Safety Evaluation Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Employees Notified of Visit:

  Yes

  No

Risk Assessments

• Is the newest version (version 6) of the risk assessment being used?

  Yes

  No

• Has the date been identified?

  Yes

  No

• Has equipment been identified?

  Yes

  No

  N/A

• Has the location or Job number been identified?

  Yes

  No

• Has the line number been identified?

  Yes

  No

  N/A

• Is the emergency name and number identified (ECC, DCC, Internal communications)?

  Yes

  No

• Has the permit information been identified?

  Yes

  No

  N/A

• Is the permit holders name identified?

  Yes

  No

  N/A

• Is the description of work identified?

  Yes

  No

• Are all crew members including the supervisor contractors and traffic control listed and Initialed?

  Yes

  No

• Has the supervisor signed the risk assessment in the proper location to identify the controls have been implemented?

  Yes

  No

• Has the traffic control personnel been identified?

  Yes

  No

  N/A

• Has the traffic control setup been identified?

  Yes

  No

  N/A

• Is traffic control setup appropriate for the day’s activities?

  Yes

  No

  N/A

• If an equipment boom is required to be over a travel lane, has the code of practice been referenced?

  Yes

  No

  N/A

• Have the hazards associated with the task been identified?

  Yes

  No

• Has the severity rating of the hazard been identified?

  Yes

  No

• Are pre-task controls identified?

  Yes

  No

• Are administrative controls identified and procedures referenced?

  Yes

  No

• Has the required PPE been listed?

  Yes

  No

Documentation

• Has a site emergency response plan (EUS-OHS-FM38) been developed where the work is off road or at one location for more than five days?

  Yes

  No

  N/A

• Has the appropriate fall protection plan been completed for any climbing activities?

  Yes

  No

  N/A

• Has the excavation checklist EUS-OHS-FM 36 been filled out?

  Yes

  No

  N/A

• Are the vehicle operator manuals available on site?

  Yes

  No

  Not Applicable

  Did Not Check

• Is a copy of the EUS safety manual available?

  Yes

  No

  Not Applicable

  Did Not Check

• Are vehicle log books completed and up to date?

  Yes

  No

  Not Applicable

  Did Not Check

• Are Equipment pre trips completed?

  Yes

  No

  Not Applicable

  Did Not Check

Emergency Response

• Are workers aware of who hold a first aid certificate onsite?

  Yes

  No

• Are workers aware of the location of first aid kits?

  Yes

  No

• Are all contents of the first aid kit present in the kit?

  Yes

  No

  Did not Check

• Is the pole top rescue kit location easily identified and accessible?

  Yes

  No

  Not Applicable

  Did Not Check

• Is the bucket evacuation kit location easily identified and accessible?

  Yes

  No

  Not Applicable

  Did Not Check

• Is the tower rescue kit location easily identified and accessible?

  Yes

  No

  Not Applicable

  Did Not Check

• Are Material Safety Data Sheets available for WHMIS products on site?

  Yes

  No

  Did not Check

• Are Fire extinguishers locations identified and accessible?

  Yes

  No

  Did not Check

General Inspection

• Is housekeeping adequate in the vehicles and onsite?

  Yes

  No

• Are hand/ power tools in safe working condition?

  Yes

  No

  Not Applicable

  Did Not Check

• Are CSA approved hard hats being worn?

  Yes

  No

  N/A

• Are CSA safety glasses with side shield being worn?

  Yes

  No

  N/A

• Is appropriate hearing protection being used for the tasks being performed?

  Yes

  No

  N/A

• Are CSA safety boots with the “omega” symbol being worn with ankle support?

  Yes

  No

  Not Applicable

  Did Not Check

• Are gloves specific to the task being worn?

  Yes

  No

  N/A

• Is CSA chainsaw PPE available and used when required?

  Yes

  No

  Not Applicable

  Did Not Check

• Are chainsaw guards in place?

  Yes

  No

  Not Applicable

  Did Not Check

• Is high reflective clothing being worn (orange or lime green vest with torso covered below 80 km/h full body above 80km/h) while working around traffic areas?

  Yes

  No

  N/A

• Are vehicles backed in to parking areas?

  Yes

  No

  N/A

• Is protective cover up inspected with the proper date stamped?

  Yes

  No

  Not Applicable

  Did Not Check

• Is rubber cover up sufficient to prevent second point of contact?

  Yes

  No

  N/A

• Are rubber gloves of the appropriate class in use and have a valid inspection date?

  Yes

  No

  Not Applicable

  Did Not Check

• Has hoisting and rigging gear been inspected with proper inspection color?

  Yes

  No

  Not Applicable

  Did Not Check

• Has fall protection equipment been inspected with proper color identifying inspection?

  Yes

  No

  Not Applicable

  Did Not Check

• Are signalers being used for equipment operations?

  Yes

  No

  N/A

• Is water available to employees on site?

  Yes

  No

  Did not Check

• Are glass and mirrors in good shape and not damaged?

  Yes

  No

  Not Applicable

  Did Not Check

• Are backup alarms functioning on heavy equipment and commercial vehicles?

  Yes

  No

  Not Applicable

  Did Not Check

• Is material being stored in a manner that prevents it from falling or rolling onto/into a person?

  Yes

  No

  Not Applicable

  Did Not Check

• Can an employee on site identify a joint occupational health and safety committee member?

  Yes

  No

  Did not Check

Behavior Assessment (Safe Start)

• Do employees appear to have their mind on task, their eyes on task not working in the line-of-fire with balance traction and grip?

  Yes

  No

• Do employees appear to be working safely without rushing, frustration, fatigue or complacency?

  Yes

  No

Signatures

• Auditor

  Sign

• Site Representative

  Sign