Universal Auditing Tool

• Site conducted

  Select Abby Trademark 4SK Infinity Sumas Ruby Creek BC Packhouse Langley Calgary Packhouse Crossfield Wellington Kingsville Leamington Other:

  • Abby
  • Trademark
  • 4SK
  • Infinity
  • Sumas
  • Ruby Creek
  • BC Packhouse
  • Langley
  • Calgary Packhouse
  • Crossfield
  • Wellington
  • Kingsville
  • Leamington
  • Other:

• What site is being audited?

• Conducted on

  Date

• Prepared by

• Location
  Address

• Department

  Select Phase I Phase II Growing Phase III Casing Barn/Dirt Shed Crew Cultivation Prep Maintenance Harvest Packing Shipping/Distribution Office Space Other:

  • Phase I
  • Phase II
  • Growing
  • Phase III
  • Casing Barn/Dirt Shed
  • Crew
  • Cultivation
  • Prep
  • Maintenance
  • Harvest
  • Packing
  • Shipping/Distribution
  • Office Space
  • Other:

• What department is being audited?

Previous Audits

• Has the previous workplace inspection sheet been reviewed with the area manager/supervisor?

  Yes

  No

• Are there any outstanding/not completed items on previous inspection?

  No

  Yes

• List item(s)

PPE

• Are the treads of associates shoes in good condition and in alignment with Highline standards?

  Compliant

  Non-Compliant

  N/A

• Is additional PPE required in the department? (i.e. safety glasses, hard hats, etc)

  Yes

  No

• Are all associates wearing required PPE in alignment with safety requirements for the area?

  Compliant

  Non-Compliant

  N/A

• Does PPE have a designated space to maintain housekeeping, cleanliness and functionality?

  Compliant

  Non-Compliant

  N/A

• Is PPE being used in the working area in good condition and free of defects/damage?

  Good

  Fair

  Poor

  N/A

• REMOVE PPE FROM THE AREA AND REQUIRE THE ASSOCIATE TO STOP WORK UNTIL PROPER PPE IS USED

• Are there signs in installed and in good condition to indicate the requirement for additional PPE?

  Compliant

  Non-Compliant

  N/A

• Is welding being conducted in the area?

  Yes

  No

• Are associates wearing a welding helmet/mask?

  Safe

  At Risk

  N/A

• Are welding barriers/screens in place to prevent other associates from being exposed to welding flash?

  Safe

  At Risk

  N/A

• Are associates wearing a respirator and/or have adequate ventelation?

  Safe

  At Risk

  N/A

• Are associate's clothing FR rated?

  Safe

  At Risk

  N/A

• Are associates wearing welding gloves?

  Safe

  At Risk

  N/A

• Is there a hot work permit present?

  Safe

  At Risk

  N/A

• Is there a fire watch?

  Safe

  At Risk

  N/A

• STOP WORK IMMEDIATELY UNTIL PRECAUSTIONS AND CONTROLS ARE IN PLACE

• Are there flammable or explosive materials near by? (within 9 meters)

  Safe

  At Risk

  N/A

• STOP WORK IMMEDIATELY UNTIL PRECAUSTIONS AND CONTROLS ARE IN PLACE

• Are respirators or PAPR units in use in the working area? (N95, Half Face, Full Face, etc.)

  Yes

  No

• Does PPE have a designated space to maintain housekeeping, cleanliness and functionality?

  Compliant

  Non-Compliant

  N/A

• Are sanitizing supplies provided to ensure the PPE is disinfected after each use?

  Safe

  At Risk

  N/A

• Are respirators worn by all associates?

  Compliant

  Non-Compliant

  N/A

• Are associates clean shaven and fit tested for respirator use?

  Compliant

  Non-Compliant

  N/A

• Are correct filters in use and within expiration date?

  Safe

  At Risk

  N/A

Housekeeping

• The work area is free of tripping hazards such as tools left on the ground, wiers, etc.

  Good

  Fair

  Poor

  N/A

• Shovels, brooms and squeegee tools are present, accessible and in good condition for associates to use in their area?

  Yes

  No

  N/A

• Are tools kept up off the floor and stored properly?

  Safe

  At Risk

  N/A

• Area floors clear of fallen mushrooms, casing material and debris?

  Good

  Fair

  Poor

  N/A

• Are floors wet or slippery?

  Good

  Fair

  Poor

  N/A

• Associates who are standing for more than 30 minutes in a static position are standing on an ergonomic mat

  Good

  Fair

  Poor

  N/A

• Safety overhead mirrors are in good condition and free of cracks or disrepair

  Good

  Fair

  Poor

  N/A

• Are materials stored neatly and safely?

  Good

  Fair

  Poor

  N/A

• Are there step ladders or stools to get to materials on higher shelves

  Safe

  At Risk

  N/A

• Are heavy and large objects stored on lower shelves?

  Safe

  At Risk

  N/A

• Is there evidence of combustible dust in the working area?

  No

  Yes

• Does any electrical equipment show signs of water exposure?

  No

  Yes

• Do associates have access to hand sanitizer, hand washing stations and clean drinking water?

  Safe

  At Risk

  N/A

• Are there garbage disposal bins, broken pallet disposal bins, recycle bins, etc. in the working area?

  Compliant

  Non-Compliant

  N/A

• Are washrooms and eating areas clean?

  Good

  Fair

  Poor

  N/A

• Are there signs indicating the process of hand washing in the area?

  Compliant

  Non-Compliant

  N/A

• Is there adequate toiletries and hand sanitizing supplies in the washroom areas?

  Compliant

  Non-Compliant

  N/A

Electrical

• Is there adequate lighting in area and are lights fully functional?

  Safe

  At Risk

  N/A

• Are junction boxes and electrical panels closed?

  Safe

  At Risk

  N/A

• Wires are in good condition and free of damage

  Safe

  At Risk

  N/A

• Immediately inform the area supervisor. DO NOT touch the extension cord if there is evidence of damage or it is not water proofed.

• Electrical panels clear of obstruction by at least 3 ft on either side and infrastructure of the panel allowing for easy and ready access

  Compliant

  Non-Compliant

  N/A

• There must be a 3 foot area clear around electrical panels. If a panel is blocked, notify the area supervisor of the issue immediately.

• Is there equipment in the work area which requires plug-in to a 600V outlet?

  Yes

  No

• Are there electrical gloves accessible to the associates in the work area?

  Safe

  At Risk

  N/A

• Are electrical gloves inspected and stamped within the past year?

  Compliant

  Non-Compliant

  N/A

• Do electrical gloves show any sign of degrading, mis-use or damage?

  Safe

  At Risk

  N/A

• Are there plug lockout devices with the equipment?

  Safe

  At Risk

  N/A

• Are extension cords used only for temporary power needs and water proofed?

  Yes

  No

  N/A

• Immediately inform the area supervisor. DO NOT touch the extension cord if there is evidence of damage or it is not water proofed.

• Are extension cords out of the aisles where they can be abused by heavy traffic?

  Safe

  At Risk

  N/A

• Is permanent wiring used instead of extension cords?

  Compliant

  Non-Compliant

  N/A

Psychosocial

• Associates do not demonstrate impairment mentally, physically or emotionally.

  Safe

  At Risk

  N/A

• Was a supervisor reachable in the area?

  Yes

  No

  N/A

• Associates do not work alone for more then 15 minutes and have a plan in place if working alone is required

  Compliant

  Non-Compliant

  N/A

• Are associates provided with adequate breaks through out their shift?

  Compliant

  Non-Compliant

  N/A

• Do associates receive clear direction, communication and feedback on work tasks and their performance?

  Compliant

  Non-Compliant

  N/A

Emergency Equipment and Building Compliance

• Is there clear instruction for all visitors and/or contractors to report to the office to sign in?

  Compliant

  Non-Compliant

  N/A

• Are there signs and indicators indicating restricted or hazardous areas?

  Safe

  At Risk

  N/A

• Are pedestrian doors and walkways free of obstruction?

  Compliant

  Non-Compliant

  N/A

• Are Exterior doors are only accessible with a key card/fob?

  Yes

  No

  N/A

• Are there Emergency exits have panic/push bars installed to allow for quick and safe exit from the building?

  Compliant

  Non-Compliant

  N/A

• Are Severe weather shelter area sign and/or indicators are clearly labeled and evident in the inspection area?

  Yes

  No

  N/A

• Are Evacuation Points and shelter areas are identified with a sign or other indicator?

  Yes

  No

  N/A

• Lighting is adequate in parking areas and out door walking areas

  Yes

  No

  N/A

• Alarm system functioning (if applicable)

  Yes

  No

  N/A

• Parking Lot lines are painted and applicable signage is present

  Yes

  No

  N/A

• Are there signs indicated smoking and vaping is prohibited on all entrance points, eating areas, first aid rooms and wahsrooms?

  Compliant

  Non-Compliant

  N/A

• Are there designated smoking areas available to associates with clear signs posted to indicate their location?

  Safe

  At Risk

  N/A

• Are there cigarette disposal units provided to associates?

  Safe

  At Risk

  N/A

• Are there signs of cigarettes being disposed of improperly?

  Safe

  At Risk

  N/A

• Are emergency doors clearly indicated by a sign and free of obstruction?

  Compliant

  Non-Compliant

  N/A

• Emergency lights functioning and present where required (exits, and in alignment with building codes).

  Compliant

  Non-Compliant

  N/A

• Are garbage disposal bins away from living structures?

  Compliant

  Non-Compliant

  N/A

• Are there any signs of wildlife or other animals onsite which could pose a hazard to associates?

  Safe

  At Risk

  N/A

• Eye wash stations present, marked with a sign, clear of obstruction, in good working condition and clean

  Compliant

  Non-Compliant

  N/A

• Fire extinguishers present, marked with a sign, and clear of obstruction

  Compliant

  Non-Compliant

  N/A

• Are alarm systems clear of obstruction and indicated by a sign?

  Compliant

  Non-Compliant

  N/A

• Fire extinguishers are inspected within the last 30 days and have a sign indicating their location

  Compliant

  Non-Compliant

  N/A

• Are fire maps posted at exits, legible and up to date?

  Compliant

  Non-Compliant

  N/A

• Are first aid stations and rooms inspected within the last 30 days and indicated by a sign??

  Compliant

  Non-Compliant

  N/A

• Is there at least one first aider on site for the department?

  Compliant

  Non-Compliant

  N/A

• Is there an AED in the working area?

  Yes

  No

• AED Units are indicated with a sign

  Yes

  No

  N/A

• AED Battery reading is, "OK"

  Yes

  No

  N/A

Lifting Devices

• Are there rails, trolleys or lifting devices in the working area?

  Yes

  No

• What type of devices are present?

  Select Hydraulic Lift Device/Platform Class Pneumatic Lift Device/Platform Class Crank - Manual Lift Device/Platform Class Electrical Lift Device/Platform Class Growing/Tunnel Doors Lift Device Harvest Manual Set Up Platforms

  • Hydraulic Lift Device/Platform Class
  • Pneumatic Lift Device/Platform Class
  • Crank - Manual Lift Device/Platform Class
  • Electrical Lift Device/Platform Class
  • Growing/Tunnel Doors Lift Device
  • Harvest Manual Set Up Platforms

• Are lines in good condition and free of cracks, splits or pin holes?

  Safe

  At Risk

  N/A

• Are controls free of malfunctions and used in accordance with SOP's?

  Safe

  At Risk

  N/A

• Are elevating devices used only within their capacity?

  Safe

  At Risk

  N/A

• Is hydraulic fluid at appropriate levels for operations?

  Safe

  At Risk

  N/A

• Is there any signs of leakage from the device?

  Safe

  At Risk

  N/A

• Has the device received and annual inspection in the past year?

  Compliant

  Non-Compliant

  N/A

• Are cable systems are in good condition?

  Safe

  At Risk

  N/A

• Can trolleys move freely and unhindered?

  Safe

  At Risk

  N/A

• Are trolley system top and bottom rails in good condition and free of breaks in welds, corrosion, bends, twists, warps, etc.?

  Safe

  At Risk

  N/A

• Are trolley pins engaged where required?

  Safe

  At Risk

  N/A

• Workplace Inspections were completed by a supervisor prior to work beginning

  Compliant

  Non-Compliant

  N/A

• Are weight capacity stickers installed, legible and complied with by operators?

  Safe

  At Risk

  N/A

• Has the device received and annual inspection in the past year?

  Compliant

  Non-Compliant

  N/A

• Are cable systems are in good condition?

  Safe

  At Risk

  N/A

• Are the crank systems in good condition?

  Safe

  At Risk

  N/A

• Can trolleys move freely and unhindered?

  Safe

  At Risk

  N/A

• Are trolley system top and bottom rails in good condition and free of breaks in welds, corrosion, bends, twists, warps, etc.?

  Safe

  At Risk

  N/A

• Are trolley pins engaged where required?

  Safe

  At Risk

  N/A

• Workplace Inspections were completed by a supervisor prior to work beginning

  Compliant

  Non-Compliant

  N/A

• Are weight capacity stickers installed, legible and complied with by operators?

  Safe

  At Risk

  N/A

• Has the device received and annual inspection in the past year?

  Compliant

  Non-Compliant

  N/A

• Are door lifts in good condition and free of bending, twisting, splits, etc.?

  Good

  Fair

  Poor

  N/A

• Are doors in good condition and free of bending, twisting, splits, etc.?

  Good

  Fair

  Poor

  N/A

• Do doors bare a legible label for weight ratings and other relevant information?

  Good

  Fair

  Poor

  N/A

• Are securing brackets in good condition and free of bending, twisting, splits, etc.?

  Good

  Fair

  Poor

  N/A

• Are fail safes in place?

  Compliant

  Non-Compliant

  N/A

• Are rails and casters in good condition and free of bending, twisting, splits, etc.?

  Safe

  At Risk

  N/A

• Trolley welds in good condition (inspect platforms at random)

  Safe

  At Risk

  N/A

• Trolleys move freely and unhindered

  Safe

  At Risk

  N/A

• Trolley system top and bottom rails in good condition and free of breaks in welds, corrosion, bends, twists, warps, etc.

  Safe

  At Risk

  N/A

• Platforms rivets and welds are in good condition

  Safe

  At Risk

  N/A

• Do associates wear fall restraint belts while harvesting on platforms?

  Safe

  At Risk

  N/A

• Are there hoists or cranes in the working area?

  Yes

  No

• Are there signs of bending, cracking, or damage on the lift device?

  Good

  Fair

  Poor

  N/A

• Are elevating devices used only within their capacity?

  Good

  Fair

  Poor

  N/A

• Are all of the bolts and nuts tightened firmly?

  Safe

  At Risk

  N/A

• Any deformed, cracked, or corroded members such as the casters, arm or base?

  Safe

  At Risk

  N/A

• Is the load rating marked and legible on the device?

  Safe

  At Risk

  N/A

• Has the device received and annual inspection in the past year?

  Compliant

  Non-Compliant

  N/A

• PM items completed by Maintenance?

  Yes

  No

  N/A

• Are there scissor/man lifts in the working area?

  Yes

  No

• Are devices operated in accordance with SOP and training and in good working condition?

  Compliant

  Non-Compliant

  N/A

• Are pre-use inspections completed by the operator prior to use?

  Compliant

  Non-Compliant

  N/A

• Is the operator wearing a fall arrest system and tied off at all times?

  Compliant

  Non-Compliant

  N/A

• Is the device in good condition?

  Compliant

  Non-Compliant

  N/A

• Are elevating devices used only within their capacity?

  Compliant

  Non-Compliant

  N/A

• Has the device received an annual inspection in the past year?

  Compliant

  Non-Compliant

  N/A

Machinery and Equipment

• Is equipment/machinery or other items tagged out of service if damaged or in a state of disrepair?

  Safe

  At Risk

  N/A

• Is there machinery in use in the working area?

