  Date

• Inspected by

• Location
  Address

Cleanliness

• Is parking lot free of debris, excessive sand, ice, snow, etc.?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are spare pallets stacked neatly at designated location?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is scrap metal in its designated location?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are parking spaces clearly marked, lines and signs visible?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are building signs clean, in good repair, and clearly legible?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are service vehicles backed in to parking spots where able?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Customer Service

• Are guest parking spaces available (no employee parked in guest spaces)?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are "No Parking" zones free of vehicles and obstructions?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Emergency

• Are all fire routes/plans clearly posted, and meeting areas specified?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Lighting

• Is there emergency lighting in place, maintained and in working order, tested and documented?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lighting fixtures in good working order?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lighting fixtures clean, allowing for optimal lighting levels?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes, accessways, gangways, stairs, work areas and walkways sufficiently lit?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Sanitation Facilities

• Is potable water made available to workers for drinking, cooking, food preparation, worker health, and personal needs?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are non-potable water outlets clearly marked "NOT SAFE FOR HEALTH OR PERSONAL USE"?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are toilets clean, serviceable, and adequate in number at the worksite?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are handwashing facilities adjacent to each toilet facility and do they contain: hot and cold or lukewarm running water and soap, or waterless skin-cleansing agents; clean, single-use hand towels stored in a sanitary container, clean individual sections of continuous cloth toweling, or air blowers; and a sanitary means for disposing of single-use hand towels?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is there a schedule for servicing, cleaning, and supplying each facility in place?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is servicing, cleaning and supplying schedule being followed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are changing rooms available for workers to change into and from protective clothing to prevent contamination from hazardous or toxic substances?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide privacy for each gender?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide separate storage facilities for street clothes?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide separate storage for protective clothing?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are designated areas provided for the consumption or storing of food, beverages, and tobacco products? Are these areas free from exposure to toxic substances?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Sanitation Facilities

• Is potable water made available to workers for drinking, cooking, food preparation, worker health, and personal needs?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are non-potable water outlets clearly marked "NOT SAFE FOR HEALTH OR PERSONAL USE"?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are toilets clean, serviceable, and adequate in number at the worksite?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are handwashing facilities adjacent to each toilet facility and do they contain: hot and cold or lukewarm running water and soap, or waterless skin-cleansing agents; clean, single-use hand towels stored in a sanitary container, clean individual sections of continuous cloth toweling, or air blowers; and a sanitary means for disposing of single-use hand towels?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is there a schedule for servicing, cleaning, and supplying each facility in place?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is servicing, cleaning and supplying schedule being followed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are changing rooms available for workers to change into and from protective clothing to prevent contamination from hazardous or toxic substances?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide privacy for each gender?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide separate storage facilities for street clothes?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Do changing rooms provide separate storage for protective clothing?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are floors are clear of any obstructions, including cables and trip or slip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are floor mats in place as needed, to contain dirt and moisture?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes clearly marked “Exit,” as well as indicating the direction of travel to the exit, if not immediately apparent?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Ergonomics

• Office equipment such as monitors, chairs, keyboards, etc. are ergonomic and minimize worker strain?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lights in operational condition, covers in place, adequate light for office work?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Customer Service

• Ceiling tiles are in place and not broken, cabinet doors are closed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are floors are clear of any obstructions, including cables and trip or slip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are floor mats in place as needed, to contain dirt and moisture?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Ergonomics

• Office equipment such as monitors, chairs, keyboards, etc. are ergonomic and minimize worker strain?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lights in operational condition, covers in place, adequate light for office work?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Customer Service

• Ceiling tiles are in place and not broken, cabinet doors are closed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are floors are clear of any obstructions, including cables and trip or slip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are floor mats in place as needed, to contain dirt and moisture?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes clearly marked “Exit,” as well as indicating the direction of travel to the exit, if not immediately apparent?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are all outlets within "wet" areas appropriate GFCI outlets?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Sanitation Facilities

• Is potable water made available to workers for drinking, cooking, food preparation, worker health, and personal needs?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are non-potable water outlets clearly marked "NOT SAFE FOR HEALTH OR PERSONAL USE"?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are designated areas provided for the consumption or storing of food, beverages, and tobacco products? Are these areas free from exposure to toxic substances?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

