Part 1 - Jurisdiction

  • Workplace falls under ____________ jurisdiction

Part 2 - Safety Policy

  • Is a current safety policy available, signed, and dated by top management?

  • Enter the date that the safety policy is signed

  • Is the company safety policy posted in a visible location?

Part 3 - Workplace Joint Safety & Health Committee (JSHC)

  • Dedicated Safety & Health bulletin board?

  • Are the meeting minutes posted and current?

  • Does the JSHC meet at least quarterly with proper quorum (worker reps > or = mgmt reps)?

Part 4 - General Workplace Requirements

  • Adequate air quality?

  • Slipping or tripping hazards?

  • Toilet facilities adequate and sanitary?

  • Thermal condition adequate for the work being conducted?

  • Adequate lighting for the work being conducted?

  • Overall housekeeping impression (0=Poor and 100=Excellent)

  • Drinking water available for workers?

Part 5 - First Aid Requirements

  • Appropiate number of first aiders per shift?

  • Reference first aider requirements?

  • Reference - Part V

    no label
  • Is the AED on site accessible and are 30 day inspections recorded at the device tag?

  • First aid kits/supplies readily available?

  • How well stocked are the first aid kits? (0=empty and 100=fully stocked)

  • Reference requirement for first aid kit contents?

  • A first aid kit must contain the following items:
    (a) general:
    (i) a recent edition of a first aid manual,
    (ii) a pair of impervious disposable gloves,
    (iii) a disposable resuscitation mask with a one-way valve,
    (iv) a disposable cold compress,
    (v) 12 safety pins,
    (vi) splinter forceps,
    (vii) one pair of 12 cm bandage scissors,
    (viii) 25 antiseptic swabs,
    (ix) waterless hand cleaner,
    (x) waterproof waste bag;

    (b) dressings - each of the following items must be sterile and individually
    wrapped in order to maintain sterility:
    (i) 16 surgical gauze pads (7.5 cm squares),
    (ii) 4 pads (7.5 cm X 10 cm, non-adhesive),
    (iii) 32 adhesive dressings (2.5 cm wide),
    (iv) 2 large pressure dressings,

    (c) bandages:
    (i) 3 triangular bandages (1 m each),
    (ii) 2 conforming bandages (10 cm each),
    (iii) 2 rolls of 2.5 cm adhesive tape,
    (iv) 1 roll of 7.5 cm elastic adhesive bandage,
    (v) 2 rolls of 7.5 cm tensor bandage.

Part 6 - Personal Protective Equipment

  • Are PPE requirements idenfitied and equipment readily available?

  • Check all that apply

  • Are workers observed to be wearing their PPE?

Part 7 - Storage of Materials and Equipment

  • Is storage and/or racking systems used in the workplace?

  • Are materials stored in a condition of safe loading?

  • Do racking systems meet design requirements?

  • Are racking systems protected from power mobile equipment?

Part 8 - Musculoskeletal Injuries (MSI's)

  • Which MSI risk factors are present in the workplace? (select all that apply)

  • Area(s) with MSI risk

  • Pictures of MSI Risk

  • Have control measures been implemented to control MSI's

Part 9 - Working Alone

  • Do any workers work alone or in isolation?

  • Has a working alone SAFE work procedure been developed?

  • Is the working alone policy/procedure posted

  • How have workers been made aware or trained on the working alone policy?

Part 10 - Harassment

  • Has a harassment prevention policy been developed?

  • Is the harassment prevention policy posted?

  • Date of policy

  • Is there evidence of workers being informed of the Policy?

Part 11 - Violence in the Workplace

  • Has a violence prevention policy been developed?

  • Is the violence prevention policy posted

  • Date of policy

  • Is there evidence of workers being informed of the Policy?

Part 12 - Hearing Conservation and Noise Control

  • Are workers exposed to noise in excess of 80 dBA in the workplace?

  • Are those persons exposed to noise in excess of 80 dBA provide information about the hazards of the level of noise?

  • Does annual hearing testing occur every 12 months for those exposed to noise levels in excess of 85 dBA LEX?

  • Is hearing protection available or provided for workers?

  • Has a noise survey been conducted in the last 12 months?

Part 13 - Egress, Stairs, and Ladders

  • Is there safe access and egress to all work areas?

  • Are emergency exits clearly marked and accessible?

  • Are ladders present in the workplace?

  • Are ladders appropiate to the workplace and in good shape?

Part 14 - Fall Protection

  • Are employees working at heights of 3 meters or more?

  • Is fall protection in place for work at heights at or greater than 3 meters?

  • Are SAFE work procedures developed to prevent falls at the workplace?

  • Is fall protection equipment stored appropriately and in good shape?

  • Are workers trained in fall protection requirements and SAFE work procedures?

Part 15 - Confined Spaces

  • Are there confined spaces in the workplace?

  • SAFE Work procedures developed for work in confined spaces?

  • Workers trained in confined space SAFE Work procedures?

  • Is appropriate equipment in place for confined space situations?

  • Has an emergency response plan been developed for confined space situations?

Part 16 - Machines, Tools, & Robots

  • Are machines or tools used in the workplace?

  • Are safegaurds in place for all machines, tools, or robots where required?

  • Are operating controls appropiately located, protected, and identifiable?

  • Are lock out procedures and equipment available where required?

  • Are machines, tools, robots inspected as per manufacturers recommendations?

Part 17 - Welding and Allied Processes

  • Are welding activities performed in the workplace?

  • Are SAFE work procedures developed for welding or hot work?

