Weekly Site Safety Inspection

• Project Name:

• Project Number:

• Site Owner:

• Weather:

• Conducted on

  Date

• Prepared by

• Superintendent:

• Foreman:

Documentation:

• Daily Safety Meeting Record Completed?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Weekly Toolbox Meeting Record completed and signed by workers?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Site Specific Plan Risk Assessment completed and signed by Safety Coordinator and Project Manager/Superintendent?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Ground Disturbance Permit completed and signed by workers?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Safety Board up to date?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• JOHS meeting minutes up to date?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All workers completed site specific orientation?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All workers completed Hall Corporation Safety Orientation?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• WCB inspection minutes posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• BC One up to date?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Date of recent BCOne Call:

• 30M33 completed and posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Notice of Project completed and posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Site Safety Rules posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Site Emergency Preparedness information completed and posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• JOHS Committee members posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Notice to Workers Posted (PL 9/PL 8)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Workers Compensation Act/ OHS regulations available (PL 29)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Traffic/ Pedestrian Management:

• Traffic Management Plan in place?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Signs, barricades, hoarding, and delineators in place as required?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• TCP's wearing appropriate PPE?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is the roadways safe for vehicle/ bicycle traffic? (i.e. potholes, saw cuts, etc.)

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• TCP certification available?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Fire Prevention:

• Fire extinguishers are tagged and checked monthly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Fire extinguishers are accessible?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Flammable materials are stored away from compressed gas or enclosed areas?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Emergency Preparedness:

• Air horn, radio or cell phone communication established?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Muster station is established and communicated?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Route to the hospital has been determined and posted?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Emergency exits are clear of obstructions and marked?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

First Aid:

• First aid attendant is scheduled for adequate level of training?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• First aid room/ dressing station is adequately stocked?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• First aid kit adequately stocked?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• First aid room is clean?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• First aid attendant's certificate is available on site?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

WHMIS

• Controlled products are labelled properly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Controlled products are stored as per Safety Data Sheets (SDS)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• SDS are up to date (within 3 years) and available?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Controlled products are handled properly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Spill kits are available on site?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Personal Protective Equipment (PPE)

• PPE requirements have been communicated?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Baisc PPE requirements (hard hat, CSA approved steel toed boots and hi-viz vests) are being worn by all workers?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• PPE is being used and maintained properly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Housekeeping:

• Toilets, washing, drinking, and eating facilities are clean and stocked?Work

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Work areas are clean of construction debris?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Pedestrian walk ways are free of tripping hazards (ie string line, wood debris, nails, etc)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Materials and equipment are parked in a safe and secure manner?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Adequate garbage containers are available on site and being used?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Spilled or leaked liquids are being cleaned up?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Mobile Equipment

• Daily Pre-Trip Inspections are being completed by operators?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Horns, lights and backup alarms are working properly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• No hydraulic leaks are notice?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Equipment is being operated at a safe speed and under control?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Seat belts are being worn?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Fire extinguishers are available in the machine?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Spill kits are available in the machine?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Only equipment operators are in moving equipment (ie no riders)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Equipment is parked in a safe location with all attachments and secured with the transmission in the manufacturer's specific park position?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Tools (Power, Gas, Hand, Pneumatic, Powder Actuated)

• Electrical cords in good condition?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Compressed air connections secured (ie with pins)?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Equipment is disconnected before repair and adjustments?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Compatible components used?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Guards are in place and used correctly?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Specialized PPE is being worn by operator?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Compressed Gas Cylinders:

• All cylinders are strapped or otherwise secured?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All cylinders are being stored away from heat, sparks, or flammable products?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Compressed gas cylinders are not stored in C-cans or enclosed areas?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All torches (oxy/fuel) are equipped with flash arrests/ suppressors?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Oxygen cylinders are not stored with flammable/ combustible cylinders?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Cylinders are capped when not in use or affixed with a regulator?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Rigging:

• All rigging has been inspected before use?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Rigging is being used as per lifting ratings?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All lifting hooks have a safety latch?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Rigging has certification tag attached?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Defective rigging is tagged out?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Fall Protection:

• All situations where fall protection is required has been identified? (over 3m/ 10ft or; when a hazard exists below work area)

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Workers are instructed to wear fall protection before entering work are where fall hazards exist?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• All fall protection equipment is inspected and maintained?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Type of fall protection being used?

