Project Name and GWR Job#
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
Winter Access Roads
Radio Access Roads
Steep Road Shoulder
One Lane Bridges
Temporary Creek Crossings
Driving in low light conditions
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?
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?
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
Abandoned homes or buildings
Other Hazards related to properties
Abandoned Farm Yards
Other Hazards related to farming and ranching
Slough or Swamp
Water bodies (lakes, rivers, creeks, ponds)
Other natural hazards
Buried Facilities (power, telephone, water, fibre optics....)
Junk piles or abandoned large objects (cars...)
Roads crossing project
Other general site hazards
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...)
Other predatory hazards
Air born or water born Pathogenes
Other environmental Hazards
ALL operators of off-road vehicles (ATV, Snowmobiles...) are REQUIRED to wear CSA or DOT approved helmets.
CSA approved hard hats
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.
Is there any other pertinent information about the project?
Are there any preoccupations about the project that require immediate action?