WORKSITE HEALTH AND SAFETY INSPECTIONS/CORRECTIVE ACTIONS

WORKSITE HEALTH AND SAFETY INSPECTION

WORKSITE CORRECTIVE ACTION

ARE YOU COMPLETING AN INSPECTION OR DOCUMENTING CORRECTIVE ACTION *

COMPLETING INSPECTION

DOCUMENTING CORRECTIVE ACTION

ENTER THE "RESULT NUMBER" FROM THE ORIGINAL EMAIL INSPECTION REPORT THAT PROMPTED THIS CORRECTIVE ACTION. *

ENTER YOUR COMPANY NAME *

ENTER YOUR EMAIL ADDRESS TO RECEIVE THE COMPLETED REPORT (REQUIRED) *

ENTER THE EMAIL ADDRESS(S) FOR OTHER INTENDED RECIPIENT(S).

RECIPIENT 1 (WHERE REQUIRED)

RECIPIENT 2 (WHERE REQUIRED)

WHO IS INSPECTING THIS SITE *

WHO IS COMPLETING THIS CORRECTIVE ACTION FORM *

SITE NAME *

GC EMERGENCY CONTACT NAME

GC EMERGENCY CONTACT PHONE NUMBER

CHECK ALL THAT APPLY *

PRE-JOB START-UP

WORKSITE

GENERAL SITE

CHECK OFF ANY POTENTIAL HAZARDS OR DEFICIENCIES FOUND FROM THE INSPECTION. YOU WILL NEED TO PROVIDE CORRECTIVE ACTIONS/ELIMINATIONS FOR ANY DEFICIENCIES FOUND.

CHECK MARK ANY DEFICIENCIES BELOW AFTER INSPECTION COMPLETION *

YOU MUST ALSO ASSIGN A PRIORITY CODE. e.g. 1A, 1B, 2C ETC . WHERE 1A IS THE HIGHEST LICKLIHOOD AND SEVERITY AND 4D IS THE LEAST LIKELY AND SEVERITY.

Please indicate the location for each of the following: If not available enter N/A *

	-
Fire Extinguisher	-
First aid kits	-
SDS's	-
Waste Disposal	-
Access/Egress - general	-
Access/Egress worksite	-
ERP posted	-
Washrooms	-
Eyewash station	-

Name of site first aider(s) *

PRIORITY CODES

ASSIGN A PRIORITY CODE: 1-4 FOR SEVERITY AND A-D FOR PROBABILITY FOR ANY HAZARDS OR DEFICIENCIES IDENTIFIED. FOR EXAMPLE 1A, 1B, 2B ETC. WHERE "1A" IS THE HIGHEST PRIORITY.

HAZARD ASSESSMENT PROCEDURE DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH THE HAZARD ASSESSMENT PROCEDURE? *

CODE OF PRACTICE/PROCEDURE DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH THE CODE of PRACTICE/PROCEDURE? *

TRAFFIC CONTROL/FLASSERS/BARRICADES DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH TRAFFIC CONTROL/FLASHERS/BARRICADES? *

FIRE EXTINGUISHERS DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH THE FIRE EXTINGUISHERS? *

DESIGNATED SMOKING AREA DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH DESIGNATED SMOKING AREA? *

SITE CONTRACTOR FIRST AIDERS DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH SITE CONTRACTOR FIRST AIDERS? *

FIRST AID KIT DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH FIRST AID KITS? *

LOCK OUT PROCEDURES/ENERGY CONTROL DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH LOCK OUT PROCEDURES/ENERGY CONTROL? *

ELECRITCAL WIRING AND GUARDS DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH ELECTRICAL WIRING AND GUARDS? *

PROTECTION TO PUBLIC DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH PROTECTION TO PUBLIC? *

SDS'S AVAILABILITY DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH SDS'S AVAILABILITY? *

WASTE DISPOSAL DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH WASTE DISPOSAL? *

MATERIAL STORAGE AND HANDLING DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH MATERIAL STORAGE AND HANDLING? *

ACCESS/EGRESS DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH ACCESS/EGRESS? *

ERP POSTED DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH ERP POSTED? *

SITE CONTRACTOR DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH SITE CONTRACTOR ORIENTATION? *

FLAMMABLES DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH FLAMMABLES? *

FLOOR OPENING DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH FLOOR OPENINGS? *

FALL HAZARD DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH FALL HAZARDS? *

HEAVY EQUIPMENT DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH HEAVY EQUIPMENT? *

EQUIPMENT PROTECTION DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH ENVIROMENTAL PROTECTION? *

OTHER TRADES DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH OTHER TRADES? *

WASHROOMS DEFICIENCY PRIORITY CODE? *

WHAT IS THE DEFICIENCY(S) IDENTIFIED WITH WASHROOMS? *

ARE WORKERS ALLOWED TO BEGIN OR CONTINUE WORKING? *

DESCRIBE THE ACTIONS TAKEN TO ELIMINATE OR MITIGATE THE HAZARDS IDENTIFIED *

DATE OF CORRECTION * +

DATE OF INSPECTION * +

TIME OF INSPECTION OR CORRECTION *

AM/PM? *

AM

PM

SIGNATURE *

clear

HAZARD ASSESSMENT PROCEDURE	CODE OF PRACTICE/PROCEDURE	TRAFFIC CONTROL/FLASHERS/BARRACADES
FIRE EXTINGUISHERS	DESIGNATED SMOKING AREA	SITE CONTRACTOR FIRST AIDERS
FIRST AID KITS	LOCKOUT PROCEDURE/ENERGY CONTROL	ELECTRICAL WIRING AND GUARDS
PROTECTION TO PUBLIC	SDS AVAILABILITY	WASTE DISPOSAL
MATERIAL STORAGE AND HANDLING	ACCESS/EGRESS	ERP POSTED
SITE CONTRACTOR ORIENTATION	FLAMMABLES	FLOOR OPENINGS
FALL HAZARDS	HEAVY EQUIPMENT ON SITE	ENVIRONMENTAL PROTECTION
OTHER TRADES	TOILETS AVAILABLE	AIRBORNE DUST/PARTICULATE
NEW WORKERS	EYE WASH STATION	GASEOUS ENVIRONMENT
PPE POLICY POSTED	OTHER