Information
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Project Name:
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Project Number:
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Site Owner:
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Weather:
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Conducted on
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Prepared by
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Superintendent:
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Foreman:
Site Inspection:
Documentation:
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Daily Safety Meeting Record Completed?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Weekly Toolbox Meeting Record completed and signed by workers?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Site Specific Plan Risk Assessment completed and signed by Safety Coordinator and Project Manager/Superintendent?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Ground Disturbance Permit completed and signed by workers?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Safety Board up to date?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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JOHS meeting minutes up to date?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All workers completed site specific orientation?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All workers completed Hall Corporation Safety Orientation?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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WCB inspection minutes posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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BC One up to date?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Date of recent BCOne Call:
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30M33 completed and posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Notice of Project completed and posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Site Safety Rules posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Site Emergency Preparedness information completed and posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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JOHS Committee members posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Notice to Workers Posted (PL 9/PL 8)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Workers Compensation Act/ OHS regulations available (PL 29)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Traffic/ Pedestrian Management:
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Traffic Management Plan in place?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Signs, barricades, hoarding, and delineators in place as required?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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TCP's wearing appropriate PPE?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is the roadways safe for vehicle/ bicycle traffic? (i.e. potholes, saw cuts, etc.)
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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TCP certification available?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Fire Prevention:
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Fire extinguishers are tagged and checked monthly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Fire extinguishers are accessible?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Flammable materials are stored away from compressed gas or enclosed areas?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Emergency Preparedness:
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Air horn, radio or cell phone communication established?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Muster station is established and communicated?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Route to the hospital has been determined and posted?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Emergency exits are clear of obstructions and marked?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
First Aid:
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First aid attendant is scheduled for adequate level of training?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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First aid room/ dressing station is adequately stocked?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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First aid kit adequately stocked?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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First aid room is clean?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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First aid attendant's certificate is available on site?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
WHMIS
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Controlled products are labelled properly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Controlled products are stored as per Safety Data Sheets (SDS)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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SDS are up to date (within 3 years) and available?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Controlled products are handled properly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Spill kits are available on site?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Personal Protective Equipment (PPE)
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PPE requirements have been communicated?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Baisc PPE requirements (hard hat, CSA approved steel toed boots and hi-viz vests) are being worn by all workers?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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PPE is being used and maintained properly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Housekeeping:
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Toilets, washing, drinking, and eating facilities are clean and stocked?Work
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Work areas are clean of construction debris?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Pedestrian walk ways are free of tripping hazards (ie string line, wood debris, nails, etc)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Materials and equipment are parked in a safe and secure manner?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Adequate garbage containers are available on site and being used?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Spilled or leaked liquids are being cleaned up?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Mobile Equipment
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Daily Pre-Trip Inspections are being completed by operators?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Horns, lights and backup alarms are working properly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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No hydraulic leaks are notice?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Equipment is being operated at a safe speed and under control?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Seat belts are being worn?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Fire extinguishers are available in the machine?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Spill kits are available in the machine?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Only equipment operators are in moving equipment (ie no riders)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Equipment is parked in a safe location with all attachments and secured with the transmission in the manufacturer's specific park position?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Tools (Power, Gas, Hand, Pneumatic, Powder Actuated)
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Electrical cords in good condition?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Compressed air connections secured (ie with pins)?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Equipment is disconnected before repair and adjustments?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Compatible components used?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Guards are in place and used correctly?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Specialized PPE is being worn by operator?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Compressed Gas Cylinders:
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All cylinders are strapped or otherwise secured?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All cylinders are being stored away from heat, sparks, or flammable products?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Compressed gas cylinders are not stored in C-cans or enclosed areas?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All torches (oxy/fuel) are equipped with flash arrests/ suppressors?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Oxygen cylinders are not stored with flammable/ combustible cylinders?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Cylinders are capped when not in use or affixed with a regulator?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Rigging:
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All rigging has been inspected before use?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Rigging is being used as per lifting ratings?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All lifting hooks have a safety latch?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Rigging has certification tag attached?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Defective rigging is tagged out?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Fall Protection:
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All situations where fall protection is required has been identified? (over 3m/ 10ft or; when a hazard exists below work area)
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Workers are instructed to wear fall protection before entering work are where fall hazards exist?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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All fall protection equipment is inspected and maintained?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Type of fall protection being used?
