Work Site Safety Inspection
Date of Inspection
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site Location/Address
# of Workers on Site
Site Supervisor
Danny Finn
Eric Scott-Iversen
Greg Skeavington
Theo van Zyl
Add name if not listed above
Site Supervisor Email (optional)
example@example.com
Manager Name
Manager Email
example@example.com
Scope of Work (one or more)
Brush Saws Operations
Burning
Chipping
Climbing
Felling
Piling
Pruning
Shop/Office Work
Stump Grinding
Tree Removal
Yard Work
Add Other Scope of Work
Weather
Sunny
Overcast
Rain
Snow
Windy
Other
Temperature °C
Back
Next
Save before Submitting
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
OHS Act, Regs and Manual Accessible
Please Select
Satisfactory
Requires Attention
N/A
OHS Act, Regs and Manual Accessible Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fuel Storage
Please Select
Satisfactory
Requires Attention
N/A
Fuel Storage Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Appropriate Report Forms Available
Please Select
Satisfactory
Requires Attention
N/A
Appropriate Report Forms AvailableComments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Equipment Inspections
Please Select
Satisfactory
Requires Attention
N/A
Equipment Inspections Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Site ERP
Please Select
Satisfactory
Requires Attention
N/A
Site ERP Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Spill Kit Available
Please Select
Satisfactory
Requires Attention
N/A
Spill Kit Available Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Fire Extinguishers & Fire Supression Equipment
Please Select
Satisfactory
Requires Attention
N/A
Fire Extinguishers & Fire Supression Equipment Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
First Aid Kits
Please Select
Satisfactory
Requires Attention
N/A
First Aid Kits Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Safe Work Distances Observed
Please Select
Satisfactory
Requires Attention
N/A
Safe Work Distances Observed Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Smoke Detectors
Please Select
Satisfactory
Requires Attention
N/A
Smoke Detectors Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Used Oil/Filters/Containers Storage
Please Select
Satisfactory
Requires Attention
N/A
Used Oil/Filters/Containers Storage Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Hazard Assessments
Please Select
Satisfactory
Requires Attention
N/A
Hazard Assessments Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Blood Stopper/Tourniquet on Saddles
Please Select
Satisfactory
Requires Attention
N/A
Blood Stopper/Tourniquet on Saddles Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Operators Competent
Please Select
Satisfactory
Requires Attention
N/A
Operators Competent Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Housekeeping
Please Select
Satisfactory
Requires Attention
N/A
Housekeeping Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Ladders
Please Select
Satisfactory
Requires Attention
N/A
Ladders Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Propane / Tiger Torch Storage
Please Select
Satisfactory
Requires Attention
N/A
Propane / Tiger Torch Storage Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Good Worker Communication
Please Select
Satisfactory
Requires Attention
N/A
Good Worker CommunicationComments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Safe Work Practices in use
Please Select
Satisfactory
Requires Attention
N/A
Safe Work Practices in use Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
PPE (Specified Below)
Please Select
Satisfactory
Requires Attention
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
Satisfactory
Requires Attention
N/A
Protection of the Public Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
SDS Available Records
Please Select
Satisfactory
Requires Attention
N/A
SDS Available Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Signage/Spotters in use
Please Select
Satisfactory
Requires Attention
N/A
Signage/Spotters in use Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Site Conditions
Please Select
Satisfactory
Requires Attention
N/A
Site Conditions Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Tools
Please Select
Satisfactory
Requires Attention
N/A
Tools Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Other Hazard
Please Select
Satisfactory
Requires Attention
N/A
not listed above
Other Hazards Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Inspector Name
Danny Finn
Eric Scott-Iversen
Greg Skeavington
Keith Mc Cabe
Mel Heyd
Theo van Zyl
Type Name if not Listed
Who Corrected
Date Corrected
-
Month
-
Day
Year
Inspection Photographs
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Corrective Action Photographs
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Inspector Email
example@example.com
Inspector Signature
Corrective Actions Completed?
YES
NO
Site Supervisor Signature
Manager Name
Manager Date Signed
-
Month
-
Day
Year
Date
Manager Signature
Save before Submitting
Submit
Should be Empty: