Date

MM

DD

YYYY

Daily Site Checklist

PPE is available and worn by all workers on site

Job Site has been visually inspected for hazards and all risks identified

Electrical lockout procedures understood and confirmed

Hazardous materials identified

Overhead visual inspection complete

Fire and First Aid equipment available

Tools are available, in safe working condition, and workers are trained in safe use

Equipment - safe removal plan discussed for old equipment

Installation - safe installation plan for new equipment

A-Hazards Identified (submit incident report and stop work)

B-Hazards identified (submit incident report and call the office - stop work if required)

C-Hazards identified, reported, and resolved

Date

MM

DD

YYYY

Name *

First Name

Last Name

Date

MM

DD

YYYY

Sections Completed

WHMIS

Safe Work Procedures

Emergency Procedures

Bullying and Harassment

First Aid

Training and Orientation

Incident Reporting and Investigations

Managing Risks

Rights and Responsibilities

Inspections and Checklists

I acknowledge that I have read and I understand the information on the Selected page(s). *

Yes

Date *

MM

DD

YYYY

Time

Hour

Minute

Second

AM PM

Type of incident *

Accident/Injury

Near miss (unsafe condition)

Other

Did you report this to the office?

Yes

No (if no, seek appropriate medical treatment first and continue trying to reach the office)