Worker Assessment Checklist - A&A Trading Ltd

• Worker Name (first & last)

• Worker Occupation

• Date of Assessment

  Date

• New / Returning Worker

• Monthly Assessment

• Worker Observation
• Location
  Address

• Worker assessment to be completed once per worker per month. This checklist should also be used to assess a new hire or a returning worker that has been away from the job for more than 6 weeks. Check appropriate boxes if "unsafe" or mark N/A. If "unsafe", provide corrective action comments for worker.

• If "Unsafe" add comments and/or photographs. If all items safe, select "Safe" from pull down arrow to the right.

Emergency Response Plan (ERP)

• Can locate ERP

  Safe

  Unsafe

  N/A

• Follows field check in procedures

  Safe

  Unsafe

  N/A

• Can identify "Safe" areas around equipment

  Safe

  Unsafe

  N/A

• Can identify FA attendant(s)

  Safe

  Unsafe

  N/A

• Has appropriate FA equipment

  Safe

  Unsafe

  N/A

Safe Work Procedures for task

• Can identify worksite hazards

  Safe

  Unsafe

  N/A

• Demonstrates safe use of safety equipment

  Safe

  Unsafe

  N/A

• Has up to date licence / certification(s)

  Safe

  Unsafe

  N/A

• Wears a seat belt in "work" vehicles

  Safe

  Unsafe

  N/A

• Vehicle maintenance and log up to date

  Safe

  Unsafe

  N/A

Before "clear to approach" signal given

• Makes eye / radio contact with machine operators

  Safe

  Unsafe

  N/A

• Identifies themselves when entering a block

  Safe

  Unsafe

  N/A

Personal Protective Equipment (PPE)

• Hard hat of contrasting colour (orange/red)

  Safe

  Unsafe

  N/A

• Uses appropriate eye / face protection

  Safe

  Unsafe

  N/A

• Uses required hearing protection

  Safe

  Unsafe

  N/A

• Uses appropriate floatation devices

  Safe

  Unsafe

  N/A

• Wears high visibility / protective clothing

  Safe

  Unsafe

  N/A

• Wears appropriate footwear for job

  Safe

  Unsafe

  N/A

• Caulk boots have sharp caulks

  Safe

  Unsafe

  N/A

Other:

• Comment

  Safe

  Unsafe

  N/A

Sign Off

• Signature of Supervisor / Trainer

  Sign

• Signature of Employee/ Contractor

  Sign