Monthly Site Inspection Checklist Form Page 4
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4Item Inspected
S
NS NA
Requires Immediate Action
20. EXTENSION CORDS
_______________________
T
T
T
Outdoor-type, rated over 300 volts
_______________________
T
T
T
Condition of casing, ends, connections
_______________________
T
T
T
GFCIs used where required
T
T
T
_______________________
Other __________________
21. TEMPORARY POWER SUPPLY
_______________________
T
T
T
Properly identified
_______________________
T
T
T
Overhead lines flagged & secured
_______________________
T
T
T
Surface cables buried or protected
_______________________
T
T
T
Other __________________
22. MATERIALS STORAGE
_______________________
T
T
T
Properly located
_______________________
T
T
T
Safely piled, stacked, bundled
_______________________
T
T
T
Properly moved or lifted
_______________________
T
T
T
Properly labeled (WHMIS)
_______________________
T
T
T
Other __________________
23. FORMWORK
_______________________
T
T
T
Guardrails and fall-arrest system
_______________________
T
T
T
Design drawings kept on project
_______________________
T
T
T
Inspection statement by engineer or competent worker
_______________________
T
T
T
Other __________________
24. SUSPENDED SCAFFOLDS
_______________________
T
T
T
Properly attached and capable of 4 times max. load
_______________________
T
T
T
Outrigger beam tied to fixed support with counterweight
_______________________
T
T
T
All mechanical/electrical devices in good condition
_______________________
T
T
T
Independent lifelines for each worker (extend to ground)
_______________________
T
T
T
Engineer’s drawing on site if required
25. SIGNS & PRINT MATERIAL
_______________________
T
T
T
OH&S Act and Regulations
_______________________
WSIB In Case of Injury Poster
T
T
T
_______________________
MOL Health & Safety at Work Poster
T
T
T
_______________________
T
T
T
MSDSs
_______________________
T
T
T
Warning signs
_______________________
T
T
T
Emergency response plan and phone list
_______________________
T
T
T
Report forms
_______________________
T
T
T
Other __________________
26. WORKER EDUCATION
_______________________
T
T
T
WHMIS training
T
T
T
_______________________
Company safety policies & program
T
T
T
_______________________
Injury reporting
_______________________
T
T
T
Hazard reporting
_______________________
T
T
T
OH&S Act and Regulations
_______________________
T
T
T
Personal H&S responsibilities
_______________________
T
T
T
Other __________________
27. HYGIENE
_______________________
T
T
T
Washroom facilities available
_______________________
T
T
T
Cleanliness of facilities
_______________________
T
T
T
Injury/hazard reporting
_______________________
T
T
T
Personal responsibilities
T
T
T
Safety policies and procedures
_______________________
T
T
T
Other __________________
_______________________
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