  Yes

  No

• What types of equipment were inspected? (choose all that apply)

  Select Headfiller Winch Tunnels Winch Hopper Packing Conveyor Slice Machine Box Machine Box Compactor Metal Detector Blending Line Overhead Tunnels Conveyor Basement Conveyor AXIS Unit Cassette Emptying Conveyor Boiler/HVAC/Air Handler Truck/Trailer Auger/Mixer Bay Door Other:

  • Headfiller
  • Winch
  • Tunnels Winch
  • Hopper
  • Packing Conveyor
  • Slice Machine
  • Box Machine
  • Box Compactor
  • Metal Detector
  • Blending Line
  • Overhead Tunnels Conveyor
  • Basement Conveyor
  • AXIS Unit
  • Cassette
  • Emptying Conveyor
  • Boiler/HVAC/Air Handler
  • Truck/Trailer
  • Auger/Mixer
  • Bay Door
  • Other:

• What equipment was inspected?

• Are guards in good condition and fastened at least in two separate locations?

  Compliant

  Non-Compliant

  N/A

• Are e-stops within reach of the operator(s) at all times?

  Compliant

  Non-Compliant

  N/A

• Are e-stops functioning?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEIDATELY UNTIL THE ESTOP CAN BE REPAIRED

• Are equipment and machinery kept clean and parked in a designated area after job tasks are completed?

  Compliant

  Non-Compliant

  N/A

• Are guards in place where required under CSA?

  Compliant

  Non-Compliant

  N/A

• Are doors and panels interlocked?

  Compliant

  Non-Compliant

  N/A

• Are interlocks functioning?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEIDATELY UNTIL THE INTERLOCK CAN BE REPAIRED

• Do guards prevent access to a hazardous area or moving part of a machine?

  Compliant

  Non-Compliant

  N/A

• Are fail safes in good working condition, in place and being used in alignment with SOP?

  Compliant

  Non-Compliant

  N/A

• Are labels and warning signs in place, legible, displayed in applicable languages and where required under CSA?

  Compliant

  Non-Compliant

  N/A

• Are pre-use inspection for equipment complete and signed off?

  Compliant

  Non-Compliant

  N/A

• PM items completed by Maintenance?

  Yes

  No

  N/A

• Are lockout stations in the area?

  Yes

  No

• Are lockout stations adequately stocked with locks, hasps and tags?

  Yes

  No

  N/A

• Are associate performing maintenance, cleaning, adjusting, etc. on equipment?

  Yes

  No

• Do associates working on site have lockout training?

  Safe

  At Risk

  N/A

• Do associates turn off disconnect switches before unplugging equipment.

  Safe

  At Risk

  N/A

• When performing maintenance, machinery and hazardous energy was identified, locked out, tagged out and tried out.

  Compliant

  Non-Compliant

  N/A

• Lockout devices are readily available to associates

  Safe

  At Risk

  N/A

• Machinery being cleaned, adjusted or repaired locked out and tagged out

  Compliant

  Non-Compliant

  N/A

• Estops are functioning and in good condition

  Compliant

  Non-Compliant

  N/A

• Cords are stored properly to prevent damage or unsafe working conditions

  Safe

  At Risk

  N/A

Change Management

• Is there any new or modified equipment in the department?

  Yes

  No

• Have there been any recent changes to the processes? i.e. equipment moved or relocated?

  Yes

  No

  N/A

• Was the JHSC involved at the onset of the process change or procuring the equipment?

  Yes

  No

  N/A

• Was a Pre-start completed with the JHSC prior to it being released to production?

  Yes

  No

  N/A

Vehicles

• Are there vehicles in use in the working area?

  Yes

  No

• Are there signs, in good condition alerting pedestrians to the hazard of operating vehicles in the area?

  Safe

  At Risk

  N/A

• Are fumes and exhaust controlled?

  Safe

  At Risk

  N/A

• Are pre-use inspections books with the unit?

  Compliant

  Non-Compliant

  N/A

• Are vehicles pre-inspected and in good working condition?

  Compliant

  Non-Compliant

  N/A

• Do operators follow SOP's and training?

  Compliant

  Non-Compliant

  N/A

• Are horns sounded at blind spots, doorways, pedestrian areas, etc?

  Compliant

  Non-Compliant

  N/A

• Are overhead mirrors located at all blind spots?

  Safe

  At Risk

  N/A

• Are associates wearing High-visibility clothing in the working area?

  Compliant

  Non-Compliant

  N/A

• Are there steps or ladders on the vehicle?

  Yes

  No

• Are the handrails, handholds in place?

  Yes

  No

  N/A

• Are the stairs in good repair?

  Yes

  No

  N/A

• Are steps free of objects, tools or debris that could cause slips?

  Yes

  No

  N/A

• Are there slow moving vehicles in the area?

  Yes

  No

• • Is there a slow moving vehicle (SMV) sign on the rear of the vehicle and in good condition?

  Safe

  At Risk

  N/A

• Are there POWER TAKE OFF (PTO) vehicles in the area?

  Yes

  No

• Do all PTO’s have shields & guards in place?

  Yes

  No

  N/A

• Is there a master shield in place where your PTO meets the vehicle?

  Yes

  No

  N/A

• Are shields on PTO’s checked periodically to ensure that they rotate freely? CHECK WITH POWER OFF AND LOCKED OUT.

  Yes

  No

  N/A

• Are there tractors in the area?

  Yes

  No

• Is the tractor equipped with a rollover protective structure (ROPS) and seatbelts?

  Safe

  At Risk

  N/A

• Are all protective shields and guarding in place?

  Compliant

  Non-Compliant

  N/A

• Is there a slow moving vehicle (SMV) sign on the rear of the tractor or towed equipment for roadway travel?