- Guardrails
- Fall Restraint
- Fall Arrest
- Work Zone with Monitor
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Guardrails are installed whenever possible, and are the right type and construction as per OHS Regulation. (125 lb resistance)
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Horizontal lifeline systems are installed as per manufacturer's instructions or OHS Regulation Guideline 11.7?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Vertical lifeline systems are installed correctly as per manufacturer's instructions?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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A written Fall Protection Plan is in place for work over 7.5m/ 25 ft?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Anchor points are the right type and strength for fall protection system? (Fall restraint: 800 lbs or 4 times body weight, Fall Arrest: 5,000 lbs)
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Electrical (Low Voltage)
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GFCI or Assured Grounding Program is in place?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Cords are intact?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Lock out procedures are in place?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Energized panels and junction boxes are covered if outdoors?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Plugs and prongs are in good condition?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Electrical cords are strung or otherwise protected?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Lighting systems are in place?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Electrical (High Voltage)
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Limits of approach
750v to 75kv- 3m/10ft
75kv to 250kv- 4.5m/15ft
250kv to 550kv- 6m/20ft -
Limits of Approach are known and maintained?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is high voltage overhead/underground power lines guarded?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Ladders
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Are ladders in good condition with suitable undamaged rungs, rails and feet?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Ladders secured in place when required?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Ladder at a 4:1 ratio and extended 3 feet above upper landing?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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No work is occurring on the last 2 steps of the ladder?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Excavations:
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Has the location of underground utilities been determined prior to beginning excavations?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is the BC One call available with the crew?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Has the utility location been clearly identified on the ground through the use of spray paint or other means?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Have utilities been hand exposed within 1m prior to mechanical excavating?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Have all exposed and undermined utilities been adequately supported?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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If the excavation is more than 1.2m/ 4ft deep have the workers been protected through the use of shoring, sloping, benching or by work instructions from a P. Engineer or Geotech?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is emergency access/egrees maintained at all times?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is the shotcrete shoring and anchor drawings signed and sealed by a P. Eng or Geotech.
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is manufactured shoring being used?
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Does the shoring cage system extend at least 1 foot above the grade, unless in a roadway?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Has the area between the shoring cage and excavation been backfilled or braced?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Has the area between the shoring cage and excavation been backfilled or braced?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is the shoring cage equipped with a ladder for access/egress?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is a copy of the shoring cage engineering certificate available on site?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Are you using benching or sloping?
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If sloping: Does it follow the 3V:4H or better sloping requirements?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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If benching: Does it follow the 3V:4H or better benching requirements?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Is written instruction being used by a Geotch/P.Engineer?
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Written Instructions for trenching must include:
-Written and available on site?
-Specify support and sloping requirements, and the subsurface condition to be expected?
-Date of issue
-Site address/location
-Drawings/ sketches, plan and sections and/or clearly written instructions
-Geotechnical description of expected soil conditions, or confirmation upon site require
-Limitations of machinery or equipment being used adjacent to the excavation
-Time period for which certification applies
-Influence of changing weather conditions
-Name of certifying engineer, signature and seal -
Does it include the above requirements?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Confined Space
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Confined spaces are identified, warning signs posted, and access points are secured against entry?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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A qualified supervisor is assigned responsibility for supervising entry and issuing entry permits?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Safe work procedures are in place, and based on the hazard assessment prepared by a qualified person?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Procedures used when entering a confined space are consistent with written procedures?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Personnel with confined space entry duties are trained in hazards and safe work procedures?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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There are provisions for rescue of persons inside a confined space, personnel are trained and equipped?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Standby personnel requirements are satisfied?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Ventilation and atmospheric monitoring requirements satisfied?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Personal protective equipment and clothing suited to the hazard are worn/ used by personnel?
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Risk Level
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Concern/ Comment:
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Other:
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Other concern/ Comment:
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Risk Level
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
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Other concern/ Comment:
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Risk Level
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Corrective Action (include expected completion date/ by whom):
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Date Corrected/ Initial:
Monthly Tools and Equipment:
Hand Tools
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Hand Saw
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Risk Level
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Comment/Concern:
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Corrective Action (include expected completion date/by whom):
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Corrected Date/ Initial:
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Sledge Hammer
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Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Watering Cans
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Shovels, Rakes, Brooms
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Rigging
-
Slings
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Wire Cables
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Hooks
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Shackles
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Clutches
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Gas Powered
-
Chop Saw
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Jumping Jack
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Plate Tamper
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Generator
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Chain Saw
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Power Broom
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Compressed Air
-
Jack Hammer/ Chipping Gun
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Compressed Air Tanks
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Electrical Tools
-
Pumps
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Coring Equipment
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Electrical Cords
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Fall Protection
-
Lanyard
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Harness
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Rope Grab
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Life Line
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Anchors
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Self Retracting Lanyards
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Confined Space
-
Tripod with Winch
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Blower
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Gas Detector
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Harness
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Other:
-
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
-
Other:
-
Small Tools
-
Risk Level
-
Comment/Concern:
-
Corrective Action (include expected completion date/by whom):
-
Corrected Date/ Initial:
Monthly PPE:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
-
Worker Name
-
PPE Inspected
- Hard Hat
- CSA Approved Boots
- Hi Viz Vest
- Respirator
- Gloves
- CSA Glasses
- Hearing Protection
-
Comment/Corrective Action Required:
-
Correct Date/ By Whom:
Signature:
-
Person Completing Inspection Report
-
Site Supervisor
-
Safety Department
