MB Electrical - Ellis Don Form E

Health & Safety Manual
SUBCONTRACTOR WEEKLY INSPECTION – FORM E
(To be completed on a weekly basis by each supervisor for the subcontractor and submitted to EllisDon)
Subcontractor Name
Project Name
Date

MonthDayYear
Date
Performed by
Signature

Clear
Personal Protective Equipment
Tools
1.Tools in good repair/properly stored
2.Safety Footwear (at all times)
2.Guards installed/functioning
3.Proper Clothing (at all times)
3.Cords/plugs in good condition
4.Eye Protection (at all times)
5.Hearing Protection (as required)
Fire Protection
6.Fall Protection (as required)
1.Fire extinguishers readily available
7.Hand Protection (as required)
lvb6r7en4ubpsm2-0
2.Hot work operations controlled
3.Flammable materials stored properly
Housekeeping
1.Storage area neat/tidy
2.Debris removed daily
3.Personnel routes kept clear
4.Material stacked safety
5.Nails removed/bent in scrap lumber
General Site Protection
1.Signs posted as appropriate
2.Barricade tape used as appropriate
3.Safety fence used as appropriate
4.Hazard areas marked/protected
5.Protruding hazards protected
Ladders/Stairs
1.Stair treads/handrails complete
2.Stairs clear of debris
3.Proper ladders selected
4.Ladders in good condition
5.Ladder used correctly
6.Access ladders secured
First Aid
1.First Aid kit available
2.First Aid attendant available/posted
3.First Aid records maintained
Program/Communication
1.All workers have onsite orientation
Railing/Floor Covers
2.Daily equipment inspection performed
1.All edges adequately guarded
3.Weekly Toolbox Safety Talk performed
3.Weekly Toolbox Safety Talk performed
2.Floor openings protected
4.Safety information posted
3.Covers marked and secured
5.Safety Data Sheets available
6.PSA’s used consistently
Scaffolds
1.Assembled by competent worker
Additional Items
Additional Items
Additional Items
2.Inspected daily/tagged
2.Inspected daily/tagged
3.Secured to structure (as required)
Electrical
1.Temporary lighting adequate
1.Temporary lighting adequate
2.GFCI’s used
3.Panel boards in good repair
Mark boxes: OK (√) Deficient (X) Not Applicable (N)
Mark boxes: OK (√) Deficient (X) Not Applicable (N)
Mark boxes: OK (√) Deficient (X) Not Applicable (N)
Comments
This Document is NOT Controlled if Printed. Confidential Information to be Used for Internal Purposes Only.

Title: Subcontractor Weekly Inspection – Form E

Department Approver: SVP, HSE
Should be Empty:

Health & Safety Manual

SUBCONTRACTOR WEEKLY INSPECTION – FORM E

Personal Protective Equipment

Tools

Fire Protection

Housekeeping

General Site Protection

Ladders/Stairs

First Aid

Program/Communication

Railing/Floor Covers

Scaffolds

Electrical