| Inspected by: |
| Company/Project: |
| Number of Employees: |
Copies to: |
| Date: |
Time: |
| DESCRIPTIONS |
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ACTION TAKEN |
| 1. SITE ACCESS |
| Clean, level ground |
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| Adequate ramps |
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| Adequate stairs |
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| Adequate ladders |
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| 2. PROTECTIVE EQUIPMENT |
| Hard hats worn |
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| Fall protection worn |
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| Skin
protection:
Worn |
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Available |
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| Eye & face protection: Worn |
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Available |
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| Hearing
protection:
Worn |
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| Available |
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| Respiratory protection: Worn |
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Available |
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| 3. GUARDRAILS, BARRICADES |
| Located where required |
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| Properly constructed |
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| Adequately secured |
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| 4. LADDERS |
| Secured |
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| Proper angle (extension ladders) |
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| Proper size and type |
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| Safe, usable condition |
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| Properly Used |
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| Prper Handrail and Landings |
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| Non-Slip condition |
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| 5. FIRE PROTECTION |
| Extinguishers where required |
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| Fully charged |
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| Adequately identified |
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| Master emergency plan |
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| 6. PUBLIC WAY PROTECTION |
| Properly located (within 4.5 m) |
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| Covered where required |
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| Min. height, width requirement |
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| Proper rail on street side |
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| Proper lighting, where required |
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| 7. HOUSEKEEPING |
| Clear walkways |
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| Clear work areas |
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| Clear access and landing |
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| 8. FALL PROTECTION |
| CSA Approved |
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| Properly worn |
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| Safe, usable condition |
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| Unprotected openings and edges |
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| Working from:
Ladders |
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Scaffolds |
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Swings tages |
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| 9. STAIRWELLS AND RAMPS |
| Proper filler blocks in metal stairs |
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| Proper cleats on ramps |
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| Adequate lighting in stairwells |
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| Proper handrails or guardrails |
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| 10. SCAFFOLDS |
| Properly erected (all parts used) |
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| Proper access to platform |
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| Proper guardrails, toeboards |
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| Properly planked |
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| Properly secured |
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| Acceptable loading |
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| 11. POWER TOOLS, EQUIPMENT |
| General condition |
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| Proper guards, cords, PPE |
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| Tagging as Defective |
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| 12. EXTENSION CORDS |
| Outdoor-type, rated over 300 volts |
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| Condition of casing, ends, connections |
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| 13. GAS CYLINDERS |
| Properly located |
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| Properly secured |
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| Properly moved or lifted |
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| Properly hooked up |
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| 14. WORKER EDUCATION |
| WHMIS training |
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| Company safety policy and program |
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| Injury reporting |
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| Hazard reporting |
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| OHS Act and Regulations |
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| Personal HS responsibilities |
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| 15. FIRST AID REQUIRMENTS |
| Adequate qualified first aiders on jobsite |
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| First aid kits:
Adequate number |
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Adequate contents |
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| 16. CRANES, HOISTS, ETC. |
| Competent signaller |
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| Proper lifting containers |
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| Safety catches on all hooks |
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| Proper use of tag lines |
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| Condition of slings, hardware |
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| Maintenance log available |
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| Competent operator |
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| Safe setup of equipment |
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| 17. TRAFFIC CONTROL |
| Trained traffic controllers |
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| Properly located |
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| Clean, regulation sign |
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| Properly dressed (including vest) |
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| 18. WELDING |
| Fire extinguisher readily available |
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| Rods and cylinders properly labeled |
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| Proper eye protection worn |
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| MSDSs readily available |
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| Properly secured ground cables |
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| Gas cylinders upright and secured |
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| Proper screens and exhaust |
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| 19. ELEVATING WORK PLATFORM |
| Working Training |
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| Properly used |
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| Safe, unsafe Condition |
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| Acceptable loading |
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| Manufacturer’s operating manual |
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| 20. TEMPORARY POWER SUPPLY |
| Properly identified |
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| Overhead lines flagged and secured |
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| Surface cables buried or protected |
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| 21. SIGNS AND PRINT MATERIAL |
| OHS Act and regulations |
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| Warning signs |
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| MSDSs |
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| Emergency phone list |
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| Report forms |
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| WSIB Form 82 poster |
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| 22. MATERIALS STORAGE |
| Properly moved or lifted |
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| Safely piled, stacked, bundled |
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| Properly labeled (WHMIS) |
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| Properly located |
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| 23. TRENCHES AND EXCAVATIONS |
| Trench |
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| Appropriate shoring used |
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| Proper access to trench |
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| Excavated soil properly placed |
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| Proper storage of materials in and above |
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| 24. CONFINED SPACES |
| Proper access to trench |
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| Proper access to trench |
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| Proper access to trench |
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| Safety harness, lifeline properly anchored and used. |
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| Rescue equipment readily available |
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| Air testing before entry |
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| Proper access |
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| 25. SUSPENDED SCAFFOLDS |
| Properly attached and capable of at least 4 times maximum load |
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| Outrigger beam tied to fixed support with adequate counterweight |
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| All mechanical/electrical devices in good working condition |
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| Independent lifelines for each worker (extend to ground) |
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| Engineer’s drawing on site if required |
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| 26. FORMWORK |
| Guardrails and fall-arrest system |
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| Inspection statement by engineer or competent worker |
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| Design drawings kept on project |
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| 27. HYGIENE |
| Cleanliness of facilities |
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