WHMIS Survey FormID=31443

  • WHMIS Program Survey

  • Instructions to use this form:

    Read the question then determine the status of

    Yes it's in place and your company can produce evidence that the system element is in place,

    Not Sure or

    No, not that I know of and your company isn't able to provide a evidence. 

    Based on the results of your survey, CORSafety will provide a series of solutions to aid in improving your program.

  • Part 1 - Safety Data Sheets

  • PT 1 - (a) Has a chemical inventory been prepared?

  • Status of PT 1 - (a)

  • PT 1 - (c) Has inventory been checked to ensure each controlled product has a corresponding SDS?

  • Status of PT 1 - (c)

  • PT 1 - (d) Are SDS's avalable to workers?                 

  • Status of PT 1 - (d)

  • PT 1 - (e) Is there a central catalogue of all SDS's?   

  • Status of PT 1 - (e)

  • PT 1 - (h) Is there a system to ensures that controlled products are accompanied by an SDS during purchasing?

  • Status of PT 1 - (h)

  • PT 1 - (i) A system of checks is done to ensure supplier SDS has all information required?.

  • Status of PT 1 - (i)

  • Part 2 - Labels

  • Image field 135

  • Pt 2 - (a) Controlled products are all received and checked for supplier labels?

  • Status of PT 2 (a)

  • PT 2 - (b) A system of workplace labeling exists on site for decanted products?

  • Status on PT 2 (b)

  • PT 2 - (c) Labels have all required information?

  • Status on PT 2 - (c)

  • PT 2 - (d) Labels are legiable?                       

  • Status of PT 2 - (d)

  • PT 2 - (e) A method of education and coding / identification is available for:

    Pipes and piping systems

  • Status of PT 2 - (e)

  • PT 2 (f) A system of placarding or posting work areas where controlled products are not in or could be edited from equipment, processes, etc.

  • Status on PT 2 - (f)

  • Part 3 - Education / Training

  • PT 3 - (a) Do the workers know what hazardous materials are present?

  • Status of PT 3 - (a)

  • PT 3 - (b) Are they aware of the requirements of WHMIS and of their own provincial health and safety legislation?

  • Status on PT 3 - (b)

  • PT 3 - (c) Do they know how to safely handle, store and dispose of the hazardous materials with which they work according to legislation where applicable?

  • Status on PT 3 - (c)

  • PT 3 - (d) Are they aware of the potential hazardous effects of the materials with which they are

    working?

  • Status on PT 3 - (d)

  • PT 3 - (e) Are they familiar with emergency and first aid?

  • Status on PT 3 - (e)

  • PT 3 - (f) Do they understand the use and purpose of control systems, including ventalation and personal protective equipment?

  • Status on PT 3 - (f)

  • PT 3 - (g) Do they know how to interpret a supplier or workplace label and what it means in terms of doing their jobs safely?

  • Status on PT 3 - (g)

  • PT 3 - (h) Do they know where they can get a copy of the SDS's?

  • Status on PT 3 - (h)

  • PT 3 - (i) Do they know how to interpret the information on a SDS and how to use it to carry out their jobs safely?

  • Status on PT 3 - (i)

  • PT 3 - (j) Are they aware of their right to refuse to do unsafe work?

  • Status on PT 3 - (j)

  • PT 3 - (k) Are they aware of their responsibility to use the information they have learned to work safely with hazardous materials?

  • Status On PT 3 - (k)

  • PT 3 - (l) Do they accept personal responsibility of using hazardous materials safely?

  • Status on PT 3 - (l)

  • PT 3 - (m) Have workers completed job specific hazardous materials training?

  • Status on PT 3 - (m)

  • PT 3 - (n) Are workers able to understand the information delivered to them during training?

  • Status on PT 3 - (n)

  • PT 3 - (o) Are workers well motivated and committed to safety and health on the job?

  • Status on PT 3 - (o)

  • PT 3 - (p) Are provisions made for training new, part-time and casual workers?

  • Status on PT 3 - (p)

  • PT 3 - (q) Are contractors and visitors to the area protected?

  • Status on PT 3 - (q)

  • PT 3 - (r) Is there evidence that the objectives of an effective training program have been met?

  • Status on PT 3 - (r)

  • PT 3 - (s) Is there a system of initiating safe work procedures from SDS information? Training in Safe Work Practices?

  • Status on PT 3 - (s)

  • PT 3 - (t) Does the worker have adequate education in labeling systems of WHMIS?

  • Status on PT 3 - (t)

  • Part 4 - Programs

  • PT 4 - (a) Is there an outline of the program in writing which is job specific?

  • Status on PT 4 (a)

  • PT 4 - (b) Are there standard safe work procedures on site?

  • Status on PT 4 - (b)

  • PT 4 - (c) Are there emergency

    procedures for:

    1. Fire
    2. Chemical spill and clean up
    3. Fugitive emmissions
    4. First Aid Response
  • Status on PT 4 - (c)
  • Should be Empty: