Monthly Site Inspection Checklist Form Page 2
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2
3
4Item Inspected
S
NS NA
Requires Immediate Action
5. SCAFFOLDS
T
T
T
_______________________
Properly erected (all parts used)
_______________________
T
T
T
Properly secured
_______________________
T
T
T
Properly planked
_______________________
T
T
T
Proper guardrails, toeboards
_______________________
T
T
T
Proper access to platform
_______________________
T
T
T
Acceptable loading
_______________________
T
T
T
Other __________________
6. POWER TOOLS, EQUIPMENT
_______________________
T
T
T
General condition
_______________________
T
T
T
Proper guards, cords, PPE
_______________________
T
T
T
Tagging as DEFECTIVE
_______________________
T
T
T
Other __________________
7. STAIRWELLS & RAMPS
_______________________
T
T
T
Proper filler blocks in metal stairs
_______________________
T
T
T
Proper cleats on ramps
_______________________
T
T
T
Adequate lighting in stairwells
_______________________
T
T
T
Proper handrails or guardrails
_______________________
T
T
T
Other __________________
8. TRAFFIC CONTROL
_______________________
T
T
T
Trained traffic controllers
_______________________
T
T
T
Properly located
_______________________
T
T
T
Clean, regulation sign
_______________________
T
T
T
Properly dressed (including vest)
_______________________
T
T
T
Other __________________
9. PUBLIC WAY PROTECTION
_______________________
T
T
T
Properly located (within 4.5 m)
_______________________
T
T
T
Entrances clearly marked
_______________________
T
T
T
Covered where required
_______________________
T
T
T
Min. height, width requirement
_______________________
T
T
T
Proper rail on street side
_______________________
T
T
T
Proper lighting, where required
_______________________
T
T
T
Otherr __________________
10. FALL PROTECTION
_______________________
T
T
T
CSA approved
_______________________
T
T
T
Properly worn
_______________________
T
T
T
Safe, usable condition
T
T
T
_______________________
Unprotected openings and edges
_______________________
T
T
T
T Ladders T Scaffolds T Swingstages
Working from:
_______________________
T
T
T
Other __________________
11. GUARDRAILS, BARRICADES
_______________________
T
T
T
Located where required
_______________________
T
T
T
Properly constructed
_______________________
T
T
T
Adequately secured
_______________________
T
T
T
Other __________________
12. GAS CYLINDERS
_______________________
T
T
T
Properly located
_______________________
T
T
T
Properly secured
_______________________
T
T
T
Properly moved or lifted
_______________________
T
T
T
Properly hooked up
_______________________
T
T
T
Other __________________
Download form at ihsa.ca/logbook
219
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