Maple Reinders Worksite Safety Inspection Form

• Document No.

• Project Name and Project Number

• Conducted on

  Date

• Conducted by

• Location
  Address

• Personnel

General

• Safety Policy - Current, Posted

  Yes

  No

  N/A

• Safety Manual - Current, Available

  Yes

  No

  N/A

• OHS Regulations Available

  Yes

  No

  N/A

• Safety Data Sheets Current, Available

  Yes

  No

  N/A

• Emergency Response Plan Posted

  Yes

  No

  N/A

• Minutes of Last Safety Meeting Posted

  Yes

  No

  N/A

• Hazard Assessments Posted

  Yes

  No

  N/A

• Last Worksite Inspection Report Posted

  Yes

  No

  N/A

First Aid (F/A)

• First Aid Location Clearly Posted

  Yes

  No

  N/A

• First Aid Kits Available / Properly Stocked/Inspected

  Yes

  No

  N/A

• First Aider List - Posted, Current

  Yes

  No

  N/A

• Adequate First Aiders on Site

  Safe

  At Risk

  N/A

• Eyewash Station Installed/Clean/Current

  Yes

  No

  N/A

• Required F/A Equipment Available/Useable

  Yes

  No

  N/A

Housekeeping

• General Site Appearance - Neat/Organized

  Safe

  At Risk

  N/A

• Lighting Conditions Adequate

  Safe

  At Risk

  N/A

• Waste Correctly Stored in Debris Containers

  Safe

  At Risk

  N/A

• Lack of Trip/Slip Hazards

  Safe

  At Risk

  N/A

• Nails Removed from Lumber/Concrete

  Safe

  At Risk

  N/A

• No Food or Wrappers left on site

  Safe

  At Risk

  N/A

Access & Egress

• Clear Walkways & Passageways

  Safe

  At Risk

  N/A

• Easy Access & Egress from all work areas

  Safe

  At Risk

  N/A

• Icy Travel areas sanded/salted

  Safe

  At Risk

  N/A

• Ramps at Safe Angle, Correct Width and Cleated

  Safe

  At Risk

  N/A

• Tripping Hazards clearly marked

  Safe

  At Risk

  N/A

• Appropriate Signage Posted

  Yes

  No

  N/A

Fire Protection

• Correct Number and Class of Fire Extinguishers

  Yes

  No

  N/A

• Fire Extinguishers Charged

  Safe

  At Risk

  N/A

• Fire Extinguishers Inspected by Technician with Last 12 Months

  Safe

  At Risk

  N/A

• Fire Extinguisher Inspected Monthly

  Safe

  At Risk

  N/A

• Extinguishers Correctly Located/Marked

  Yes

  No

  N/A

• Flammable Material Stored Correctly

  Safe

  At Risk

  N/A

• Emergency Access to Site Clear

  Safe

  At Risk

  N/A

Tools / Mobile Equipment

• In Good Condition

  Yes

  No

  N/A

• Safe Guards in Good Condition / In place / Being Used

  Safe

  At Risk

  N/A

• Defective Tools / Equipment Tagged/Locked out

  Yes

  No

  N/A

• Correct Tools available for Task at hand

  Yes

  No

  N/A

• Tools Stored Correctly

  Safe

  At Risk

  N/A

• Compressed Gas Regulators in Good Condition

  Safe

  At Risk

  N/A

• Compressed Gas Cylinders Stored Correctly

  Yes

  No

  N/A

• Equipment Inspection Current

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Fall Arrest - harness/lanyards safety to use