First Aid

• Sufficient First Aid kits available - one appx. every 2 mins. walking distance?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• All kits are properly stocked in accordance with regulation 1101?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Signs posted, indicating the location of first aid station and kits?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• First aid equipment is available and inspected/maintained, including stretcher and AED?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Health and Safety Board

• SDS are available and accessible?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Employees are trained and holding a valid first aid/CPR/WHMIS/TDG certificate, and/or other training as required?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Members with a valid certification are posted on the Health & Safety board?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Eye Wash

• Emergency eyewash stations accessible, operational, clean, and unobstructed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Emergency shower stations accessible, operational, clean, and unobstructed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Fire Prevention Equipment

• Fire extinguishers readily available, properly located and installed - 1 every 25 metres of travel?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Fire prevention equipment is unobstructed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Equipment is clearly identified, with proper signage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Equipment is inspected monthly for condition, charge, operation?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are floors are clear of any obstructions, including cables and trip or slip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are floor mats in place as needed, to contain dirt and moisture?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes clearly marked “Exit,” as well as indicating the direction of travel to the exit, if not immediately apparent?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Ergonomics

• Office equipment such as monitors, chairs, keyboards, etc. are ergonomic and minimize worker strain?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lights in operational condition, covers in place, adequate light for office work?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Customer Service

• Ceiling tiles are in place and not broken, cabinet doors are closed?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Safety

• Are walkways and working surfaces clean and clear of debris?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes clearly marked “Exit,” as well as indicating the direction of travel to the exit, if not immediately apparent?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Racking

• Uprights properly secured (bolted)?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Uprights are free of structural damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Cross beams are free of structural damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Items are stored on an appropriate pallet that spans from front cross beam to rear cross beam?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Each section is clearly labelled an appropriate weight capacity, or a clearly marked sign stating the weight capacity for each section?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Materials do not exceed rated weight capacity per section?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Safety bars are in place

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Ergonomics

• Are heavy/bulky items within proper reach to prevent stain or injury?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Ladders/Carts

• Are step ladders/stools in good repair and free of damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are carts and dollies in good repair and free of damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the weight rating clearly marked on all ladders, carts, dollies, etc?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Walkways and Working Surfaces

• Are walkways and working surfaces clean and clear of debris?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are working surfaces kept dry, or are other protective measures in place that include absorbant, ice melt (salt), floor mats, etc?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are slippery conditions, such as snow and ice, eliminated in designated walkways and working surfaces?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are obstructions, such as fasteners, splinters, sharp edges, holes or loose boards eliminated from walkways and working surfaces?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are tools, materials, equipment, and other objects used during servicing or maintenance kept clear of walkways to allow for adequate passage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are hoses and electrical service cords positioned to prevent injury to workers or damage to the hoses and cords themselves (e.g., crossover planks, beneath grating, stowed overhead)?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes clearly marked “Exit,” as well as indicating the direction of travel to the exit, if not immediately apparent?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are passageways, walkways, and working surfaces kept clear of obstructions, debris, and steel shot or similar abrasives that may create a slipping hazard?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Lighting

• Is there emergency lighting in place, maintained and in working order, tested and documented?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lighting fixtures in good working order?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are lighting fixtures clean, allowing for optimal lighting levels?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are exit routes, accessways, gangways, stairs, work areas and walkways sufficiently lit?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Dust and Dirt Removal

• Is there a program in place and followed that prevents the accumulation of dust on floors, decks, and ledges, particularly outside of abrasive-blasting enclosures?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is sufficient ventilation in place to (1) provide good operator visibility, (2) prevent dust from settling and accumulating in the room, (3) reduce dust concentrations, and (4) prevent the escape of contaminants into adjacent work areas or the environment?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are dust residues cleaned at regular intervals and in areas that may be normally overlooked (e.g., overhead)?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are cleaning methods in place to minimize dust clouds, particularly where ignition sources are present?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are vacuum cleaners approved for dust collection onsite and used?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Electrical

• Electrical panels are clearly labelled, accessible, and power sources able to be locked out?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Electrical panels free of debris and obstruction within 1 metre?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• All electrical wiring/fixtures are covered, with no exposed wiring?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Vermin Control

