Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Type of work being performed on this work site?

  • Advance Man

  • Surveying

  • Mulching

  • Drilling

  • Recording

Location of work being preformed for GWR

  • Please add GPS coordinates for Program Staging Location.

  • Nearest Town or City to Program Staging Location.

  • Please describe direction to the nearest Hospital from the Program Staging location.

Personal Protective Equipment Required by Client/Contractor

  • CSA or DOT Approved Helmet

  • CSA Approved Hard Hat

  • Eye Protection

  • Hearing Protection

  • Foot Protection

  • Hand Protection

  • Personal First Aid Kit

  • Emergency Response Plan

  • Personal H2S Monitor

  • Fire Retardant Coveralls

Emergency Response Equipment required on this worksite?

  • Is there a medic required on program?

  • Is there a requirement for an EMT Vehicle on this Program?

  • Is there a Fire Truck required on the program?

  • Is a helicopter required on the program?

  • Is fire response equipment required in or on all vehicles?

  • Are First Aid kits required in or on all vehicles?

  • Are emergency shut off switches required on Diesel Engines?

  • Is Respiratory Equipment required on site?

  • Are H2S monitors required on site?

  • Is there any other or specialty equipment needed on this program?

On Site Hazard Information

  • H2S

  • SO2

  • Plant or Production Facilities

  • Oil Wells

  • High Pressure Pipelines

  • Low Pressure Pipeline

  • Hazardous Material

  • Buried Facilities Fiber Optic, Power, Telephone, Water......

  • Overhead Powerlines

  • Crown Land

  • Private Property including Acreages

  • Abandon Farm Yards

  • Farm Yards

  • Water Wells

  • Septic Feilds

  • Live Stock

  • Corals

  • Dug Outs

  • Crops

  • Grazing Pasture

  • Humics

  • Badger Holes

  • Barb Wire Fences

  • Wooden Fences

  • Rock Piles

  • Junk Piles

  • Railway

  • Roads

  • Ditches

  • Irrigation Ditches

  • Trees

  • Brush

  • Muskeg

  • Sloughs

  • Creeks

  • Rivers

  • Lakes

  • Cliffs

  • Mountains

  • Hills

  • Please Add any other Hazards associated to this here

Predatory Hazards

  • Hunting Season

  • Trapping

  • Bears

  • Cougars

  • Wolverine

  • Badgers

  • Wolves

  • Coyotes

  • Moose

  • Elk

  • Deer

  • Snakes

  • Please add any other Predatory Hazards here

Driving Hazards

  • Wild Life

  • Weather Conditions

  • Icy Roads

  • Wet Roads

  • Gravel Roads

  • Winter Roads

  • Seasonal Roads

  • Railway Crossings

  • Blind Corners

  • Blind Hills

  • Steep Hills

  • Side Hills

  • Pot Holes

  • Steep Road Shoulders

  • Bridges

  • One Lane Bridge

  • Temporary Creek Cossings

  • Gates

  • Fields

  • Driving in to Sun Rise and or Sun Set

  • Driving at Dusk and or Dawn

  • Unmarked Intersections

  • Oilfield Activity

  • Farming Activity

  • Forestry Activity

  • School buses

  • Please Add any other Hazards found associated to driving here.

Environmental Hazards

  • Wind

  • Wind Chill

  • Snow

  • Ice

  • Rain

  • Sun

  • Extreme Cold

  • Extreme Heat

  • Flooding

  • Tornadoes

  • Avalanche

  • Blizzards

  • Insects

  • Air Born Pathogens

  • Water Born Path

  • Please add any other Hazards that deal with the environment here.

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