Work Site Safety Inspection
Date of Inspection
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site
*
500 Railway Ave
Alexander Hotel
Black Swift Lodge
Grey Wolf Lodge
McCaffery
Mountain Lynx Lodge
Multiple Sites
RV
Spring Creek Gate Road Extension
The Franklin Hotel
TMV & MLV
Enter Site if not listed above
# of Workers on Site
*
Site Superintendent
*
Please Select
Alex Osbelt
Brian Bonner
Gabe Lamarche
Jeff Glowatsky
Nevil Stow
Peter Fordham
Tom Vineham
Site Superintendent Email
*
example@example.com
Manager
Manager Email
Contractors/Workers On Site
Adlers Fire Stop
Alpine Overhead Doors
Big Horn Sheet Metal
Bow Valley Safety
Bow-Cor Welding
Canglass
Canmore West Eavestrough
Cascade Mechanical
Competition Concrete
Convergint Technologies
Diamond Fireplaces
Downer Contracting
Dust Be Gone
Enlightened Organizing
Gallant Insulation
Guisti
Flipped Canoe Cribbing Inc.
Hellbent Geothermal
Henry's Electric
Heritage Decking
Iceline Waterproofing
KCP Energy
Legacy kitchens
Lomaw Contracting
Master Pools
McCool Construction YYC
Men in Kilts
Mountain Prism Painting
Northstar Fire Protection
Old West Flooring
Oskar
Peter's Exteriors
Primary Engineering
Prime Drywall
Procat Contracting Ltd.
Rgo
S2S Electric
SCMV - Construction
SCMV - Client Care
SCMV - RV/Maintenance
Set in Stone
Thompson Drilling
Tristar Woodworks
Wayco Electric
Woodpecker European Timber Framing
Type name if not listed above
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
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Inspection Items and Corrective Actions
Have there been any near misses?
YES
NO
Please explain
Are there any outstanding items from 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
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
Noise Assessments Conducted?
Please Select
Yes
No
Noise Assessment Equipment Used
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 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
Other Hazard
Please Select
Imminent Danger
Serious
Minor
Acceptable
N/A
not listed above
Other Hazards Records Comments / Corrective Actions
Responsible
Target Date
-
Month
-
Day
Year
Who Corrected
Date Corrected
-
Month
-
Day
Year
Safety Summary
Inspection Photographs
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of
Corrective Action Photographs
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of
Inspector Name
Inspector Email
example@example.com
Inspection Team
Inspector Signature
Inspection Internally QC'd by BVS?
*
YES
NO
Site Superintendent Name
Site Superintendent Date Signed
-
Month
-
Day
Year
Date
Site Superintendent Signature
Manager Name
Manager Date Signed
-
Month
-
Day
Year
Date
Manager Signature
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