Monthly Health & Safety Building Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Inspection Requirements: A written inspection of work places is required by legislation
  Responsibility: Health & safety committee duty, supported and signed by management
  Frequency: An inspection is required at a minimum of once per month
  Scope: All or part of the work place, to ensure fully inspected on annual basis
  Support: Refer to this form, and Work Place Committee Guide, pages 19-22

A. GENERAL INTERIOR (Applies to most work environments)

Documentation

• Part II of the Canada Labour Code is posted and easily accessible to employees

  Yes

  No

  N/A

• Shaw’s Health and Safety Policy posted and easily accessible to employees<br><br>

  Yes

  No

  N/A

• List of first aid providers including contact details is posted<br>

  Yes

  No

  N/A

• The MSDS binder up to date (all sheets created within the past 3 years)<br>

  Yes

  No

  N/A

• Minutes from last H&S Committee meeting sent to Safety Services to post on Shaw Central<br>

  Yes

  No

  N/A

• Near Miss Reports are completed and maintained<br><br>

  Yes

  No

  N/A

• Incident Investigations are completed and maintained <br><br>

  Yes

  No

  N/A

Exits and Entrances

• Exit doors are free from any locks or fastenings that could restrict escape<br>

  Yes

  No

  N/A

• Routes, signs, and doors are clearly marked and lit<br><br>

  Yes

  No

  N/A

• Exits are free from obstructions<br>

  Yes

  No

  N/A

• Automatic doors are working properly<br>

  Yes

  No

  N/A

• Combustible material is kept out of exit areas<br><br>

  Yes

  No

  N/A

• Entrance mats are in good condition, flat, and clean<br><br>

  Yes

  No

  N/A

• Exterior of exit doors are free of snow and ice accumulation<br><br>

  Yes

  No

  N/A

• No compressed gas canisters/ cylinders are stored within 1m of an exit<br><br>

  Yes

  No

  N/A

Stairways

• Stairs, stairwells, and landings are kept clear, unobstructed, and free of combustible materials<br><br>

  Yes

  No

  N/A

• Stairways are adequately lit<br><br>

  Yes

  No

  N/A

• Steps, treads, surfaces, and handrails are in good condition<br>

  Yes

  No

  N/A

Kitchen

• Cleaning and maintenance program for bottled water dispensers and/or water filtration systems<br>as instructed by the manufacturer or accepted industry practice (check for presence of<br>maintenance tags with dates and initials)<br>

  Yes

  No

  N/A

• All lunch room garbage cans must be equipped with a lid, unless stored in a cupboard<br><br>

  Yes

  No

  N/A

• All appliance are Shaw approved (Fridge, microwave, coffee maker)<br><br>

  Yes

  No

  N/A

Lighting

• Walking and working areas are adequately lit<br><br>

  Yes

  No

  N/A

• Light fixture protective lenses are in place, clean and in good condition<br>

  Yes

  No

  N/A

• Lighting levels are sufficient for the work being performed<br><br>

  Yes

  No

  N/A

• Windows that provide natural lighting are clean<br>

  Yes

  No

  N/A

• The emergency lighting system is checked once a month<br><br>

  Yes

  No

  N/A

• The emergency lighting system checked annually under simulated power failure or electrical<br>fault conditions<br>

  Yes

  No

  N/A

Ventilation

• Air filters appear to be clean (if observable)<br><br>

  Yes

  No

  N/A

• Diffusers and returns unobstructed<br><br>

  Yes

  No

  N/A

Temperature and Humidity

• Temperature is maintained at comfortable level, approximately 20 – 24C (68 – 75 F)

  Yes

  No

  N/A

• Humidity is maintained at 30 – 60 percent (approximate)

  Yes

  No

  N/A

• Heaters are not permitted near combustible material

  Yes

  No

  N/A

• Ventilation systems, dehumidifiers and humidifiers are cleaned and maintained

  Yes

  No

  N/A

Floors

• Floors are clean, dry, and free from debris, and clutter<br>

  Yes

  No

  N/A

• Signs are posted where floors are wet

  Yes

  No

  N/A

• Surfaces are free from slip hazards (water, ice, snow, oil, grease)

  Yes

  No

  N/A

• Surfaces are free from trip hazards (electrical cords, broken floor tiles, torn carpet)

  Yes

  No

  N/A

First-aid Kits

• First-aid kits located within reasonable proximity (within 2 floors) and identified by sign

  Yes

  No

  N/A

• Supplies are consistent with the required inventory

  Yes

  No

  N/A

• Name and contact details of trained first aid attendants listed on or near kit

  Yes

  No

  N/A

• Eyewash stations are located in designated areas and wash solution within expiry date

  Yes

  No

  N/A

• Eyewash stations and emergency showers are maintained in a clean and sanitary condition

  Yes

  No

  N/A

• Eyewash stations and emergency showers are tested for functionality at least monthly (if a<br>plumbed system, test by allowing water to run for at least 2 minutes)

  Yes

  No

  N/A

Fire Protection

• Emergency procedures posted at locations accessible to every employee and on each floor of<br>the building

  Yes

  No

  N/A

• Fire extinguishers are mounted, visible and unobstructed in designated location<br>- Verify the locking pin is intact and the tamper seal is unbroken<br>- Examine for obvious physical damage, corrosion, leakage, or clogged nozzle<br>- Confirm the pressure gauge is in the green<br>- Check to confirm last professional service date on extinguisher tag is within 12 months<br>- Initial and date the tag to document monthly inspection<br>- Operating instructions/ decals on extinguishers face outward<br>- Fire extinguishers are not stored on the floor

  Yes

  No

  N/A

• Fire doors are self-closing, closed, in good repair, and free from obstruction

  Yes

  No

  N/A

• Fire alarm pull stations and panels are well marked and accessible

  Yes

  No

  N/A

• Fire drill is conducted at minimum once per year

  Yes

  No

  N/A

• Ceiling Sprinkler heads unobstructed

  Yes

  No

  N/A

• Ceiling tiles in place free of cracks or water damage

  Yes

  No

  N/A

• Fire Protection devices are operational (detectors)

  Yes

  No

  N/A

Stacking And Storage

• Shelves/racks are sturdy and suitable for the weight of the product stored

  Yes

  No

  N/A

• Shelves/racks are in good condition (no sharp, splintered, or rough corners)

  Yes

  No

  N/A

• Shelves/racks are properly secured to wall or ground

  Yes

  No

  N/A

• Heavier products are stored on lower shelves (at or near waist level)

  Yes

  No

  N/A

• Materials are stored securely on shelves (to prevent falling objects)

  Yes

  No

  N/A

• File cabinets drawers don’t open into aisles, drawers not left open/unattended

  Yes

  No

  N/A

Noise

• Equipment generating excessive noise is isolated from general work areas

  Yes

  No

  N/A

• Hearing protection is available in designated areas

  Yes

  No

  N/A

• Areas where hearing protection required are clearly marked with appropriate signage

  Yes

  No

  N/A

Electrical

• Electrical equipment is locked and tagged out when repair or maintenance is required

  Yes

  No

  N/A

• Sufficient lock and tags are in stock and in use

  Yes

  No

  N/A

• No flammable or combustible materials are stored within electrical rooms/ vaults

  Yes

  No

  N/A

• No material is stored or located within a 1 m radius of electrical panels

  Yes

  No

  N/A

Hazardous Materials (i.e. chemicals)

• Containers with controlled products are labeled (according to WHMIS requirements)

  Yes

  No

  N/A

• Controlled products are used and stored as per MSDS instructions

  Yes

  No

  N/A

• MSDS are obtained, accessible to employees and dated within that last 3 years

  Yes

  No

  N/A

• All areas in which hazardous materials are stored/ located have appropriate signage

  Yes

  No

  N/A

• Hazardous materials are stored at least 100 mm (10 cm) above floor level

  Yes

  No

  N/A

• Flooring material of areas in which hazardous materials are stored are impermeable (i.e. not<br>made of wood, etc.)

  Yes

  No

  N/A

• All containers of flammable and combustible liquids are kept closed when not in use

  Yes

  No

  N/A

• All flammable and combustible liquids are stored within fire-rated (yellow) cabinets or on<br>secondary containment (i.e. spill pallets)

  Yes

  No

  N/A

• No propane canisters/ cylinders are stored inside of buildings

  Yes

  No

  N/A

Tools & Equipment

• Tools and equipment are in good working order

  Yes

  No

  N/A

• Defective tools and equipment are tagged out for repair/replacement and have been taken out<br>of service

  Yes

  No

  N/A

• Guards are installed for machinery with moving, rotating, charged or hot parts. Pinch-points<br>are clearly identified/ labeled.

  Yes

  No

  N/A

• No home-made or modified tools/ equipment are available for use

  Yes

  No

  N/A

Confined Spaces

• All confined spaces are clearly identified and access restricted

  Yes

  No

  N/A

• Confined Space Entry Permits are completed and maintained at site

  Yes

  No

  N/A

• Gas monitor calibration records maintained at site

  Yes

  No

  N/A

B. LOCATION SPECIFIC

Desks

• Desks allow freedom of knee/leg movement

  Yes

  No

  N/A

• Work surfaces are large enough to hold work materials

  Yes

  No

  N/A

Computer Monitors

• Monitor heights can be adjusted to suit individual worker

  Yes

  No

  N/A

• Monitors are positioned to be free of glare and shadows

  Yes

  No

  N/A

Chairs

• Chairs have a stable base (5 wheels or casters)

  Yes

  No

  N/A

• Chairs swivel and have adjustable backrest and seat

  Yes

  No

  N/A

Environment

• Adjustable task lights are available for use over source documents

  Yes

  No

  N/A

• Window blinds are available to block out sunlight (glare)

  Yes

  No

  N/A

Warehouse

• The overhead shipping door is operating properly

  Yes

  No

  N/A

• The emergency stop operates correctly

  Yes

  No

  N/A

• The sensing edge reverses the door upon contact with an object

  Yes

  No

  N/A

• Dock edges are clearly visible (i.e. painted yellow)

  Yes

  No

  N/A

• Materials are stored at least 18 inches below fire sprinkler heads

  Yes

  No

  N/A

• Pallets are limited to a stack height of 6 feet

  Yes

  No

  N/A

• Forklifts are equipped with:<br>- working front horn<br>- rear back-up alarm<br>- portable fire extinguisher

  Yes

  No

  N/A

• Forklift daily inspection checklist completed and signed

  Yes

  No

  N/A

• Forklift recharging station checked for cleanliness and:<br>- acid-resistant gloves<br>- goggles/ face shield<br>- acid-resistant apron<br>- fire extinguisher<br>- acid-neutralizing agent/ acid spill-kit<br>combustible materials stored at least 1.5 m away

  Yes

  No

  N/A

• Power Pallet Jack is equipped with a working horn

  Yes

  No

  N/A

• All ladders being stored must be secured to the wall or placed horizontally

  Yes

  No

  N/A

• All ladders that have been identified as defective must be tagged and taken out of service

  Yes

  No

  N/A

• All portable ladders display the CSA certification label

  Yes

  No

  N/A

Building Exterior

• If accessible, is the roof free of trip hazards

  Yes

  No

  N/A

• Unsafe areas are cordoned off (construction)

  Yes

  No

  N/A

• Sidewalks are free of debris, and sanded if slippery

  Yes

  No

  N/A

• Outdoor stairs are free and clear of water and snow

  Yes

  No

  N/A

• Parking or smoking is not permitted near air intake systems

  Yes

  No

  N/A

Parking Lot

• The parking lot surface is free of large potholes

  Yes

  No

  N/A

• Parking blocks are in place to prevent vehicles from contacting electrical outlets

  Yes

  No

  N/A

• Parking lot lighting is sufficien

  Yes

  No

  N/A

• Appropriate signage (i.e. wheelchair parking)

  Yes

  No

  N/A

• Vehicles parked in appropriate locations

  Yes

  No

  N/A

• Quarterly Vehicle Inspections Completed

  Yes

  No

  N/A

Antenna Compound

• Gates are locked (where applicable)

  Yes

  No

  N/A

• Warning signs are posted

  Yes

  No

  N/A

• Antennas secured from unauthorized access

  Yes

  No

  N/A

• Notes

•  Refer to all sections above where “No” was indicated

•  Identify recommendations for each

•  Complete the Health & Safety Inspection Report to include follow-up details and date of completion

• Inspection Date/Time

  Date
• Location
  Address

• Department/Area Covered

• Inspection Completed By

• Findings of Inspection (Observed Issues & Recommendations)

• H&S Committee Employee Chair

  Sign

• H&S Committee Employer Chair

  Sign

• Management (Senior Leadership)

  Sign

• Note: Return document with action
  taken/planned to H&S Committee within 30
  days of inspection. All inspections must be
  keep for a minimum of 3 years