Work Site Safety Inspection
Date of Inspection
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site
*
Work Site for PDF
Work Site (OLD)
24060 8th on 8th
24099 Canalta
24110 Beamers Gateway
25025 BPL Alpine Apartments
25132 Mountain Animal Hospital
26007 Charleston Phase 2
Enter Site if not listed above
# of Workers on Site
*
Site Superintendent
*
Please Select
David Wyse
Jeff Iverson
Kamil Franek
Kenny Vermette
Kit Hunter
Kurtis Jones
Maia Schumacher
Mike Young
Terry Leblanc
Site Superintendent Email
*
example@example.com
Project Manager
Project Manager Email
example@example.com
Construction Manager
*
Construction 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
Masonry
Electrical
Add Other Scope of Work
Describe Specific Scope of Work
Weather
Sunny
Overcast
Rain
Snow
Windy
Other
Temperature °C
Was a toolbox talk completed?
Yes
No
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Next
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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 Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chemical Storage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Chemical Storage Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Electrical
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Extension Cords, Power Cables
Electrical Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Inspections
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Equipment Inspections Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ERP
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
ERP Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Excavations
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Excavations Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fire Extinguishers
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fire Extinguishers Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
First Aid Kits/First Aid
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
First Aid Kits/First Aid Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fall Protection/Fall Arrest
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection/Fall Arrest Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fall Protection Barricades
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection Barricades Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fall Protection Plan (if required)
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Fall Protection Plan Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hazard Assessments reviewed
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Hazard Assesments reviewed Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Health & Safety Committee
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Health & Safety Committee Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hot Work Permit
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Hot Work Permit Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Housekeeping
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Housekeeping Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ladders
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Ladders Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Lighting
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Lighting Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Material Storage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Material Storage Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Noise Assessments Conducted?
Please Select
Yes
No
Noise Assessment Equipment
Noise Assessment Location/Area
Noise Assessment Tasks/Tools in use
Noise Assessment Readings
Noise Assessments
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Noise Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Orientations Completed
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Orientations Completed Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PPE (Specified Below)
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
PPE Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Protection of the Public
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Protection of the Public Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Safety Meeting/Toolbox Records
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Safety Meeting/Toolbox Records Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Scaffolding
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Scaffolding Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signage
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Signage Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site Conditions
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Site Conditions Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tools
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
Tools Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Other Hazard
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
not listed above
Other Hazard Comments/Corrective Action
Responsible
Target Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Who Corrected
Date Completed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Safety Summary
Inspection Photographs
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Corrective Action Photographs
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Inspector Name
*
Inspector Email
*
example@example.com
Inspection completed by a Bow Valley Safety Inspector?
*
YES
NO
Inspection Team
Inspector Signature
*
Reviewed By
Reviewer Job Title
Please Select
Safety Administrator
Safety Manager
Site Foreman
H&S Committee Member
Site Superintendent
Technical Manager
Manager
Other
Date Reviewed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewer Signature
Work Site Inspection Review
Work Site Superintendent
Review and complete corrective actions. Submit each time to save any changes.
When ALL corrective actions have been completed, sign and Date
Submit below to send to the manager for signature.
Work Site Superintendent Name
Work Site Superintendent Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Work Site Superintendent Signature
Manager
Review then Sign and Date to complete the inspection report.
Submit to close the reportand receive the final PDF copy.
Manager Name
Manager Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Manager Signature
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