Urbandale Job Site Inspection

• Site

• Job Number

• Prepared by

• Location
  Address

General

• Date and Time

  Date

• How Many Employees?

  Select 1-5 6-10 11-15 16-20 21-25 26+

  • 1-5
  • 6-10
  • 11-15
  • 16-20
  • 21-25
  • 26+

Items Inspected ( Please Include Images or Additional Notes if Element is Not Satisfactory)

Signs and Print Material

• OH&S Act and Regulations ( Green Book)

  Yes

  No

  N/A

• WSIB Form 82 Poster

  Yes

  No

  N/A

• Properly Labelled Hazardous Materials ( WHMIS)

  Yes

  No

  N/A

• SDSs

  Yes

  No

  N/A

• Warning Signs

  Yes

  No

  N/A

• Report Forms

  Yes

  No

  N/A

First Aid Requirements

• Certified First Aiders On Site

  Yes

  No

  N/A

• Adequate Number of First Aid Kits

  Yes

  No

  N/A

• Adequate Contents in all First Aid Kits

  Yes

  No

  N/A

• Emergency Phone List

  Yes

  No

  N/A

Fire Protection

• Extinguishers Where Required ( Visible and Fully Charged )

  Yes

  No

  N/A

Worker Education

• WHMIS Training

• Company Safety Policy and Program

  Yes

  No

  N/A

• Injury Reporting

  Yes

  No

  N/A

• Hazard Reporting

  Yes

  No

  N/A

• OH&S Act and Regulations

  Yes

  No

  N/A

• Others

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hat

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Hand Gloves

  Yes

  No

  N/A

• Safety Harness functional and well used

  Yes

  No

  N/A

• Others

  Yes

  No

  N/A
Site Access and Housekeeping

• Location

• Adequate Ramps

  Yes

  No

  N/A

• Clear Walkways

  Yes

  No

  N/A

• Clear Work Areas

  Yes

  No

  N/A

• Guard rails / pit covers

  Yes

  No

  N/A

• Others

  Yes

  No

  N/A

Materials Storage

• Properly Located

  Yes

  No

  N/A

• Safely Piled, Stacked, Bundled

  Yes

  No

  N/A

• Properly Moved or Lifted

  Yes

  No

  N/A

Temporary Power Supply

• Properly Identified

  Yes

  No

  N/A

• Overhead Lines Flagged and Secured

  Yes

  No

  N/A

• Surface Cables Buried or Protected

  Yes

  No

  N/A
Equipment and Power Tools

• Type of Equipment sampled

• Name of Operator

• Items inspected:

  Select Back-up Camera Head Lights Tall Lights Wipers Wind Shield Fluid Maintenance Log Book Fire Extinguisher Seal Belt Horn Break Light Squeaking Sounds

  • Back-up Camera
  • Head Lights
  • Tall Lights
  • Wipers
  • Wind Shield Fluid
  • Maintenance Log Book
  • Fire Extinguisher
  • Seal Belt
  • Horn
  • Break Light
  • Squeaking Sounds

• Proper Guards, Cords and PPE

  Good

  Fair

  Poor

  N/A

• Proper Tag Out Procedure When Defective

  Good

  Fair

  Poor

  N/A

Extension Cords

• Outdoor Type, Rated over 300 Volts

  Good

  Fair

  Poor

  N/A

• Condition of Casing, Ends, Connections

  Good

  Fair

  Poor

  N/A

Guardrails and Ladders

• Secured

  Yes

  No

  N/A

• Properly Angled

  Yes

  No

  N/A

• Proper Size and Type

  Yes

  No

  N/A

• Safe and Usable Condition ( Handrail, Landing, Non-Slip Bases)

  Yes

  No

  N/A

• Properly Used

  Yes

  No

  N/A

• Open pits covered

  Yes

  No

  N/A

Gas Cylinders

• Properly Located

  Yes

  No

  N/A

• Properly Secured

  Yes

  No

  N/A

Trenches and Excavation

• Adequate locates

  Yes

  No

  N/A

• Excavated Soil Properly Placed

  Yes

  No

  N/A

• Appropriate Shoring Used

  Yes

  No

  N/A

• Proper Access to Trench

  Yes

  No

  N/A

• Proper Storage of Materials In and Above

  Yes

  No

  N/A

Traffic Control

• Properly Located

  Good

  Fair

  Poor

  N/A

• Clean,Regulation Sign

  Good

  Fair

  Poor

  N/A

• Properly Dressed ( Including Vest)

  Yes

  No

  N/A

Hygiene

• Washroom Facilities Available

  Yes

  No

  N/A

• Cleanliness of Facilities

  Yes

  No

  N/A
Follow Up Actions

• 1

Sign Off

• Safety Office

  Sign

• On Site Representative/ Site Superintendent

  Sign