• Is there a vermin control program in place that is maintained?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the work area constructed, equipped, and maintained to prevent the entrance or harborage of rodents, insects, and other vermin?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Control of Spills

• Is machinery and equipment clean and maintained regularly?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are drip pans and guards in place to catch possible spills?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Material Handling and Storage

• LPG and all other compressed gas cylinders are stored properly as per the applicable SDS?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are flammable and combustible substances, such as paint thinners, solvents, rags, scrap, and waste, being disposed of or stored in covered, fire-resistant containers at the end of each work shift, or when the job is completed, whichever occurs first?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Has gear and equipment, used for materials handling and rigging, been inspected for safety before each shift and at intervals throughout the shift? Is defective gear or equipment replaced or repaired?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are appropriate danger or caution signs in place to notify workers of possible hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are materials stored in their designated place and stacked to avoid fall or collapse?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Storage and Maintenance of Tools and Equipment

• Are tools inspected, cleaned and repaired regularly?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are damaged or worn tools removed from service?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are all fire extinguishers, electrical panels, eyewash stations, and safety showers inspected and tested routinely and kept in working order?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Waste Disposal

• Are there enough garbage cans in designated break areas and other locations where trash may accumulate? Are they big enough for the volume of waste?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are garbage cans constructed of noncorrosive, leak-proof, and easy to clean material, or are they disposable?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is there a schedule in place and followed for emptying garbage cans to prevent overfilling?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are garbage cans intended for disposing of food emptied daily and outfitted with solid tight-fitting covers?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Working at Heights

• "Fall Rescue Plan" is in place for working at heights, to safely and quickly retrieve a fallen/suspended worker?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Portable and fixed ladders in good condition, no broken parts or physical damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Man cage has proper PPE - chains/locks/gate - and is in good working condition, inspected annually and before each use?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Dock

• Are all warning lights outside of the dock working and of the correct colour?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the dock plate in good working condition?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the truck locking device working or is there an appropriate wheel chocking and truck disabling system in place?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Walkways and Work Surfaces

• Is the floor surface free of hazards (when not in use) such as; water, oil, dirt, slip and trip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the drain/grease trap functioning properly?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are the pressure washer and air hoses and accessories stored properly after use to prevent trip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the wash bay left clean and floor relatively dry between uses?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

SOP's

• Are non-slip work boots worn by workers using the wash bay?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are coveralls, gloves, safety glasses and face shields worn by workers using the wash bay?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Walkways and Working Surfaces

• Are floors and work surfaces clear of trip, cut, and slip hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the welding area free of all flammable and potentially explosive substances, such as; rags, oil, cardboard, paper, compressed gas cylinders (ex. LPG), aerosol cans, etc.?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

SOP's

• Are users of the equipment in the welding bay properly trained on its use?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is all mandated PPE (ex. welding mask, leather gloves, safety goggles, respirator) being used when working in the welding bay area?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Is the ventilation system maintained and functioning?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Battery crane/battery handling devices maintained, lock out procedures posted?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Battery changing procedure posted?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Proper PPE available - face shield, safety glasses, apron, gloves - and used in battery maintenance?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Walkways and Working Surfaces

• Is the floor and aisles clear of debris such as strapping, plastic wrap, and other hazards?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are all units properly tagged and in a designated location?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Are any units that do not fit completely inside a parking spot or work bay are sectioned off with appropriate pylons, caution tape, etc.?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Racking

• Uprights properly secured (bolted)?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Uprights are free of structural damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Cross beams are free of structural damage?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Items are stored on an appropriate pallet that spans from front cross beam to rear cross beam?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Each section is clearly labelled an appropriate weight capacity, or a clearly marked sign stating the weight capacity for each section?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Materials do not exceed rated weight capacity per section?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Safety bars are in place

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Investigations

• Are all accidents/incidents being investigated ?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Investigations are being carried out by both management and worker representatives?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Recommendations are being made and followed up on?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

• Incidents and near misses are documented and kept on file?

  Select 5 4 3 2 1 0 N/A

  • 5
  • 4
  • 3
  • 2
  • 1
  • 0
  • N/A

Completion

• Recommendations

• Full Name and Signature of the Inspector

  Sign

• Full Name and Signature of the Manager

  Sign