  Compliant

  Non-Compliant

  N/A

• When towing equipment, are safety hitch pins and chains in use and in good condition?

  Compliant

  Non-Compliant

  N/A

• Is there an inspection book with the vehicle?

  Compliant

  Non-Compliant

  N/A

• Are tractors pre-inspected and in good working condition?

  Compliant

  Non-Compliant

  N/A

Ladders

• Are there ladders, stools or rolling staircases in the working area?

  Yes

  No

• Stools and ladders in good condition?

  Safe

  At Risk

  N/A

• Are ladders set up properly before use?

  Compliant

  Non-Compliant

  N/A

• Ladders do not demonstrate signs of alteration or repairs.

  Safe

  At Risk

  N/A

• The correct ladder type and height is being used for the job task.

  Safe

  At Risk

  N/A

• Feet and braces of ladders are in good condition.

  Safe

  At Risk

  N/A

• There are no loose bolts, no cracks, no splits in frames, excessive rust/corrosion observed.

  Safe

  At Risk

  N/A

• Rails are not twisted or distorted.

  Safe

  At Risk

  N/A

• Steps are not missing, loose or broken.

  Safe

  At Risk

  N/A

• Are permanent ladders for roof or other access in the area?

  Yes

  No

• Are permanent ladders in good condition & inspected regularly?

  Yes

  No

  N/A

• Do ladders prevent unauthorized use?

  Yes

  No

  N/A

• Do ladders ascending to areas over 10 ft in height have 42" rails around the top of the ladder or anchor points to prevent falls?

  Yes

  No

  N/A

Chemical

• Is there an SDS binder available to associates?

  Yes

  No

  N/A

• Has the SDS binder been reviewed in the past 2 years?

  Compliant

  Non-Compliant

  N/A

• Is there a chemical storage area in the working area?

  Yes

  No

• Chemicals are stored on spill containment pallets and a emergency spill kit is available in the event of an emergency

  Compliant

  Non-Compliant

  N/A

• Is a spill kit within 50 feet of the storage area and indicated by a sign?

  Compliant

  Non-Compliant

  N/A

• Are flammable liquids properly stored?

  Compliant

  Non-Compliant

  N/A

• PPE available and in good condition for handling chemicals as outlined by SDS sheets

  Compliant

  Non-Compliant

  N/A

• Chemical sotrage prevents un-authorized persons from accessing hazardous substances

  Compliant

  Non-Compliant

  N/A

• Are there signs indicting only authorized personnel may enter the space due to the presence of WHIMS 2015 controlled products?

  Compliant

  Non-Compliant

  N/A

• Associates have WHMIS 2015 training - especially those who access chemical storage areas

  Compliant

  Non-Compliant

  N/A

• Proper fire fighting equipment within 10 ft of the chemical storage area

  Compliant

  Non-Compliant

  N/A

• Is the storage area and products organized to keep incompatible products separated?

  Compliant

  Non-Compliant

  N/A

• Are hazardous products stored away from heat sources?

  Compliant

  Non-Compliant

  N/A

• Are containers in good condition and free of leaks or damage?

  Compliant

  Non-Compliant

  N/A

• Are all products labelled, and are missing or damaged labels replaced immediately?

  Compliant

  Non-Compliant

  N/A

• Are bonding and grounding connections immediately available for flammable products?

  Compliant

  Non-Compliant

  N/A

• Is the ventilation for the storage area adequate for the products stored within?

  Compliant

  Non-Compliant

  N/A

• Are there metal containers for oily rags and other flammable discarded items?

  Compliant

  Non-Compliant

  N/A

• A continuous 15-min eye wash station/chemical shower is present and within 50 ft of the storage area

  Compliant

  Non-Compliant

  N/A

Docks

• Are there docks in the working area?

  Yes

  No

• Are dock lights functioning properly and in good working condition ?

  Safe

  At Risk

  N/A

• Are trailer stands and glad locks are applied when loading and uploading trailers?

  Compliant

  Non-Compliant

  N/A

• Associates do not enter trailers when loading or unloading is being performed by another associate

  Compliant

  Non-Compliant

  N/A

• Associates use isle way mirrors when walking through the cooler and docks area

  Safe

  At Risk

  N/A

• Blind spots and corners have warning signs and safety mirrors to reduce hazards in the working area

  Safe

  At Risk

  N/A

Heights, Stairways, Hallways and Aisles

• Are there stairways in the inspection area?

  Yes

  No

• Are the stairways well lit?

  Yes

  No

  N/A

• Are the handrails, handholds in place?

  Yes

  No

  N/A

• Are the stairs in good repair?

  Safe

  At Risk

  N/A

• Are steps & walkways free of objects, tools or debris that could cause slips?

  Safe

  At Risk

  N/A

• Are stairwells clear and unblocked?

  Yes

  No

  N/A
Tap to enter information

• Are mirrors installed at blind corners?

  Safe

  At Risk

  N/A

• Are traffic mirrors in good condition?

  Yes

  No

  N/A

• Do associates use traffic mirrors when walking or operating equipment in the working area?

  Compliant

  Non-Compliant

  N/A

• Do associates work in any area elevated above the working area?

  Yes

  No

• Do associates use and inspect the approved safety harness/lanyard/lifeline and suitable anchor point?

  Compliant

  Non-Compliant

  N/A

• Are there rails around the entire working area with a height of 42", center rail and kickplate or an anchor/tie-off point for workers to tether to?

