Monthly Inspection Checklist

Monthly Inspection ChecklistSite/Contractor Name:Date:Location:No. of Employees:Conducted By:S – Satisfactory NS – Not Satisfactory NA – Not ApplicableItem Inspected S NS NA Requires Immediate Action1. SITE ACCESSClean, level ground _______________________Adequate ramps _______________________Adequate stairs _______________________Adequate ladders _______________________Other __________________ _______________________2. HOUSEKEEPINGClear walkways _______________________Clear work areas _______________________Clear access and landing _______________________Other __________________ _______________________ 3. PERSONAL PROTECTIVE EQUIPMENTHead protection _______________________Foot protection _______________________Eye protection _______________________Hearing protection _______________________Respiratory protection _______________________Fall protection (plan, rescue) _______________________Other __________________ _______________________4. LADDERSSecured _______________________Proper angle (extension ladders) _______________________Proper size and type _______________________Safe, usable condition _______________________Properly used _______________________Proper handrail and landings _______________________Non-slip bases _______________________Other __________________ _______________________218 ihsa.ca

Item Inspected S NS NA Requires Immediate Action5. SCAFFOLDSProperly erected (all parts used) _______________________Properly secured _______________________Properly planked _______________________Proper guardrails, toeboards _______________________Proper access to platform _______________________Acceptable loading _______________________Other __________________ _______________________6. POWER TOOLS, EQUIPMENTGeneral condition _______________________Proper guards, cords, PPE _______________________Tagging as DEFECTIVE _______________________Other __________________ _______________________7. STAIRWELLS & RAMPSProper filler blocks in metal stairs _______________________Proper cleats on ramps _______________________Adequate lighting in stairwells _______________________Proper handrails or guardrails _______________________Other __________________ _______________________8. TRAFFIC CONTROLTrained traffic controllers _______________________Properly located _______________________Clean, regulation sign _______________________Properly dressed (including vest) _______________________Other __________________ _______________________9. PUBLIC WAY PROTECTIONProperly located (within 4.5 m) _______________________Entrances clearly marked _______________________Covered where required _______________________Min. height, width requirement _______________________Proper rail on street side _______________________Proper lighting, where required _______________________Otherr __________________ _______________________10. FALL PROTECTIONCSA approved _______________________Properly worn _______________________Safe, usable condition _______________________Unprotected openings and edges _______________________Working from: Ladders Scaffolds Swingstages _______________________Other __________________ _______________________11. GUARDRAILS, BARRICADESLocated where required _______________________Properly constructed _______________________Adequately secured _______________________Other __________________ _______________________12. GAS CYLINDERSProperly located _______________________Properly secured _______________________Properly moved or lifted _______________________Properly hooked up _______________________Other __________________ _______________________Download form at ihsa.ca/logbook219

Item Inspected S NS NA Requires Immediate Action13. CONFINED SPACESProper access _______________________Air testing before entry _______________________Rescue equipment readily available _______________________Safety harness, lifeline properly anchored & used _______________________Second person for rescue _______________________Outgoing air monitored _______________________Entry permit where required _______________________Other __________________ _______________________14. FIRST AID REQUIRMENTSAdequate qualified first aiders on jobsite _______________________First aid kits: Adequate number Adequate contents _______________________Other __________________ _______________________15. FIRE PROTECTIONMaster emergency plan _______________________Extinguishers where required _______________________Fully charged _______________________Adequately identified _______________________Other __________________ _______________________16. CRANES, HOISTS, ETC.Safe setup of equipment _______________________Maintenance log available _______________________Competent operator _______________________Condition of slings, hardware _______________________Safety catches on all hooks _______________________Proper use of tag lines _______________________Proper lifting containers _______________________Competent signaller _______________________Other __________________ _______________________17. WELDINGRods & cylinders properly labeled _______________________MSDSs readily available _______________________Properly secured ground cables _______________________Proper eye protection worn _______________________Proper screens and exhaust _______________________Gas cylinders upright and secured _______________________Fire extinguisher readily available _______________________Other __________________ _______________________18. ELEVATING WORK PLATFORMWorker training _______________________Properly used _______________________Safe, usable condition _______________________Acceptable loading _______________________Manufacturer’s operating manual _______________________Other __________________ _______________________19. TRENCHES & EXCAVATIONSProperly sloped, where required _______________________Excavated soil properly placed _______________________Appropriate shoring used _______________________Proper access to trench _______________________Proper storage of materials in and above _______________________Other __________________ _______________________220 ihsa.ca

Item Inspected S NS NA Requires Immediate Action20. EXTENSION CORDSOutdoor-type, rated over 300 volts _______________________Condition of casing, ends, connections _______________________GFCIs used where required _______________________Other __________________ _______________________21. TEMPORARY POWER SUPPLYProperly identified _______________________Overhead lines flagged & secured _______________________Surface cables buried or protected _______________________Other __________________ _______________________22. MATERIALS STORAGEProperly located _______________________Safely piled, stacked, bundled _______________________Properly moved or lifted _______________________Properly labeled (WHMIS) _______________________Other __________________ _______________________23. FORMWORKGuardrails and fall-arrest system _______________________Design drawings kept on project _______________________Inspection statement by engineer or competent worker _______________________Other __________________ _______________________24. SUSPENDED SCAFFOLDSProperly attached and capable of 4 times max. load _______________________Outrigger beam tied to fixed support with counterweight _______________________All mechanical/electrical devices in good condition _______________________Independent lifelines for each worker (extend to ground) _______________________Engineer’s drawing on site if required _______________________25. SIGNS & PRINT MATERIALOH&S Act and Regulations _______________________WSIB In Case of Injury Poster _______________________MOL Health & Safety at Work Poster _______________________MSDSs _______________________Warning signs _______________________Emergency response plan and phone list _______________________Report forms _______________________Other __________________ _______________________26. WORKER EDUCATIONWHMIS training _______________________Company safety policies & program _______________________Injury reporting _______________________Hazard reporting _______________________OH&S Act and Regulations _______________________Personal H&S responsibilities _______________________Other __________________ _______________________27. HYGIENEWashroom facilities available _______________________Cleanliness of facilities _______________________Injury/hazard reporting _______________________Personal responsibilities _______________________Safety policies and procedures _______________________Other __________________ _______________________221