MSAP - Planned General Inspection

• Audit Title:

• Location/Area/Cell
  Address

• Conducted by:

• Conducted on:

  Date

• Personnel:

GENERAL

• Is House Keeping in good order?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is the Travel Way in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is the Lighting in good order?

  Yes

  No

  N/A

• Class

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Are the Stairs/Ladders/Platforms in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Are the Exsits - Access/Signage up to standard?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

VENTILATION/ENVIRONMENT

• Is the Air (Dust, Fume, Moisture) in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is the Heat in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is the Ventilation up to standards?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

SUPPORT SYSTEM

• Is Electrical up to standard?

  Yes

  No

  N/A

• Add media

  Media

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Is Compressed Air & Water in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Do the Signage/Tags meet requirements?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

STORAGE SYSTEMS

• Chemical Storage/ WHMIS

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is Oil Storage in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is Fuel Storage up to standard?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Actions Required:

• Add media

  Media

LARGE EQUIPMENT

• Is General Condition up to standard?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is Guarding in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

TOOLS/SMALL EQUIPMENT

• Is General Condition up to standard?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

• Is Guarding in good condition?

  Yes

  No

  N/A

• Class:

  A - Extreme Risk (immediate action)

  B - High Risk (adressed within 3 days)

  C - Medium Risk (adressed within 7 days)

  D - Low Risk (adressed within 31 days)

• Condition and Actions Required:

• Supervisor Responsible:

• Add media

  Media

10 GOLDEN RULES - Fit For Work, Driving, Ground Stability, Lifting, Rigging and Hoisting, Energy Isolation, Working at Heights, Hazardous Substances, Permit to Work, Protective Devices and Guarding, Personal Protective Equipment

• Remarks:

• Department:

• General Foreman:

• Supervisor:

• Signature:

  Sign