  Compliant

  Non-Compliant

  N/A

• Are rails, catwalks and working platforms in good condition? (check welds, structures, etc.)

  Safe

  At Risk

  N/A

Racking and Storage

• Is there racking in the dock area?

  Yes

  No

• Is racking in good condition (no visable damage, missing braces?)

  Yes

  No

  N/A

• Does the racking have a load capacity sticker?

  Yes

  No

  N/A

• Are there contact barriers infront of racking posts to prevent accidental contact?

  Safe

  At Risk

  N/A

Environment and Physical Hazards

• Is it hard to hear in the area?

  Safe

  At Risk

  N/A

• Are associate required to wear ear protection?

  Yes

  No

• Are associates wearing hearing protection?

  Yes

  No

  N/A

• Are seasonal controls adequately supplied? (salt, shovels, sunglasses, rain gear, etc.)

  Safe

  At Risk

  N/A

• Do temporary floor or ground openings have standard railings or someone constantly on guard?

  Safe

  At Risk

  N/A

• Are drain covers in good condition?

  Safe

  At Risk

  N/A

• Are workers protected from excessive heat/cold?

  Safe

  At Risk

  N/A

• Are there confined spaces in the working area?

  Yes

  No

• Are confined spaces clearly labeled in applicable languages?

  Compliant

  Non-Compliant

  N/A

• Is there controls in place to prevent any access to the space?

  Compliant

  Non-Compliant

  N/A

• Are workers permitted to work in the confined space(s)?

  Yes

  No

• Is there currently work being conducted in the confined space(s)?

  Yes

  No

• Are emergency and rescue procedures/equipment in place (e.g. trained safety watchers, winches, etc.)?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEDIATELY AND REQUIRE ALL ASSOCIATES TO EVACUATE THE SPACE> DO NOT ENTER THE SPACE.

• Has the work been authorized by a confined space work permit?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEDIATELY AND REQUIRE ALL ASSOCIATES TO EVACUATE THE SPACE> DO NOT ENTER THE SPACE.

• Is atmospheric testing ongoing and in alignment with Highline and CSA standards?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEDIATELY AND REQUIRE ALL ASSOCIATES TO EVACUATE THE SPACE> DO NOT ENTER THE SPACE.

• Are the confined space procedures and training available and followed by all involved?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEDIATELY AND REQUIRE ALL ASSOCIATES TO EVACUATE THE SPACE> DO NOT ENTER THE SPACE.

• Are entry and exit procedures adequate?

  Compliant

  Non-Compliant

  N/A

• STOP WORK IMMEDIATELY AND REQUIRE ALL ASSOCIATES TO EVACUATE THE SPACE> DO NOT ENTER THE SPACE.

Return to Work

• Are there any associates in the working area who are on modified duties or have recently returned to regular duties?

  Yes

  No

• Is the associate willing to be interviewed? NOTE: This survey is intended to gather feedback from Highline associates who have participated in our Return to Work process. We thank your for your participation in the plan and in completing this survey. This survey is voluntary!

  Yes

  No

• Modified work was offered to me from the onset of my report of illness/injury.

  Yes

  No

  N/A

• The RTW process was explained to me at the beginning so that I could understand what I should expect to happen at each stage of the process.

  Yes

  No

  N/A

• The modified work plan was developed with my specific needs in mind.

  Yes

  No

  N/A

• I felt I was part of the plan development process at all stages and had the opportunity to agree or disagree with the plan as proposed.

  Yes

  No

  N/A

• There was open communication between myself and members of the HR team during the plan.

  Yes

  No

  N/A

• There was open communication between myself and my supervisor(s) during the plan.

  Yes

  No

  N/A

• I felt that the RTW process was as easy and smooth as possible.

  Yes

  No

  N/A

• Additional comments:

• Name of Associate:

  Sign

• Duration of Modified Plan:

• Date of Injury/illness

  Date

• Date RTW plan ended:

  Date

• Name of associate:

New Associates

• Are there new supervisors who require training?

  Yes

  No

• Are there any new associates?

  Yes

  No

• Name of Associate Interviewed

• Did their supervisor complete a hazard walkthrough prior to the associate beginning work?

  Yes

  No

  N/A

• The associate must stop work immediately until a supervisor has trained the associate on hazards and their controls within the department.

• Can the associate remember any hazards from their hazard walkthrough and Highline's control measures?

  Yes

  No

  N/A

• What hazards were identified and what were the controls listed?

• Does the associate know where to go in the event of an emergency (fire, violence, power outage, severe weather)?

  Yes

  No

  N/A

• Retrained the associate on their evacuation points - Associate initial

  Sign

• Are there any comments or concerns from the associate in regards to health and safety in the workplace?

  Yes

  No

• Comments:

Contractor Safety Compliance

• Are there any contractor(s) in the department performing work?

  Yes

  No

• Has the contractor(s) signed in at the front office?

  Compliant

  Non-Compliant

  N/A

• Has the contractor(s) completed the Highline COVID19 Screening in at the front office?

  Safe

  At Risk

  N/A

• Has the contractor(s) completed contactor safety training prior to performing work?

  Safe

  At Risk

  N/A

• Do contractors have valid training certifications on their person or in a reachable area?

  Compliant

  Non-Compliant

  N/A

Safety Board

• Is there a Safety and Wellness Information board in your inspection area?

