Monthly Inspection Checklist

Site/Contractor Name: Date:

Location: No. of Employees:

Conducted By:

S – Satisfactory NS – Not Satisfactory NA – Not Applicable

Item Inspected S NS NA Requires Immediate Action

1. SITE ACCESS
Clean, level ground T T T _______________________
Adequate ramps T T T _______________________
Adequate stairs T T T _______________________
Adequate ladders T T T _______________________
Other __________________ T T T _______________________

2. HOUSEKEEPING
Clear walkways T T T _______________________
Clear work areas T T T _______________________
Clear access and landing T T T _______________________
Other __________________ T T T _______________________

3. PERSONAL PROTECTIVE EQUIPMENT

Head protection T T T _______________________
Foot protection T T T _______________________
Eye protection T T T _______________________
Hearing protection T T T _______________________
Respiratory protection T T T _______________________
Fall protection (plan, rescue) T T T _______________________
Other __________________ T T T _______________________

4. LADDERS
Secured T T T _______________________
Proper angle (extension ladders) T T T _______________________
Proper size and type T T T _______________________
Safe, usable condition T T T _______________________
Properly used T T T _______________________
Proper handrail and landings T T T _______________________
Non-slip bases T T T _______________________
Other __________________ T T T _______________________

218 ihsa.ca
 Item Inspected S NS NA Requires Immediate Action

5. SCAFFOLDS
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 __________________ T T T _______________________

6. POWER TOOLS, EQUIPMENT

General condition T T T _______________________
Proper guards, cords, PPE T T T _______________________
Tagging as DEFECTIVE T T T _______________________
Other __________________ T T T _______________________

7. STAIRWELLS & RAMPS

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 __________________ T T T _______________________

8. TRAFFIC CONTROL
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 __________________ T T T _______________________

9. PUBLIC WAY PROTECTION

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 __________________ T T T _______________________

10. FALL PROTECTION

CSA approved T T T _______________________
Properly worn T T T _______________________
Safe, usable condition T T T _______________________
Unprotected openings and edges T T T _______________________
Working from: TLadders TScaffolds TSwingstages T T T _______________________
Other __________________ T T T _______________________

11. GUARDRAILS, BARRICADES

Located where required T T T _______________________
Properly constructed T T T _______________________
Adequately secured T T T _______________________
Other __________________ T T T _______________________

12. GAS CYLINDERS

Properly located T T T _______________________
Properly secured T T T _______________________
Properly moved or lifted T T T _______________________
Properly hooked up T T T _______________________
Other __________________ T T T _______________________

Download form at ihsa.ca/logbook

219
Item Inspected S NS NA Requires Immediate Action

13. CONFINED SPACES

Proper access T T T _______________________
Air testing before entry T T T _______________________
Rescue equipment readily available T T T _______________________
Safety harness, lifeline properly anchored & used T T T _______________________
Second person for rescue T T T _______________________
Outgoing air monitored T T T _______________________
Entry permit where required T T T _______________________
Other __________________ T T T _______________________

14. FIRST AID REQUIRMENTS

Adequate qualified first aiders on jobsite T T T _______________________
First aid kits: TAdequate number TAdequate contents T T T _______________________
Other __________________ T T T _______________________

15. FIRE PROTECTION

Master emergency plan T T T _______________________
Extinguishers where required T T T _______________________
Fully charged T T T _______________________
Adequately identified T T T _______________________
Other __________________ T T T _______________________

16. CRANES, HOISTS, ETC.

Safe setup of equipment T T T _______________________
Maintenance log available T T T _______________________
Competent operator T T T _______________________
Condition of slings, hardware T T T _______________________
Safety catches on all hooks T T T _______________________
Proper use of tag lines T T T _______________________
Proper lifting containers T T T _______________________
Competent signaller T T T _______________________
Other __________________ T T T _______________________

17. WELDING
Rods & cylinders properly labeled T T T _______________________
MSDSs readily available T T T _______________________
Properly secured ground cables T T T _______________________
Proper eye protection worn T T T _______________________
Proper screens and exhaust T T T _______________________
Gas cylinders upright and secured T T T _______________________
Fire extinguisher readily available T T T _______________________
Other __________________ T T T _______________________

18. ELEVATING WORK PLATFORM

Worker training T T T _______________________
Properly used T T T _______________________
Safe, usable condition T T T _______________________
Acceptable loading T T T _______________________
Manufacturer’s operating manual T T T _______________________
Other __________________ T T T _______________________

19. TRENCHES & EXCAVATIONS

Properly sloped, where required T T T _______________________
Excavated soil properly placed T T T _______________________
Appropriate shoring used T T T _______________________
Proper access to trench T T T _______________________
Proper storage of materials in and above T T T _______________________
Other __________________ T T T _______________________

220 ihsa.ca
 Item Inspected S NS NA Requires Immediate Action

20. EXTENSION CORDS

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 __________________ T T T _______________________

21. TEMPORARY POWER SUPPLY

Properly identified T T T _______________________
Overhead lines flagged & secured T T T _______________________
Surface cables buried or protected T T T _______________________
Other __________________ T T T _______________________

22. MATERIALS STORAGE

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 __________________ T T T _______________________

23. FORMWORK
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 __________________ T T T _______________________

24. SUSPENDED SCAFFOLDS

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 T T T _______________________

25. SIGNS & PRINT MATERIAL

OH&S Act and Regulations T T T _______________________
WSIB In Case of Injury Poster T T T _______________________
MOL Health & Safety at Work Poster 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 __________________ T T T _______________________

26. WORKER EDUCATION

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 __________________ T T T _______________________

27. HYGIENE
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 __________________ T T T _______________________

221