  Select Guardrails Fall Restraint Fall Arrest Work Zone with Monitor

  • Guardrails
  • Fall Restraint
  • Fall Arrest
  • Work Zone with Monitor

• Guardrails are installed whenever possible, and are the right type and construction as per OHS Regulation. (125 lb resistance)

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Horizontal lifeline systems are installed as per manufacturer's instructions or OHS Regulation Guideline 11.7?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Vertical lifeline systems are installed correctly as per manufacturer's instructions?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• A written Fall Protection Plan is in place for work over 7.5m/ 25 ft?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• 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)

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Electrical (Low Voltage)

• GFCI or Assured Grounding Program is in place?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Cords are intact?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Lock out procedures are in place?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Energized panels and junction boxes are covered if outdoors?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Plugs and prongs are in good condition?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Electrical cords are strung or otherwise protected?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Lighting systems are in place?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Electrical (High Voltage)

• 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?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is high voltage overhead/underground power lines guarded?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Ladders

• Are ladders in good condition with suitable undamaged rungs, rails and feet?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Ladders secured in place when required?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Ladder at a 4:1 ratio and extended 3 feet above upper landing?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• No work is occurring on the last 2 steps of the ladder?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Excavations:

• Has the location of underground utilities been determined prior to beginning excavations?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is the BC One call available with the crew?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Has the utility location been clearly identified on the ground through the use of spray paint or other means?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Have utilities been hand exposed within 1m prior to mechanical excavating?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Have all exposed and undermined utilities been adequately supported?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• 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?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is emergency access/egrees maintained at all times?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is the shotcrete shoring and anchor drawings signed and sealed by a P. Eng or Geotech.

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is manufactured shoring being used?

  Yes

  No

  N/A

• Does the shoring cage system extend at least 1 foot above the grade, unless in a roadway?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Has the area between the shoring cage and excavation been backfilled or braced?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Has the area between the shoring cage and excavation been backfilled or braced?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is the shoring cage equipped with a ladder for access/egress?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is a copy of the shoring cage engineering certificate available on site?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Are you using benching or sloping?

  Yes

  No

  N/A

• 

• If sloping: Does it follow the 3V:4H or better sloping requirements?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• 

• If benching: Does it follow the 3V:4H or better benching requirements?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Is written instruction being used by a Geotch/P.Engineer?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Confined Space

• Confined spaces are identified, warning signs posted, and access points are secured against entry?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• A qualified supervisor is assigned responsibility for supervising entry and issuing entry permits?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Safe work procedures are in place, and based on the hazard assessment prepared by a qualified person?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Procedures used when entering a confined space are consistent with written procedures?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Personnel with confined space entry duties are trained in hazards and safe work procedures?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• There are provisions for rescue of persons inside a confined space, personnel are trained and equipped?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Standby personnel requirements are satisfied?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Ventilation and atmospheric monitoring requirements satisfied?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Personal protective equipment and clothing suited to the hazard are worn/ used by personnel?

  Yes

  No

  N/A

• Risk Level

  Low

  Moderate

  High

• Concern/ Comment:

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

Other:

• Other concern/ Comment:

• Risk Level

  Low

  Moderate

  High

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Other concern/ Comment:

• Risk Level

  Low

  Moderate

  High

• Corrective Action (include expected completion date/ by whom):

• Date Corrected/ Initial:

• Person Completing Inspection Report

  Sign

• Site Supervisor

  Sign

• Safety Department

  Sign