Information
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Dart Services Ltd. Representative
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Date:
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Location
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Company work is being done for.
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Type of work
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Signature
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1. Is there a written safety program (Company Manual) , and do you know where it is located:
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2. Do you have a copy of your companies small Orientation Book:
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3. Do you have your daily vehicle inspection sheet and is it filled out?
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4. Do you have a blank copy of a Hazard Assessment Form in your truck?<br>
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5. Do you have a blank copy of a Incident / Near Miss form in your vehicle?
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6. Do you have a copy of the emergency plans complete with contact names and numbers in your Vehicle?
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7. Have you received your companies safety orientation? Where and When.
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8. How often are safety meetings held for work site?
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9. Is the appropriate training in place?
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10. First Aid Training
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Expiry Date:
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11. H2S Training (H2S Alive)
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Expiry Date:
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12. WHIMIS Training
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Expiry Date:
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13. Transportation of Dangerous Goods
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Expiry Date
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14. Fire Extinguisher
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Expiry Date:
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15. Confined Space
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Expiry Date:
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16. Ground Disturbance 1/2
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Expiry Date:
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17. Power Mobile Equipment
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Expiry Date:
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18. EGSO
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Expiry Date:
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19. Hard Hat
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20. Fire Retardant coveralls (or equivalent)
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21. Safety Glasses or Eye Protection
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22. Footwear
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23. Personal Monitor
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24. Hearing Protection
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25. Eyewash
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26. Communication Equipment
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27. Positive Air Shutoff
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28. Fire Extinguisher (inspected, tag readable, and current, accessible
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29. First Aid Kit
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30. Fall Arrest Equipment (harness, lanyards, steps, ladder)
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31. Slings (Ratings marked clearly and in good condition.)
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32. Load Ratings marked clearly on pickers
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33. Emergency Reflectors
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34. Warning Signs, Barricades (Overhead Power lines, Open Excavating, High pressure, etc.)
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35. Do you know your Legislated Rights and Responsibilities?
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36. Wind Direction Indicators
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Comments
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Supervisor
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Worker