  • Is a hot work permit system implemented?

  • Are flashback arrestors on all gas welding units?

Part 18 - Radiation

  • Are workers exposed to radiation in the workplace?

  • Are SAFE work procedures in place for using radiation?

  • Are workers trained and aware of hazards assocaited with radiation exposure?

Part 19 - Fire and Explosive Hazards

  • Appropiate number and type of fire extinguishers present in the workplace?

  • Are fire extinguishers charged, wall mounted, and accessible?

  • Containment in place for flammible, combustable, or contaminated materials?

  • Is there flammible or combustable material in the atmosphere?

Part 21 - Emergency Washing Facilities

  • Is appropiate emegency eye wash/shower equipment in place?

  • Is the emergency equipment accessible, clean, and operational?

  • Are workers trained in the use of emergency washing equipment?

Part 22 - Powered Mobilie Equipment (PME)

  • Is powered mobile equipment (PME) present in the workplace?

  • Are PME operators certified

  • Are operators completing pre-shift inspections?

  • Is all PME equipped with audible warning devices, fire extinguisher, and braking systems?

  • Are all seatbelts and seats operational and in good repair?

  • Is PME being operated in safe manner and used as intended by the manufacturer?

  • Are all PME units annually maintained and have visible load capacity plates

Part 20 - Vehicular and Pedestrial Traffic

  • Is walkway protection required?

  • Are pedestrian and powered mobile equipment lanes marked?

Part 23 - Cranes and Hoists

  • Are cranes or hoists used in the workplace?

  • Are crane operators certifed and properly trained?

  • Is a maintenance or annual inspection schedule readily available for all cranes?

  • Is the log book (inspection sheet) available and up to date for cranes 1 tonne or more?

  • Are cranes operated in safe manner(side loading, suspended loads, etcÂ…)

Part 24 - Pile Driving

  • Are there pile driving activities in the workplace?

  • Are there SAFE Work procedures for pile driving equipment?

Part 25 - Overhead Electrical Lines

  • Is work conducted near overhead electrical lines?

  • Are there SAFE Work procedures for working near overhead electrical lines?

  • Is an emergency plan in place in the event of contact with electrical lines?

Part 26 - Excavations and Tunnels

  • Are excavation and/or tunnels dug in the workplace?

  • Are there SAFE Work procedures for excavation work?

  • Are support structures and/or shoring adequate?

Part 27 - Compressed Air Enviroment

  • Are workers exposed to a compressed air environment?

  • Are there SAFE Work procedures for working in a compressed air enviroment?

Part 28 - Scaffolds / Elevated Work Platforms

  • Are workers on scaffolds or elevated platforms?

  • Are there SAFE Work procedures for using scaffolds or work platforms?

Part 29 - Falsework and Flyforms

  • Are falsework or flyform systems used in the workplace?

  • Are there SAFE Work procedures for falsework or flyform systems?

Part 30 - Temporary Structures

  • Are temporary structures assembled in the workplace?

  • Are there SAFE Work procedures for constructing or using temp structures?

  • Appropiate flooring, gaurding, stairways and landings?

Part 31 - Roof Work

  • Is roof work done in the workplace?

  • Are there SAFE Work procedures for roof work?

  • Are workers using appropiate fall protection?

Part 32 - Precast Concrete

  • Is pre-cast concrete used in the workplace?

  • Are there SAFE Work procedures for precast concrete work?

Part 33 - Demolition Work

  • Does demolition work take place in the workplace?

  • Are there SAFE Work procedures for demolition work?

Part 34 - Explosives

  • Are explosives used in the workplace?

  • Are there SAFE Work procedures for the use of explosives?

  • Are the blasters certified?

Part 35- Workplace Hazardous Materials Information System (WHMIS)

  • Are controlled chemicals or biological hazards present in the workplace?

  • Is a chemical inventory or matrix available?

  • Is there a WHMIS training program in place?

  • Are all controlled substances labelled properly?

  • Are MSDS sheets available for all controlled substances and current to 3 years?

Part 36 - Chemical & Biological Hazards

  • Are there SAFE Work procedures for chemical or biological hazards?

  • Is monitoring occuring to ensure workers are not exposed to airborn hazards?

Part 37 - Asbestos

  • Is asbestos present in the workplace?

  • Is an inventory of asbestos containing materials available?

  • Are there SAFE Work procedures for abatement or an asbestos control plan in place?

Part 38 - Electrical Safety

  • Is electrical work performed in the workplace?

  • Is a lockout policy or procedure in place for electircal work?

  • Is an inventory of lockout stations available?

  • Are electrical systems installed and protected as required?

Part 39 - Health Care Facilities

  • Is the workplace a healthcare facility?

  • Are there SAFE Work procedures for infectious materials?

  • Are there SAFE Work procedures for patient handling?

  • Are there SAFE Work procedures for waste and laundry?

Part 40 - Forestry and Arboriculture

  • Is the workplace involved in forestry operations?

  • Are there SAFE Work procedures for forestry operations?

  • Are haul roads constructed according to requirements?

Part 41 - Oil and Gas

  • Does the workplace have wells that are drilled, operated, or served?

  • Are there SAFE Work procedures for drilling, operating, or servicing wells?

  • Is the log book for the rig available and recently inspected?

Part 42 - Firefighters

  • Does the workplace employ firefighters?

  • Are there SAFE Work procedures for responding to an emergency?

  • Is equipment inspected?

Part 43 - Diving Operations

  • Are diving operations occurring in the workplace?

  • Are there SAFE Work procedures diving operations?

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