Information

  • Date

  • Branch

  • Job Site

  • Location
  • Safety Professional

  • Foreman

  • Superintendent

  • Consultant/GC/Architect

  • Crew Member Attending

  • Reported on Site With

  • Last Evaluation Date

Job Details & Specific Details Of The Job At Time Of Evaluation

  • Details

Distribution

  • Doug Flynn

  • Regional VP

  • Branch Manager

  • Department Manager

  • Superintendent

  • Health & Safety Department

  • Foreman & Crew

Fire Prevention/ Fire Safety

  • Fire Extinguishers on Walls visible and clearly marked.<br>

  • Workers Trained in Extinguisher Use.

  • Extinguishers maintained and tested this year.<br>

  • Emergency routes clearly marked.<br>

  • Emergency exits clear.<br>

  • Combustibles stored properly.<br><br>

  • Other

Safety Response

  • First Aid Trained Persons On Site.

  • First Aid Kits.

  • Emergency Plan.

  • Worker Aware Of Emergency Plan.

  • Evacuation Muster Point.

  • Emergency Phone List.

  • First Aid and accident reports available and used.<br>

  • Other

Equipment & Machinery

  • Workers trained to use properly.

  • Lock Out Procedure in Place.

  • Safe Work Procedure used.

  • Emergency stops clearly marked and working properly.

  • Perimeter Warning System in Place.

  • Openings Guarded or Secured Properly.

  • Guards and safety devices maintained and working properly.

  • Inspected before each use.

  • Noise controlled.<br>

  • Workplace adequate.

  • Fumes and Exhaust controlled.

  • Other

Site Access

  • Adequate Entrances.

  • Clean Level Ground.

  • Adequate Ladders, stairs where required.

  • Other

Housekeeping

  • Are aisles kept free of Obstructions.

  • Areas well lit.

  • Garbage Bins available and in suitable locations.

  • Other

Personal Protective Equipment

  • Maintained and clean.

  • Foot Protection.

  • Eye & Face Protection.

  • Hearing Protection

  • Hand Protection.

  • Hi-Vis Outerwear.

  • Other

Ladders

  • Properly Secured Top & Bottom.

  • Proper Angle 1:4.

  • Proper Size & And Type.

  • Safe Usable Condition.

  • Properly Used.

  • Other

Power Hand Tools & Equipment

  • General Condition.

  • Proper Guards.

  • Use Defective Tags.

  • Other

Electrical

  • Plug, Cords, and sockets in good condition.

  • Extension cords minimized.<br>

  • Access to plugs and sockets clear.

  • Proper cords and plugs used.

  • Electrical tools in good repair.

  • Are power disconnects and switches for machines clearly marked.

  • Other

Worker Equipment Training

  • Machine Training ( Press Brake, Punch Press, Saws etc).

  • Welding/Cutting Training.

  • Forklift Training

  • Other Equipment.

  • Other

Lighting

  • Is Lighting adequate in all areas.

  • Is task Lighting provided in areas of low light or high glare.

  • Does the work area emergency lighting work and is it adequate.

  • Is glare and contrast minimized.

  • Are workers eyes protected from welding and cutting processes.

  • Other

Material Storage

  • Safely Stacked and Secured

  • Properly Bundled or Containerized

  • Properly Located

  • Properly Labeled (WHMIS)

  • Other

Worker Education

  • WHMIS Trained

  • Oriented in company Safety Policy.

  • Aware Of H&S Committee And Worker Representative

  • Orientated With Injury/Hazard Reporting

  • Orientated On Provincial Construction Regulations

  • Other

Site Collateral Material

  • Provincial Construction Regulations

  • MSDS Sheets On Site/Worker Access

  • Safety Manual On Site

  • Warning Signs.

  • Injury Passport

  • Washroom/Lunch Area Cleanliness

  • Weekly Safety Talk

  • PLRA Completed

  • Other

Storage

  • Are items stored on shelves properly.

  • Is Lifting/ Moving equipment used whenever possible instead of manual lifting.

  • Are floors around shelves clear.

  • Are racks and shelves maintained.

  • Are floors dry and clean.

  • Other

First Aid Requirements

  • Adequate First Aiders On Site

  • Adequate Number of First Aid Kits

  • Adequate Contents in Kits & Reports

  • Other

Safety Board

  • Information up-to-date and available for all workers to view.

  • Other

Totals

  • Red Category - Major Issue

  • Yellow Category - Moderate Issue

  • Blue Category - Minor Issue

  • Follow-up Required

Review

  • Site Supervisor/Forman

  • Health & Safety

  • Superintendent

Comments

  • Comments

Photos

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

  • Add media

  • Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.