4S Site Inspection
Company Name
Location
Project
(Project/Job # not found in the project dropdown? If yes, Please select "Other" from the project name dropdown and write
down the project identifier or job #.)
Project Identifier/Job # Date Supervisor/Site Contact
yyyy-mm-dd
Inspection Conducted By
Activities performed at the time of site Inspection
Checklist ( Notes: S = Satisfactory, NS = Not Satisfactory, NI = Needs Improvement, N/A = Not Applicable )
Site Access
1. Clearly Marked with Adequate Signage S NS NI N/A
Protocols
2. COVID-19 Screening (Completed and Adequate) S NS NI N/A
3. Site Orientation (Completed and Adequate) S NS NI N/A
Safety Board/Postings
4. Health & Safety Policy Statement (Signed, Dated and Current within 12 S NS NI N/A
months)
5. Workplace Violence & Harassment Policy Statement (Signed, Dated and S NS NI N/A
Current within 12 months)
6. Company Rules S NS NI N/A
7. OHS Act & Regulations (Green Book) S NS NI N/A
8. Prevention Starts Here Poster S NS NI N/A
9. WSIB Form 82 (1234 Poster) S NS NI N/A
10. Notice of Project/Form 1000 S NS NI N/A
11. Site Health & Safety Representative/JHSC (if applicable) S NS NI N/A
12. Disposable non-latex gloves in varying sizes (at least 2 pair) S NS NI N/A
13. Emergency Response Plan (Roles & Responsibilities, Emergency S NS NI N/A
Procedures, Emergency Communication Procedure, Relevant Parties,
Approvals)
14. Emergency Contact List S NS NI N/A
15. Directions to Nearest Hospital S NS NI N/A
16. Site Map Indicating Evacuation Muster Point & Fire Extinguisher S NS NI N/A
Locations
First Aid and Emergency Equipment Requirements
17. Certificate(s) of First Aider(s) Posted and Valid S NS NI N/A
18. First Aider Present On-Site and Reflects Posted Certificate S NS NI N/A
19. First Aid Kit Available and Proper Size for Workforce S NS NI N/A
20. First Aid Kit Log Form Available and Completed as Required S NS NI N/A
21. First Aid Kit Inspections (At Least Quarterly) ? Marked on Kit S NS NI N/A
22. Other Emergency Equipment (i.e. eye-wash, etc.) available, adequate, S NS NI N/A
inspected and tested, as required
23. An appropriate emergency communication system in place to alert S NS NI N/A
workplace parties to the emergency (and consistent with ERP)
Fire Protection
24. Fire Extinguishers Mounted, Present where Required, Marked and S NS NI N/A
Location Clearly Labelled with Signage and in Good Condition
25. Fire Extinguishers Monthly Inspections Completed (4SafeCom and S NS NI N/A
Tags)
26. Fire Extinguishers Annual Re-Certification Completed S NS NI N/A
Documentation
27. Job Hazard Analysis (site-specific JHAs), Safe Work Practices, Safe Job S NS NI N/A
Procedures, Health and Safety Manual Available On-Site
28. Hazard Assessments (Daily Completed, Consecutive and Completed by S NS NI N/A
Appropriate Personnel)
29. Equipment Pre-Use Inspections (Completed, if Applicable) S NS NI N/A
30. Annual Certifications Present On-Site (eg. WAH anchor points) S NS NI N/A
31. Supervisor Weekly Inspections (Completed, Consecutive and S NS NI N/A
Completed by Appropriate Personnel)
32. Weekly Toolbox Talks (Completed and Consecutive) S NS NI N/A
33. Monthly Worker Representative Inspections (Completed, Consecutive S NS NI N/A
and Completed by Appropriate Personnel, if Applicable)
34. Safety Data Sheets Available for Chemicals On-Site (spot check at least S NS NI N/A
one)
35. Containers and Bottles Containing Substances Properly Labelled (spot S NS NI N/A
check at least one)
Site Safety Requirements
Notes: S = Satisfactory, NS = Not Satisfactory, NI = Needs Improvement, N/A = Not Applicable
Requirement Status Comment Picture
S NS NI N/A
S NS NI N/A
S NS NI N/A
S NS NI N/A
S NS NI N/A
S NS NI N/A
Additional Comments/Special Direction
Comments/Notes for 4S
Supervisor/ Worker Interview Questions (Notes: P = Positive, NI = Need Improvement)
Group
Worker Not Available Available
Inspector Name
Name
Date: yyyy-mm-dd
Supervisor/Site Contact Name
Name
Date: yyyy-mm-dd
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