Eiffel Work Site Inspection
Date of Inspection
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site
*
Max--Montana
Max--Princeton Cityscapes
Max--Rosewood Estates
Max--Stratford on the Park
Max --Riverview Place
Max --Riveside Towers
YCH-345-1-Doherty Residence
YCH-370-5-McCollister
YCH-387-4-193 Country Lane Drive
YCH-183-31-8th Floor Demising Wall
YCH-430-1-Fickes Barndominium
YGC-374-15-Montana Gym
YGC-397-1-Canco Gas Station - Car Wash
YGC-402-1-134 Forge Rd SE Calgary
YGC-447-1-PRAIRIE SOUND CIRCLE
YGC-452-1-Master Bedroom Renovation
YGC--Southcenter Mall
Enter Site if not listed above
Other Work Site
# of Workers on Site
*
Work Site Superintendent
*
Work Site Superintendent Email
*
example@example.com
Manager
Manager Email
example@example.com
Contractors/Workers On Site
Scope of Work
Site Work
Cribbing
Framing
Siding
Roofing
Dry Walling
Carpentry
Steel Framing
Concrete
Painting
Plumbing
Edit
Describe Specific Scope of Work
Weather
Sunny
Overcast
Rain
Snow
Windy
Other
Temperature °C
Back
Next
Inspection Items and Corrective Actions
Have there been any near misses?
YES
NO
Please explain
Are there any outstanding items form the last inspection?
YES
NO
Items Outstanding
Certificates/Tickets (copy on site)
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Certificates/Tickets (copy on site) Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Chemical Storage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Chemical Storage Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Electrical
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Extension Cords, Power Cables
Electrical Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Equipment Inspections
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Equipment Inspections Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
ERP
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
ERP Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Excavations
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Excavations Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fire Extinguishers
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fire Extinguishers Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
First Aid Kits/First Aid
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
First Aid Kits/First Aid Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fall Protection/Fall Arrest
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection/Fall Arrest Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fall Protection Barricades
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection Barricades Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fall Protection Plan (if required)
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection (if required) Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Hazard Assessments reviewed
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Hazard Assessments reviewed Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Health & Safety Committee
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Health & Safety Committee Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Hot Work Permit
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Hot Work Permit Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Housekeeping
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Housekeeping Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Ladders
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Ladders Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Lighting
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Lighting Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Material Storage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Material Storage Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Orientations Completed
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Orientations Completed Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
PPE (Specified Below)
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
PPE Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Protection of the Public
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Protection of the Public Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Safety Meeting/Toolbox Records
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Safety Meeting/Toolbox Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Scaffolding
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Scaffolding Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Signage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Signage Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Site Conditions
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Site Conditions Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Tools
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Tools Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Safety Summary
Inspection Photographs
Browse Files
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of
Corrective Action Photographs
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of
Inspector Name
*
Inspector Email
*
example@example.com
Inspector Signature
*
Site Superintendent Name
Site Superintendent Date Signed
-
Month
-
Day
Year
Date
Site Superintendent Signature
Manager Name
Date Signed
-
Month
-
Day
Year
Date
Manager Signature
Submit
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