GENERAL INSPECTION

Date*

Date

Base*

Time*

Hour Minutes

AM/PM Option

Inspection Team*

Weather at time of Inspection*

Temperature at time of Inspection*

Emergency Prepareness

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Resolution
• Emergency Response Plan in place • Emergency Procedures Binders easily accessible & by every phone

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Emergency Signs & Barricades; in place and updated

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Enough and appropriate emergency supplies are available for each worker

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Evacuation Warden is designated • Primary and Secondary escape routes are clear and clearly visible

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Fire Warden is designated • Parking lot is clean & with no hazards • Fire hydrants are clear and accessible

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Wrench located at gas shut-off valve outside building – not obstructed

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Fire Extinguishers in proper locations, up to date, fully charged, not damaged, and not corroded or obstructed • Flip and shake extinguisher • Check off monthly inspection on Fire Extinguisher tag

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Emergency lighting in good working conditions – not obstructed • All Emergency exits clearly marked; inside and outside, no obstructions and hazards (ice, snow, no slipping, & no tripping)

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• First aid kit(s) well stocked & easily accessible, in compliance, and First Aid Kit tag monthly inspected • First aid submission records updated

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Eye Wash Station in good working order and free of obstructions – not out of date

What Action is Required:

Briefly explain 0/200

General Housekeeping

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Resolution
All lighting is adequate & in good working conditions; clean and no burnt-out lamps (replacements available)

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Sufficient waste containers; clean & emptied regularly

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Storage areas properly illuminated, clean & organized – No obstruction

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Non-slip tread on stairs • Railings strong & secured • No tripping hazards (stairs area)

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Aisles, walkways, floors, and windows cleared of obstructions and congestion

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Equipment & materials store in assigned locations

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Rsolution
Hazardous materials properly yielded, properly labeled, and properly stored

What Action is Required:

Briefly explain 0/200

Spills and Environmental

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Rsolution
• Spills are cleaned up promptly • Proper PPE available & used • Warning signs for wet/slippery floors

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Rsolution
• Spill kit properly stocked, easily accessible & ready for use

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Hazardous materials properly disposed As per SDS (Safety Data Sheet)

What Action is Required:

Briefly explain 0/200

Tools & Equipment

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Resolution
• Ladders & Stepping stools in good repair & properly inspected & stored • In compliance with OHS regulations

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Tools & Equipment properly stored • Tools & Equipment are organized / with no damage / up to date

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Personnel is properly trained in tools & Equipment prior to using

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
All guards and safety devices present and in good working conditions

What Action is Required:

Briefly explain 0/200

Safe Work Practices

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Resolution
• File drawers kept closed if not in use • Desks clean and organized

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Cords and cables are not on the way • Extensions cords used within limits • Power-bars dust & lint free/no clutter

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Safe lifting techniques always used • Proper lifting equipment available and within regulations

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• No smoking in unauthorized areas • No smoking signs easily visible

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Workers use and wear PPE properly, in good repair, is readily available, and it is task appropriate

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Signs and bulletin boards organized & readable

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
All structure integrity in good repair e.g., doors open safely and are in good conditions

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Washrooms clean & well stocked • Adequate cleaning supplies available

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Compressed gas cylinders stored vertically & secured to prevent falling over

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Manuals are current and in proper locations (COM, POH, SMS, MCM, etc.)

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Flight information sheets completed and filed correctly

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Oil logs completed correctly • Fuel logs completed correctly • Training forms completed correctly

What Action is Required:

Briefly explain 0/200

Compliance - Personnel

Only use Key words for Action Required.*

	OK	Action Required	Risk Priority	Immediate Resolution
• Company policies, practices, and procedures are readily available and implemented • WSP available for each task

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Proper ergonomics being exercised to prevent injuries

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
PPE training is provided for all personnel, clients, and visitors

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• Legislative requirements • Industry standards/practices • Harassment policies posted/followed

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
Training in place to prevent musculoskeletal injuries

What Action is Required:

Briefly explain 0/200

*

	OK	Action Required	Risk Priority	Immediate Resolution
• All personnel are properly trained for every task • Training is tracked and up to date

What Action is Required:

Briefly explain 0/200

Exposure:*

Probability:*

Severity:

Risk Level:

NOTES & OBSERVATIONS (Include positive observations & thank the personnel for their cooperation)

0/400

Please add attachment if you need more space to write your observations.

Take Photo 1

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Inspection Completed by:*

First NameLast Name

Your Work Email

example@lrhelicopters.ca

Signature*

Clear

Date*

Date

* Next Step: This form is submitted to the Health & Safety Coordinator or assigned Manager for final review and approval as outlined by the Company's SMS Manual. *

Name

First NameLast Name

Signature

Clear

Date

L R HELICOPTERS INC.

If you need more space for the "Action Required" field, please use the space provided for notes at the bottom of the form.