Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Type of work being performed by Great West Resources on this site.

  • Advance

  • Cutting (Saw/Mulching)

  • Surveying

  • Drilling

Worksite information

  • Project Name and GWR Job#

  • Prime Contractor

  • Is there an Emergency Response Plan available for this project?

  • Project Manager and Contact Information

  • Other Contact People on Prime Contractor's Emergency Response Plan.

  • GPS coordinates of program staging location and direction from primary lodging.

  • Describe directions to nearest Hospital or Health Centre from Program Staging Location.

  • S.T.A.R.S. site location, ID number and expiry

Driving Hazards

  • Wildlife

  • Wet Roads

  • Icy Roads

  • Gravel Roads

  • Winter Access Roads

  • Seasonal Roads

  • Radio Access Roads

  • Steep Road Shoulder

  • Potholes

  • Railway Crossings

  • Blind Corners

  • Blind Hills

  • Steep Hills

  • Narrow Bridges

  • One Lane Bridges

  • Ice Bridges

  • Temporary Creek Crossings

  • Unmarked Intersections

  • Gates

  • Field Crossings

  • Driving in low light conditions

  • Oilfield Activity

  • Farming Activity

  • Forestry/Logging Activity

  • School Buses

  • Add any other Driving Hazards associated to driving to worksite

  • How far is staging or the worksite from lodging? How long does it take to travel this distance following speed limits and restrictions?

Emergency Response Equipment required by GWR or Prime Contractor on this worksite.

  • Is there a medic required on program? Refer to OH&S regulations for suggested minimums.

  • Is there a requirement for an Emergency Medical Transport Vehicle on this program?

  • Can the medic reach the extremities of the project within the time regulations?

  • Is there a requirement for a Fire Truck on the worksite?

  • Is a helicopter required or recommended for this worksite?

  • Are H2S monitors required on site?

  • Is Respiratory Equipment required on site?

  • All Great West Resources employees' vehicles MUST have First Aid Kits as well as Fire Extinguishers.

  • Are emergency shut off switches required on Diesel Engines?

  • Is there any other or specialty safety equipment required or recommended on this site?

Site Hazards - Oil and Gas

  • H2S

  • SO2 or burning stacks

  • Gas plants or other production facilities

  • Active Oil Wells

  • Abandoned Oil Wells

  • Oil Well Drilling or site preparation

  • High, Medium or Low Pressure Pipelines

  • Other hazardous materials

Site Hazards - Properties

  • Crown Land

  • Dwellings

  • Acreages

  • Abandoned homes or buildings

  • Water Wells

  • Sceptic Fields

  • Other Hazards related to properties

Site Hazards - Farming and Ranching

  • Farm Yards

  • Abandoned Farm Yards

  • Livestock

  • Corals

  • Crops

  • Grazing Pastures

  • Humics

  • Rock Piles

  • Irrigation Ditches

  • Dugouts

  • Other Hazards related to farming and ranching

Site Hazards - Natural Hazards

  • Badger Holes

  • Trees

  • Brush

  • Muskeg

  • Slough or Swamp

  • Water bodies (lakes, rivers, creeks, ponds)

  • Mountainous area

  • Cliffs

  • Hills

  • Side hills

  • Weather conditions

  • Other natural hazards

Site Hazards - General Hazards

  • Buried Facilities (power, telephone, water, fibre optics....)

  • Overhead Powerlines

  • Barbwire Fences

  • Wooden Fences

  • Junk piles or abandoned large objects (cars...)

  • Railways

  • Roads crossing project

  • Ditches

  • Other general site hazards

Predatory Hazards

  • Hunting

  • Trapping

  • Bears (if the type is known, please provide)

  • Felines (cougars, lynx...) precise type

  • Canines (wolves, coyotes...) precise type

  • Ungulates (deer, moose, elk...) precise type

  • Other carnivores (badgers, wolverines, weasels...)

  • Snakes

  • Other predatory hazards

Environmental Hazards

  • Wind

  • Snow

  • Ice

  • Rain

  • Sun

  • Extreme Heat

  • Extreme Cold

  • Windchill

  • Flooding

  • Tornadoes

  • Avalanches

  • Blizzards

  • Insects

  • Air born or water born Pathogenes

  • Other environmental Hazards

Personal Protective Equipment required by Great West Resources

  • ALL operators of off-road vehicles (ATV, Snowmobiles...) are REQUIRED to wear CSA or DOT approved helmets.

  • CSA approved hard hats

  • Eye Protection

  • Hearing Protection

  • Foot Protection

  • Hand Protection

  • Personal First-Aid kit

  • Personal H2S monitor

  • Fire retardant coveralls

  • All workers are required to carry an up to date Emergency Response Plan as well as have a copy in their vehicles.

  • All workers are required to carry their up to date safety tickets.

Remarks

  • Is there any other pertinent information about the project?

  • Are there any preoccupations about the project that require immediate action?

  • Comments

  • Assessor

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