  Yes

  No

• Highline Mushrooms Safety and Wellness Policy current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Employment Standards Information present and in good condition

  Compliant

  Non-Compliant

  N/A

• Worker Rights Information present and in good condition

  Compliant

  Non-Compliant

  N/A

• Workers compensation (1,2,3,4, WBC, WorkSafe Injury) Poster present and in good condition

  Compliant

  Non-Compliant

  N/A

• Highline Mushrooms Violence, Bullying and Harassment policy and standard current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• JHSC Meeting Minutes current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• JHSC Member Photos and Contact information current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Health and Safety at Work poster present and in good condition

  Compliant

  Non-Compliant

  N/A

• Ministry of Labour field reports, orders, tickets and fines current, present and in good condition (if applicable)

  Compliant

  Non-Compliant

  N/A

• Injury Reporting and Disability and Claims poster current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• List of first aiders present?

  Compliant

  Non-Compliant

  N/A

• Emergency Contact Numbers current, present and in good condition?

  Compliant

  Non-Compliant

  N/A

• A copy of the OH&S Act is current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• A safety and wellness policy and information binder is current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Important information - Hazards, substances, safety alerts, etc. (if applicable)

  Compliant

  Non-Compliant

  N/A

• Was any hazard identified which has not been identified in the past or needs to be revisited?

  Yes

  No

RECOGNIZE

HAZARD

• What activity or hazard could cause injury or illness?

• What hazard groups can cause injury, illness, property damage or damage to the environment? (select all that apply)

  Select Physical Safety MSD Chemical Physical Agent Psychosocial Biological Manual Material Handeling

  • Physical Safety
  • MSD
  • Chemical
  • Physical Agent
  • Psychosocial
  • Biological
  • Manual Material Handeling

• What is the source of the hazard to the associate/environment?

  Select Compressed Air High Pressure Fluids Confined Space Driving Electrical Material Handling Material Storage Molten Material Machine or Equipment Slip or Trip Temperature Vehicular Hazards Working at Heights

  • Compressed Air
  • High Pressure Fluids
  • Confined Space
  • Driving
  • Electrical
  • Material Handling
  • Material Storage
  • Molten Material
  • Machine or Equipment
  • Slip or Trip
  • Temperature
  • Vehicular Hazards
  • Working at Heights

• What is the potential outcome of exposure to the hazard?

  Select Skin injection Skin injection Asphyxiation Engulfment Entrapment Explosion Collision Contact with pedestrian Other Stress Violence Arc flash Electrocution Fire hazard Crushing Fire hazard Laceration Puncture or injection Sharp edges - laceration/contusion Struck by Worker contact Fire hazard Trip hazard Worker contact Burn Fire Flying particles/materials - impact or injection Full body pinch point - crushing Grinding/Sanding - friction & abrasion Impact - stabbing & puncture In-running nip - entanglement, drawing in Moving part - entanglement, cutting, shear Pinch point - crushing or shear Rotating or sharp part - cutting or shearing Rotation - entanglement Sharp edges - laceration/contusion Worker contact – laceration/contusion/puncture/other Falls to same height Burn/Scald Falling to surface below Objects falling on workers below Other

  • Skin injection
  • Skin injection
  • Asphyxiation
  • Engulfment
  • Entrapment
  • Explosion
  • Collision
  • Contact with pedestrian
  • Other
  • Stress
  • Violence
  • Arc flash
  • Electrocution
  • Fire hazard
  • Crushing
  • Fire hazard
  • Laceration
  • Puncture or injection
  • Sharp edges - laceration/contusion
  • Struck by
  • Worker contact
  • Fire hazard
  • Trip hazard
  • Worker contact
  • Burn
  • Fire
  • Flying particles/materials - impact or injection
  • Full body pinch point - crushing
  • Grinding/Sanding - friction & abrasion
  • Impact - stabbing & puncture
  • In-running nip - entanglement, drawing in
  • Moving part - entanglement, cutting, shear
  • Pinch point - crushing or shear
  • Rotating or sharp part - cutting or shearing
  • Rotation - entanglement
  • Sharp edges - laceration/contusion
  • Worker contact – laceration/contusion/puncture/other
  • Falls to same height
  • Burn/Scald
  • Falling to surface below
  • Objects falling on workers below
  • Other

• How likely is the hazard to cause injury or illness now?

  1 - Very Improbable

  2 - Improbable

  3 - Probable

  4 - Very Probable

  5 - Inevitable

• How often is the job task interacting with the hazard?

  1 - Very Rarely

  2 - Infrequent

  3 - Occasional

  4 - Frequent

  5 - Continuously

• How severe could an incident be?

  2- Minor

  4 - Moderate

  6 - Serious

  15 - Major

  20 - Fatal

• What is the level of risk? (Probability + Frequency x Severity)

  Select Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage). Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

  • Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage).
  • Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence
  • Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority
  • Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

• What is the source of the hazard to the associate/environment?

  Select Awkward Posture High Force Demands Poor Tool or Equipment Design Poor Workstation Design Repetition Static Posture

  • Awkward Posture
  • High Force Demands
  • Poor Tool or Equipment Design
  • Poor Workstation Design
  • Repetition
  • Static Posture

• What is the potential outcome of exposure to the hazard?

  Select MSD injury Other

  • MSD injury
  • Other

• What is the source of the hazard to the associate/environment?

  Select Combustible Compressed Gas Corrosive Flammable Reactivity Toxic

  • Combustible
  • Compressed Gas
  • Corrosive
  • Flammable
  • Reactivity
  • Toxic

• What is the potential outcome of exposure to the hazard?

