SPECTRUM CONTRACTING INC.

• Conducted on

  Date

• Prepared by

Personal Protective Equipment

• Employees working at or above the grid inside or working on scaffolding outside wearing hard hats?

  Safe

  Unsafe

  N/A

  M.I.T

• Employees and subcontractor employees are wearing hard hat correctly?

  Safe

  Unsafe

  N/A

  M.I.T

• Wearing safety glasses for the task being performed?

  Safe

  Unsafe

  N/A

  M.I.T

• Wearing gloves for the task being performed?

  Safe

  Unsafe

  N/A

  M.I.T

• Wearing masks for the task being performed?

  Safe

  Unsafe

  N/A

  M.I.T

• Masks have been inspected and safe to use?

  Safe

  Unsafe

  N/A

  M.I.T

• Wearing ear protection for loud noise (ear plugs) for the task being performed?

  Safe

  Unsafe

  N/A

  M.I.T

• Wearing proper footwear for the task at hand?

  Safe

  Unsafe

  N/A

  M.I.T

General Site

• Lack of, inadequate trip /fall hazard inside or out the site? (flooring transitions, temporary floor changes, sidewalks, parking lots, etc)

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of, or inadequate, Traffic Management Plan (TMP)?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of traing in TMP? (contractors and visitors)

  Safe

  Unsafe

  N/A

  M.I.T

• Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

  Safe

  Unsafe

  N/A

  M.I.T

• Inadequate housekeeping?

  Safe

  Unsafe

  N/A

  M.I.T

Emergency

• Lack of, no emergency plans for site?

  Safe

  Unsafe

  N/A

  M.I.T

• Emergency procedures not displayed on site?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of training and rehearsal of emergency plans?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of, or inadequate first aid kit equipment for site?

  Safe

  Unsafe

  N/A

  M.I.T

• Insufficient access to formally trained First Aiders for all shifts?

  Safe

  Unsafe

  N/A

  M.I.T

• Insufficient / unlabeled Fire extinguishers?

  Safe

  Unsafe

  N/A

  M.I.T

Working at Heights

• Fall risks of 2m or more? (including void, pits and trenches)

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of edge protection? (e.g. barricade)

  Safe

  Unsafe

  N/A

  M.I.T

• Unsafe or incomplete edge protection?

  Safe

  Unsafe

  N/A

  M.I.T

Scaffold

• Unsafe or incomplete scaffolds?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of inspection protocol for scaffolds?

  Safe

  Unsafe

  N/A

  M.I.T

• Exceeded Safe Work Load (SWL)? (tools, stored materials, number of persons)

  Safe

  Unsafe

  N/A

  M.I.T

• Incorrect tagging of scaffold components?

  Safe

  Unsafe

  N/A

  M.I.T

• Incompatible scaffold components?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsecured toe boards?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsecured footing? (no sound)

  Safe

  Unsafe

  N/A

  M.I.T

• Incorrect tie points ?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsecured tie points?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsecured guard railing system?

  Safe

  Unsafe

  N/A

  M.I.T

Ladders

• Unsafe or damaged ladders?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsafe positioning of ladders?

  Safe

  Unsafe

  N/A

  M.I.T

• Ladder not properly secured?

  Safe

  Unsafe

  N/A

  M.I.T

• Ladder unsuitable for the job (e.g. metal ladder used for electrical work)

  Safe

  Unsafe

  N/A

  M.I.T

Hazardous Chemical

• Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)

  Safe

  Unsafe

  N/A

  M.I.T

• Incompatible chemicals stored near each other?

  Safe

  Unsafe

  N/A

  M.I.T

• Inadequate spill containment equipment?

  Safe

  Unsafe

  N/A

  M.I.T

• Inaccessible Safety Data Sheets on site?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of emergency procedures for injury/spills/fire etc?

  Safe

  Unsafe

  N/A

  M.I.T

• Excessive quantities stored on site or in vehicles?

  Safe

  Unsafe

  N/A

  M.I.T

• Insufficient ventilation?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsuitable storage containers? (unlabeled or stored in food containers)

  Safe

  Unsafe

  N/A

  M.I.T

Environmental Hazzards

• Lack of, or inadequate Environmental Management plan (EMP)?

  Yes

  No

  N/A

Electrical Hazards

• Damaged extension cord?

  Safe

  Unsafe

  N/A

  M.I.T

• Overloading outlets?

  Safe

  Unsafe

  N/A

  M.I.T

Power and Hand Tools

• Lifting Equipment - unsafe or damaged plant?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of maintenance, testing and inspection?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of SWL information displayed?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsafe or damage lifting equipment, including rope, slings, chains, hooks?

  Safe

  Unsafe

  N/A

  M.I.T

• Unlicensed operators?

  Safe

  Unsafe

  N/A

  M.I.T

Harness

• Unsafe or damaged harness

  Safe

  Unsafe

  N/A

  M.I.T

• Incompatible hooks/equipment?

  Safe

  Unsafe

  N/A

  M.I.T

• Unlabelled or does not meet AS?

  Safe

  Unsafe

  N/A

  M.I.T

• Unsafe or uncertified anchor points?

  Safe

  Unsafe

  N/A

  M.I.T

• Lack of inspection protocol for equipment?

  Safe

  Unsafe

  N/A

  M.I.T

• Select date

  Date

• Add signature

  Sign