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Health and Safety Checklist

(Work Based Learning Work Site Safety Assessment)

Organization*
Date
MM slash DD slash YYYY
Address*
Street Address City Province Postal Code
Site Supervisor
First Name Last Name
Floors and Walkways
Exits are marked; walkways and stairways are clear
- Satisfactory
- Unsatisfactory
- Not Applicable
Locations of cleanup supplies are identified
- Satisfactory
- Unsatisfactory
- Not Applicable
Non-slip mats, grates, or slip-free coatings are used in potentially wet areas
- Satisfactory
- Unsatisfactory
- Not Applicable
Stairways have handrails
- Satisfactory
- Unsatisfactory
- Not Applicable
Additional occupationally-specific consideration(s) - Floors and Walkways
Please type your rating after each item (Satisfactory / Unsatisfactory)
Comment
More info for any item above if necessary
Ladders (including step stools, etc.)
Ladders appear to be in good condition
- Satisfactory
- Unsatisfactory
- Not Applicable
Ladders have safety feet
- Satisfactory
- Unsatisfactory
- Not Applicable
Non-metal ladders are used where there is a possibility of electric shock
- Satisfactory
- Unsatisfactory
- Not Applicable
Additional occupationally-specific consideration(s) - Ladders
Please type your rating after each item (Satisfactory / Unsatisfactory)
Comment
More info for any item above if necessary
Fire Safety
There are at least two emergency exits for each work area
- Satisfactory
- Unsatisfactory
- Not Applicable
Fire exits are clearly marked and pathways to exits are clear
- Satisfactory
- Unsatisfactory
- Not Applicable
Emergency procedures are posted and discussed in student orientation
- Satisfactory
- Unsatisfactory
- Not Applicable
Fire extinguisher(s) are available and marked
- Satisfactory
- Unsatisfactory
- Not Applicable
Additional occupationally-specific consideration(s) - Fire Safety
Please type your rating after each item (Satisfactory / Unsatisfactory)
Comment
More info for any item above if necessary
Electrical Hazards
Visible electric cords are in good condition (unfrayed and without defects)
- Satisfactory
- Unsatisfactory
- Not Applicable
Any floor cords and cables are covered with safety covers
- Satisfactory
- Unsatisfactory
- Not Applicable
Emergency “stop” switch is available to shut down electricity (where applicable)
- Satisfactory
- Unsatisfactory
- Not Applicable
Additional occupationally-specific consideration(s) -Electrical Hazards
Please type your rating after each item (Satisfactory / Unsatisfactory)
Comment
More info for any item above if necessary
Machine Guarding and Mechanical Safety
Machines are securely attached to the floor
- Satisfactory
- Unsatisfactory
- Not Applicable
Machines have protective guards as appropriate to protect workers
- Satisfactory
- Unsatisfactory
- Not Applicable
Emergency turn off switches are functional and available where appropriate
- Satisfactory
- Unsatisfactory
- Not Applicable
Safe use procedures are posted and discussed in student orientation
- Satisfactory
- Unsatisfactory
- Not Applicable
Additional occupationally-specific consideration(s) -Machine Guarding and Mechanical Safety
Please type your rating after each item (Satisfactory / Unsatisfactory)
Comment
More info for any item above if necessary

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