  Yes

  No

  N/A

• Fall Arrest Equipment Used Correctly

  Safe

  At Risk

  N/A

• Workers using fall arrest possess formal training

  Yes

  No

  N/A

• Appropriate Hard Hat (CSA/ANSI) Used

  Yes

  No

  N/A

• Proper Foot in use/Condition

  Yes

  No

  N/A

• Appropriate Hearing Protection Available

  Yes

  No

  N/A

• Appropriate Hearing Protection Used

  Safe

  At Risk

  N/A

• Appropriate Safety Eyewear in Use

  Safe

  At Risk

  N/A

• Appropriate Respirator Protection Available

  Yes

  No

  N/A

• Appropriate Respiratory Protection Use Correctly

  Safe

  At Risk

  N/A

• Fit Testing Records available for all employees using respiratory protection

  Yes

  No

  N/A

• Appropriate Gloves Available/ In Use

  Safe

  At Risk

  N/A

• High Visibility Vest Available/In Use

  Safe

  At Risk

  N/A

Hygiene

• Trailer/Lunch Room is Clean

  Yes

  No

  N/A

• Adequate Toilet Facilities Available, Serviced Recently, Sanitary

  Yes

  No

  N/A

• Appropriate Clean up Facilities Available

  Yes

  No

  N/A

Ladders

• All Ladders in good Condition

  Yes

  No

  N/A

• All Ladders Secured Top and Bottom/On Solid Ground

  Yes

  No

  N/A

• Top and Bottom of Ladder Clear of Obstructions

  Yes

  No

  N/A

• Ladder extends past platform by at least 3 rungs

  Yes

  No

  N/A

• All ladders being used correctly

  Safe

  At Risk

  N/A

Barricades

• Floor/ Shaft Openings Covered/ Barricaded Correctly

  Yes

  No

  N/A

• Guard Rails in Place.<br><br>Includes Toeboard

  Yes

  No

  N/A

• Sleeve Holes Covered

  Yes

  No

  N/A

• Appropriate Warning Signs Posted

  Yes

  No

  N/A

• Barricade Tape Used Correctly

  Yes

  No

  N/A

Electrical

• Electrical Cords in Good Condition/Neat

  Yes

  No

  N/A

• Electrical Panels in Good Condition

  Yes

  No

  N/A

• GFI working

  Yes

  No

  N/A

• Appropriate Lock Out in Place

  Yes

  No

  N/A

• All Tools Double Insulated or Grounded

  Yes

  No

  N/A

• Plugs/Switches/Disconnect in Good Repair

  Yes

  No

  N/A

• Signage/Barricades Appropriate

  Yes

  No

  N/A

• Generators and Light Towers used as Generators are properly grounded

  Yes

  No

  N/A

Site Access & Security

• Fencing / Hoarding in place

  Yes

  No

  N/A

• Site Access Signage in Place

  Yes

  No

  N/A

• Site Road Safe/Accessible

  Yes

  No

  N/A

• Snow Removal Planned For

  Yes

  No

  N/A

• Dust Controlled

  Yes

  No

  N/A

• Mud Tracking Controlled

  Yes

  No

  N/A

Excavations & Shoring

• Permits Issued as Required

  Yes

  No

  N/A

• Locates Completed and Within 14 days

  Yes

  No

  N/A

• Adequate Shoring in Place

  Yes

  No

  N/A

• Appropriate Trench Access

  Yes

  No

  N/A

• Appropriate Traffic Control in Place

  Yes

  No

  N/A

• Tools/Equipment away from edge of trench

  Yes

  No

  N/A

• Spoil Pile at least 1meter from trench edge

  Yes

  No

  N/A

• Barricade / Appropriate Signage on Embankment

  Yes

  No

  N/A

Scaffolding

• Guard Rails in Place

  Yes

  No

  N/A

• Sound Frames/ Bracing/ Boards/ Platforms/ Hardware in Use

  Yes

  No

  N/A

• Sound / Level Footing

  Yes

  No

  N/A

• All Feet on the Ground

  Yes

  No

  N/A

• Tower Erected Plumb and Square

  Yes

  No

  N/A

• All Braces in Place

  Yes

  No

  N/A

• Tower Secured Vertically (~ 2 - 3 m) when hoarded

  Yes

  No

  N/A

• Outriggers in place Properly whenever Tower Height Exceeds 3 x Width

  Yes

  No

  N/A

• Wheel / Locks in good condition

  Yes

  No

  N/A

• Safe Access & Egress

  Yes

  No

  N/A

• Tagged appropriately

  Yes

  No

  N/A

Form Work

• Appropriate Guard Rails in Place.<br><br>Includes toe boards

  Yes

  No

  N/A

• Fall Protection Used Correctly

  Yes

  No

  N/A

• Engineered Drawings On-site

  Yes

  No

  N/A

• Debris Removed from Work Platforms

  Yes

  No

  N/A

• Protruding Rebar Protected

  Yes

  No

  N/A

Handling / Storage of Material

• Hoisting Equipment in Good Condition

  Yes

  No

  N/A

• Neat Marked Storage Areas

  Yes

  No

  N/A

• Vehicle / Pedestrian Traffic separated at Off - Load Area

  Yes

  No

  N/A

• Traffic Control while on access road

  Yes

  No

  N/A

• Warning Signs Posted

  Yes

  No

  N/A

Explosive Actuated Tools

• Tools Inspected prior to use each day

  Yes

  No

  N/A

• Charges Stored in Protected Area

  Yes

  No

  N/A

• Only Qualified Personnel Operating Powder Actuated Tools

  Yes

  No

  N/A

• Superintendent Comments

• Superintendent Signature

  Sign

• HSE Inspector Comments

• HSE Inspector

  Sign

• Project Manager Comments

• Project Manager Signature

  Sign

• Branch Manager Comments

• Branch Manager signature

  Sign

• Safety Manager Comments

• Safety Manager Signature

  Sign