  Select Fire/Explosion Violent release of energy/gas Acid - skin burn/mucous membrane exposure Acid/base incompatibility reaction Alkaline - skin burn/mucous membrane exposure Liquid - Fire/explosion Gas - Fire/explosion Dangerous reaction Absorption - Illness Dermatitis Ingestion – Illness Ingestion – Carcinogen Inhalation – Illness Inhalation - Carcinogen Injection – Illness Injection - Carcinogen

  • Fire/Explosion
  • Violent release of energy/gas
  • Acid - skin burn/mucous membrane exposure
  • Acid/base incompatibility reaction
  • Alkaline - skin burn/mucous membrane exposure
  • Liquid - Fire/explosion
  • Gas - Fire/explosion
  • Dangerous reaction
  • Absorption - Illness
  • Dermatitis
  • Ingestion – Illness
  • Ingestion – Carcinogen
  • Inhalation – Illness
  • Inhalation - Carcinogen
  • Injection – Illness
  • Injection - Carcinogen

• If Hazardous materials are present, are there SDS sheets available to associates at all times and are associates trained in WHMIS 2015?

  Compliant

  Non-Compliant

  N/A

• What SDS sheet or training is required?

  Yes

  No

  N/A

• What is the source of the hazard to the associate/environment?

  Select Extreme Cold Extreme Heat Lighting Noise UV Exposure Vibration

  • Extreme Cold
  • Extreme Heat
  • Lighting
  • Noise
  • UV Exposure
  • Vibration

• What is the potential outcome of exposure to the hazard?

  Select Cold stress Heat stress Hazard exposure due to lack of visibility Eye strain Hearing loss Skin or eye damage Hand/Arm - MSD or vascular disorder Whole body - Back pain

  • Cold stress
  • Heat stress
  • Hazard exposure due to lack of visibility
  • Eye strain
  • Hearing loss
  • Skin or eye damage
  • Hand/Arm - MSD or vascular disorder
  • Whole body - Back pain

• What is the source of the hazard to the associate/environment?

  Select Boredom Harassment Stress Violence Work overload Long hours

  • Boredom
  • Harassment
  • Stress
  • Violence
  • Work overload
  • Long hours

• What is the potential outcome of exposure to the hazard?

  Select Mental Illness Violent Situation Physical Health Decline

  • Mental Illness
  • Violent Situation
  • Physical Health Decline

• What is the source of the hazard to the associate/environment?

  Select Bacteria Mold Viral

  • Bacteria
  • Mold
  • Viral

• What is the potential outcome of exposure to the hazard?

  Illness/Disease

• What is the source of the hazard to the associate/environment?

  Select Bending Lifting Pushing or Pulling

  • Bending
  • Lifting
  • Pushing or Pulling

• What is the potential outcome of exposure to the hazard?

  Strain

• Hazard Images and DIagrams

  Media

• Additional Comments

ASSES AND CONTROL

• Use this tool when considering control implementation and recommendations.

  
Asses, Controls and Recommendations

• What legal requirements, codes, benchmarks or standards apply to the identified hazards, work processes or work activities?

  Select OHSA CSA Electrical Fire/Building Other

  • OHSA
  • CSA
  • Electrical
  • Fire/Building
  • Other

• What legal requirement is in non-coompliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Are controls immediately put into place or recommended introducing a new hazard? (congestion, confined space, etc.)

  Safe

  At Risk

  N/A

• Describe in detail what the new hazard identified is:

• Will new training be required for the new controls put into place?

  Yes

  No

  N/A

• What training will be required?

• Are any labels, signs or decals required if controls are put in place?

  Yes

  No

  N/A

• What labels, signs or decals are required?

• Is additional PPE required?

  Safe

  At Risk

  N/A

• What type of PPE is required?

  Select

• Please specify here:

• Is a Safety Alert required or alteration to a hazard checklist?

  Yes

  No

  N/A

• What action is required?

• What CSA Standard is in non-compliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What electrical code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What fire/building code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Describe the non-compliance

  Yes

  No

  N/A

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Recommended timeline of completion:

  Date

• Additional Comments:

EVALUATE

Evaluation

• Following recommended control implementation, how likely is the hazard to cause injury or illness now?

  1 - Very Improbable

  2 - Improbable

  3 - Probable

  4 - Very Probable

  5 - Inevitable

• Following recommended control implementation, how often is the job task interacting with the hazard?

  1 - Very Rarely

  2 - Infrequent

  3 - Occasional

  4 - Frequent

  5 - Continuously

• Following recommended control implementation, how severe could an incident be?

  2- Minor

  4 - Moderate

  6 - Serious

  15 - Major

  20 - Fatal

• Following recommended control implementation, what is the level of risk? (Probability + Frequency x Severity)

  Select Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage). Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

  • Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage).
  • Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence
  • Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority
  • Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

• Additional Comments:

Supervisor and Auditor Sign Off

• Supervisor Signature

  Sign

• Do supervisors need any assistance in safety related items?

  Yes

  No

• What items were indicated by supervisors:

• Do supervisors have adequate Modified Work Packages?

  Yes

  No

  N/A

• Were workplace pre-start Inspections were completed by a supervisor or lead hand prior to work beginning?

  Compliant

  Non-Compliant

  N/A

• Were any items flagged on instpections which require immediate attention?

  No

  Yes

• Please indicate items and responsible parties here:

• Auditor Signature

  Sign

• JHSC Member Signature

  Sign

Comments, Concerns and Details

• Any related comments, infractions, non-compliance items can be documented here: