Site Inspection

• Site name

  Select Beverly Manning Southside Westside SpruceGrove Strathcona Duggan Edwards Lymburn Palisades Parkview Sherwood Park (baseline) St. Albert Edmonton warehouse Contract Services CEPS West CEPS South McLeod Varisty Trans Canada Chinook Airdrie Bowtrail Deer Valley Calgary warehouse Grande Prairie CEPS Grande Prairie

  • Beverly
  • Manning
  • Southside
  • Westside
  • SpruceGrove
  • Strathcona
  • Duggan
  • Edwards
  • Lymburn
  • Palisades
  • Parkview
  • Sherwood Park (baseline)
  • St. Albert
  • Edmonton warehouse
  • Contract Services
  • CEPS West
  • CEPS South
  • McLeod
  • Varisty
  • Trans Canada
  • Chinook
  • Airdrie
  • Bowtrail
  • Deer Valley
  • Calgary warehouse
  • Grande Prairie
  • CEPS Grande Prairie

• Conducted on

  Date

• Inspected by Brandon Pregizer

Office and Ergonomics

• Chairs in good condition and properly adjusted. 1pt

  Yes

  No

  N/A

• Monitor at a reasonable height. 1pt

  Yes

  No

  N/A

• Team member can demonstrate proper posture while sitting. 2pt

  Yes

  No

  N/A

• Computer/cords installed properly, no trip hazards, powerbar not overloaded. 1pt

  Yes

  No

  N/A

• Computers, phone, faxes printers clean & free of dust. 1pt

  Yes

  No

  N/A

• Office is neat and tidy and well organized. No signs of clutter. 5pt

  Yes

  No

  N/A

• Emergency phone numbers posted by phone. 1pt

  Yes

  No

  N/A

Fire Safety and Security

• Extinguishers clear of obstructions. 3pt

  Yes

  No

  N/A

• Have all the fire extinguishers been checked and signed off on a monthly basis. 5pt

  Yes

  No

  N/A

• How many Fire extinguisher were not inspected.

• Is the fire extinguisher and mount brackets in good condition. 5pt<br>e.g fully charged, pin in place, securely mounted to the wall.

  Yes

  No

  N/A

• Fire extinguishers inspected in the last year. 2pt

  Yes

  No

  N/A

• When was the last annual fire extinguisher inspection

  Date

• Fire extinguishers signs posted (easily identified). 1pt

  Yes

  No

  N/A

• FE mounted mounted no higher than 5 feet 1pt

  Yes

  No

  N/A

• Check Smoke Detector (if site has one). 1pt

  Yes

  No

  N/A

• Fire extinguisher nearby electric testing area and chemical storage unit. 1pt

  Yes

  No

  N/A

Firstaid Kits and Eyewash Stations

• Eye wash stations are accessible and easily identified, clean and expiry date checked. 2.pt

  Yes

  No

  N/A

• First aid kits and eye wash stations are accessible and easily identified. 2pt

  Yes

  No

  N/A

• First-aid kits clean, stocked, expiry dates are checked. 5pt

  Yes

  No

  N/A

• Which First-aid items are not present or in low of supplies.

  Select Antiseptic Wipes: 10 Band-aids: 50 4" x 4" Gauze Pads: 20 Conform Bandage 3": 2 Compress Bandage 4": 3 Compress Bandage 6": 3 ABD Pad 8" x 10": 1 Triangular Bandage: 4 First Aid Scissors: 1 First Aid Tweezers: 1 Adhesive Tape 1": 1 Tensor Bandage 3": 2 Eye Pad: 1 1 way valve pocket mask: 1

  • Antiseptic Wipes: 10
  • Band-aids: 50
  • 4" x 4" Gauze Pads: 20
  • Conform Bandage 3": 2
  • Compress Bandage 4": 3
  • Compress Bandage 6": 3
  • ABD Pad 8" x 10": 1
  • Triangular Bandage: 4
  • First Aid Scissors: 1
  • First Aid Tweezers: 1
  • Adhesive Tape 1": 1
  • Tensor Bandage 3": 2
  • Eye Pad: 1
  • 1 way valve pocket mask: 1

• How many first-aid kits are clean, stocked, expiry dates are checked.

• When does the anti septic wipes expire. Note: Choose the most recent expiry date

  Date

• First aid reports accessible by each first aid kit. 3pt

  Yes

  No

  N/A

• Sufficient number of first aiders on site. 3pt

  Yes

  No

  N/A

• How many first aiders are on site

Entrances, Exits,

• Emergency exits unobstructed from the inside and outside. 5pt

  Yes

  No

  N/A

• Emergency exits sign light bulbs illuminating light. 5pt<br>

  Yes

  No

  N/A

• Site maps by emergency exits/ 1pt

  Yes

  No

  N/A

• Doorways and staircases clear of material and equipment. 1pt

  Yes

  No

  N/A

• Emergency lighting tested and working. 3pt

  Yes

  No

  N/A

• Adequate doorways and ramps. 1pt

  Yes

  No

  N/A

• Back door locked from the outside. 2pt

  Yes

  No

  N/A

Housekeeping

• Are all the light bulbs illuminating light. 2pt

  Yes

  No

  N/A

• How many light bulbs are burnt out

• Windows covered with blinds, drapes, or other means of controlling sunlight. 1pt

  Yes

  No

  N/A

• Electric cords are in good condition. 2pt

  Yes

  No

  N/A

• Plugs sockets and light switches in good condition. 2pt

  Yes

  No

  N/A

• Electric cords tucked away to reduce tripping hazards. 2pt

  Yes

  No

  N/A

• Gas meters unobstructed. 3pt

  Yes

  No

  N/A

• Electrical panels unobstructed 3.pt

  Yes

  No

  N/A

• Wash rooms clean, hand soap, paper towel and toilet paper is available. 2pt

  Yes

  No

  N/A

• Lunch room clean: microwave, fridge, sink, cupboards. 2pt

  Yes

  No

  N/A

• Floor surfaces even. 1pt

  Yes

  No

  N/A

• Work area neat and tidy, no signs of clutter. 5pt<br>

  Yes

  No

  N/A

• Aisles clear of merchandise, debris, and tripping hazards. 5pt<br>

  Yes

  No

  N/A

• Main aisles at least 1 meter wide. 1pt

  Yes

  No

  N/A

• Is the site entrance mats properly placed. 3pt

  Yes

  No

  N/A

• Carpets and tiles in good condition. 1pt

  Yes

  No

  N/A

• Are the floors dry at site entrance and everywhere else. 3pt

  Yes

  No

  N/A

• Are there wet floor signs posted. 3pt

  Yes

  No

  N/A

• Stairs and handrails in good condition. 1pt

  Yes

  No

  N/A

• Ladders/stepstool in safe accessible location and in good condition. 1pt

  Yes

  No

  N/A

WHMIS/MSDS

• MSDS binder available, updated (within 3 years). 5pt<br>

  Yes

  No

  N/A

• Chemicals stored in a upright position and away from heat source. 3pt

  Yes

  No

  N/A

• Donated chemicals disposed of properly and are not being used by staff. 5pt

  Yes

  No

  N/A

• Clear Spray bottles labelled properly with name of chemical, safety precautions, and refer to MSDS. 5pt

  Yes

  No

  N/A

Parking Lot/Sidewalks

• Side walks and pathway to garbage bin clear of ice, snow, & garbage. 10pt<br><br>

  Yes

  No

  N/A

• Side walk Maintenance logbook being filled out (seasonal). 5pt

  Yes

  No

  N/A

• Shopping carts brought inside within a reasonable time. 2pt

  Yes

  No

  N/A

Health and Safety Board/Binder

• H & S Board neat and tidy. 5pt

  Yes

  No

  N/A

• OHS handbook accessible. 2pt

  Yes

  No

  N/A

• Health and Safety Policy Binder accessible. 2pt

  Yes

  No

  N/A

• Weekly Site Inspections be completed consistently. 10pt<br>

  Yes

  No

  N/A

• H&S board updated: emergency contact, H&S bulletins, first aiders, site map: Refer to Policy 817. 10pts

  Yes

  No

  N/A

• Which forms were not updated on the H&S board

  Select Commitment to health and safety Emergency Response Plan Site Map H&S Embassy meeting WCB Poster OIS clinic list H&S feedback forms Monthly Safety meeting List of First aiders Emergency contact list H&S ambassadors list H&S Bulletin Support Services booklet Weekly Inspections

  • Commitment to health and safety
  • Emergency Response Plan
  • Site Map
  • H&S Embassy meeting
  • WCB Poster
  • OIS clinic list
  • H&S feedback forms
  • Monthly Safety meeting
  • List of First aiders
  • Emergency contact list
  • H&S ambassadors list
  • H&S Bulletin
  • Support Services booklet
  • Weekly Inspections

• How many of the forms are updated. 1pt each form for a total score of 14 Reminder: Emergency contact, first aiders, and H&S ambassadors is each 1 pt

• DWIS updated “Days Without Injury Sign”. 2pt

  Yes

  No

  N/A

• How many days without Injury

• Date it was last updated

  Date

Store, Processing, DC, Warehouse

• Is this a store, DC, or a warehouse

  Yes

  No

  N/A

• Are pictures mounted or placed no higher than five (5) feet from the ground, if so they must have signage advising customers to ask for help removing the picture. 3pt

  Yes

  No

  N/A

• Fatigue mats provided to team members. 1pt

  Yes

  No

  N/A

• Vulcan's filled no higher then the yellow line. 5pt

  Yes

  No

  N/A

• Filled totes stacked no higher than 4. 2pt

  Yes

  No

  N/A

• Empty totes stacked no higher then 15. 2pt

  Yes

  No

  N/A

• Totes can be lifted with 2 fingers. 2pt

  Yes

  No

  N/A

• Merchandise stored on shelves properly eg: heavy on bottom light on top, items not protruding into the aisles. 1pt

  Yes

  No

  N/A

• Are racks and shelves in good condition and stable. 1pt

  Yes

  No

  N/A

• Are signs and fixtures securely fastened to the wall? e.g pictures, posters, fixtures. 1pt

  Yes

  No

  N/A

• Are Gaylords placed on the right size pallet. 2pt

  Yes

  No

  N/A

• Is it clean around dumpster/compactor. 3pt

  Yes

  No

  N/A

• Are Operators properly trained. 5pt

  Yes

  No

  N/A

• Operator daily forklift check-list filled out consistently. 5pt<br>

  Yes

  No

  N/A

• Is the equipment regularly maintained? Forklift, Compactor, Pallet Jack, Bailer. 5pt

  Yes

  No

  N/A

• Does the site have a forklift?

  Off

  On

• When was the Forklift last maintained

  Date

• Does the site have a Bailer machine.

  Off

  On

• When was the Bailer last maintained

  Date

• Does the site have a compactor.

  Off

  On

• When was the Compactor last maintained

  Date

• Does the site have a Pallet jack

  Off

  On

• When was the Pallet jack last maintained

  Date

PPE Check

• Are steel-toed boots being worn for specific job tasks e.g: operating forklift or pallet jack, handling a pallet or furniture, working at the donation door. 5pt

  Yes

  No

  N/A

• Are cut resistant gloves being worn for specific job tasks e.g: handling unprocessed donations, receiving donations at donor door, handling pallets. 5pt

  Yes

  No

  N/A

• Are the donation attendants wearing their safety vest. 5pt

  Yes

  No

  N/A

Team member Survey - Yes when team member answers correctly, place No if answered incorrectly or is unsure

• Survey 1

  Off

  On

• Enter Name

• How do you use a fire extinguisher? P.A.S.S. 1pt<br>Answer: pull aim squeeze and sweep, point at the base of the fire

  Yes

  No

  N/A

• If you are injured, what are you to do? (tell your supervisor or manager right away). 1pt<br>Answer: Report the injury to your manager or supervisor right away

  Yes

  No

  N/A

• Do you know what WHMIS and MSDS is and what it means? 2pt<br>Answer:<br>1. WHMIS (Workplace Hazardous Material Information System) is worker awareness program about the hazardous chemicals in the workplace.<br>2. WHIMS educates workers on Responsibilities of the supplier, employer, and the worker. Procedures for safely storing, using and handling hazardous chemicals Properly labeling clear spray bottles with a workplace label 8 hazard symbols ex: fire, compressed gas, corrosive etc. What MSDS (Material Safety Data Sheet) are and the location of the binder

  Yes

  No

  N/A

• Do you know the OIS (Occupational Injury Services) clinic is and the benefits it offers? 2pt<br>Answer:<br>1. Same day access to a physician with a background in occupational medicine and WCB-Alberta training (target wait time of 30 minutes or less)<br>2. Don’t have to pay for forms to be filled out that usually cost $60<br>3. The doctor will create an individualized modified work plan to help you recover quickly and safely so you may return to your regular work duties when you’re better.

  Yes

  No

  N/A

• What is your sites emergency evacuation plan in case of a fire, tornado, gas leak or bomb threat? 2pt

  Yes

  No

  N/A

• Survey 2

  Off

  On

• Enter Name

• How do you use a fire extinguisher? P.A.S.S. 1pt<br>Answer: pull aim squeeze and sweep, point at the base of the fire

  Yes

  No

  N/A

• If you are injured, what are you to do? (tell your supervisor or manager right away). 1pt<br>Answer: Report the injury to your manager or supervisor right away

  Yes

  No

  N/A

• Do you know what WHMIS and MSDS is and what it means? 2pt<br>Answer:<br>1. WHMIS (Workplace Hazardous Material Information System) is worker awareness program about the hazardous chemicals in the workplace.<br>2. WHIMS educates workers on Responsibilities of the supplier, employer, and the worker. Procedures for safely storing, using and handling hazardous chemicals Properly labeling clear spray bottles with a workplace label 8 hazard symbols ex: fire, compressed gas, corrosive etc. What MSDS (Material Safety Data Sheet) are and the location of the binder

  Yes

  No

  N/A

• Do you know the OIS (Occupational Injury Services) clinic is and the benefits it offers? 2pt<br>Answer:<br>1. Same day access to a physician with a background in occupational medicine and WCB-Alberta training (target wait time of 30 minutes or less)<br>2. Don’t have to pay for forms to be filled out that usually cost $60<br>3. The doctor will create an individualized modified work plan to help you recover quickly and safely so you may return to your regular work duties when you’re better.

  Yes

  No

  N/A

• What is your sites emergency evacuation plan in case of a fire, tornado, gas leak or bomb threat? 2pt

  Yes

  No

  N/A

• Survey 3

  Off

  On

• What is your sites emergency evacuation plan in case of a fire, tornado, gas leak or bomb threat? 2pt

  Yes

  No

  N/A

• Enter Name

• How do you use a fire extinguisher? P.A.S.S. 1pt<br>Answer: pull aim squeeze and sweep, point at the base of the fire

  Yes

  No

  N/A

• If you are injured, what are you to do? (tell your supervisor or manager right away). 1pt<br>Answer: Report the injury to your manager or supervisor right away

  Yes

  No

  N/A

• Do you know what WHMIS and MSDS is and what it means? 2pt<br>Answer:<br>1. WHMIS (Workplace Hazardous Material Information System) is worker awareness program about the hazardous chemicals in the workplace.<br>2. WHIMS educates workers on Responsibilities of the supplier, employer, and the worker. Procedures for safely storing, using and handling hazardous chemicals Properly labeling clear spray bottles with a workplace label 8 hazard symbols ex: fire, compressed gas, corrosive etc. What MSDS (Material Safety Data Sheet) are and the location of the binder

  Yes

  No

  N/A

• Do you know the OIS (Occupational Injury Services) clinic is and the benefits it offers? 2pt<br>Answer:<br>1. Same day access to a physician with a background in occupational medicine and WCB-Alberta training (target wait time of 30 minutes or less)<br>2. Don’t have to pay for forms to be filled out that usually cost $60<br>3. The doctor will create an individualized modified work plan to help you recover quickly and safely so you may return to your regular work duties when you’re better.

  Yes

  No

  N/A

Additional Notes and signatures

• Notes

  Yes

  No

  N/A

• Notes

  Drawing

• Health and Safety Advisor Signature

  Sign

• Supervisor or H&S Ambassador signature

  Sign

• Manager or assistance manager signature

  Sign