Worksite Inspection Form
Conducted By #1:
Conducted By #2:
Date of Inspection
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Month
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Day
Year
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Complete the inspection by providing a rating to each component.
Rows
Compliance
Non-Compliant
Corrected
Dust masks, hearing protection available:
Hand tools – condition etc
Machine Lockout /Tag out system in place.
Fuels/Hazardous chemicals stored correctly
First Aid Kit (supplies as OH&S)
Eye Wash Stations – Full & Clean Bottle
Material stored correctly: (on rack etc)
Absorbent available for spills.
Slings, chains lifting gear stored correctly
Safety glasses cleaning kit stocked:
Fire extinguishers inspected, accessible.
Machine Guards and Barriers available.
Electrical cords & cables free of damage.
Grinders / Saws etc with safety guards.
Oil Leaks: (no spills etc)
Emergency Response Plan; signage.
Hazard signs. (Noise, safety glasses etc)
WHMIS labeling SDS sheets dated correct
Walkways, Exits etc clear and accessible.
Proper PPE in use and available to visitors
Overhead doors operational
Trash containers provided and useable.
General Housekeeping.
Exhaust fan operational and clean
Heating System Operational
Ventilation system in place for welding.
Emergency exit lights operational
Work areas illuminated (no blown bulbs)
Work Areas & Surfaces clean and tidy.
Workers compliant with work procedures
Additional Comments:
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Do you require to write corrective actions?
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Yes
No
How many corrective actions do you need?
1
2
3
4
5
6
7
8
9
10
Task Name
Task 1
Task Notes
Task Notes 1
Assignee
matt.gamble@bencoweldingltd.com
treyr@bci-ab.ca
Assignee 1
Task Name
Task 2
Task Notes
Task Notes 2
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee2
Task Name
Task 3
Task Notes
Task Notes 3
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 3
Task Name
Task 4
Task Notes
Task Notes 4
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 4
Task Name
Task 5
Task Notes
Task Notes 5
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 5
Task Name
Task 6
Task Notes
Task Notes 6
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 6
Task Name
Task 7
Task Notes
Task Notes 7
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 7
Task Name
Task 8
Task Notes
Task Notes 8
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 8
Task Name
Task 9
Task Notes
Task Notes 9
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 9
Task Name
Task 10
Task Notes
Task Notes 10
Assignee
Benco Management
Balzer Safety Dept
Both
Assignee 10
Managers Name
First Name
Last Name
Managers Signature
Date of Managers Signature
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Month
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Day
Year
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