Information
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INSTRUCTIONS:
Actions that are completed within 48 hours of the inspection must be entered as completed on the form. All other actions must be entered into the HSEQ Support Tool within 48 hours from the end of the inspection and the HSEQ action # recorded on the form. -
AREA
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Conducted on
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Inspected by
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Document No.
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Form#: COMM-016-0211 R1
FIRE EXTINGUISHER
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Map posted in the area listing the locations off all the fire extinguishers
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Monthly Inspection
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Annual Inspection
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Properly installed
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Accessible
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
FIRE PROTECTION EQUIPMENT
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All hose cabinets have been checked monthly
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All fire equipment is accessible and not blocked
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
MSDS (hard copy only required in areas where there is no computer access to ACTIO)
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Available to workers
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Check 2 chemicals from the area to ensure they have MSDS in the system
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
EYEWASH STATIONS / SHOWERS
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Map posted in area listing the locations of all eyewash stations and showers
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Monthly check performed
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Check expiry date on bottle - Date valid
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Accessible
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Properly installed
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
FIRST AID KITS
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Kit sealed
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Accessible
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Log book
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
HOUSEKEEPING
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Are walkways/active work areas clear of tripping hazards
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Are walkways/active work areas clear of slipping hazards
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Garbage segregated
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5 S
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
EXITS
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Clear of ice, snow, overhang, debris
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Exit lights functioning
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Closing properly
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Easy to open/close with appropriate handles
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Accessible
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
LIGHTING
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Sufficient lighting for work area
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Burned out lights replaced
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Emergency lights checked
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
WHMIS Storage and Labeling
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Are chemicals labeled according to WHMIS
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Are chemicals stored according to WHMIS
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
GAS CYLINDERS
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Are gas cylinders stored according to procedure
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
ELECTRICAL EXTENSION CORDS
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Are cords in good repair
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Are cords marked with the correct colour for this quarter for ground wire testing
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
AED
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Monthly checks completed
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
TOOLS
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Are there any homemade or non-approved tools in the workplace
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ASSESS: Must the condition or practice be rectified or actioned?
- YES - immediately ("A" Class Hazard)
- YES - within 48 hours ("B" Class Hazard)
- NO
- "C" Class / Commendation
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If YES (for "A" and "B" Class Hazards)
Action
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Action
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Responsible person
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Required completion date
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HSEQ Support Tool - Action #
