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RENTAL | PRE-JOB SAFETY CHECKLIST (FILLABLE ONLINE)
• The intention of this checklist is to identify applicable OH&S Regulations (WorkSafeBC), Codes (BC Building Code, BC Fire Code) and applicable Health & Safety Policies prior to commencement of any work (project) being completed for the Owner.
• All Contractors and their sub-contractors must operate as per the identified Regulations, Codes and applicable Health & Safety Policies.
• This checklist must be submitted to your Landlord c/o AWM Alliance Real Estate Group Ltd. (“AWM”) Liaison (acting as the Agent for the Owner) before work commences.
• The AWM Liaison will retain this document for the Owner’s record.
Property Address c/o AWM Liaison Name
*
Email
*
Enter Email
Confirm Email
Contact (Office)
Contact (Cell)
Project Name / Owner
*
Building Code
Location
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Scope of Work
*
Contract Date
*
Project Duration
*
1. Do you inspect site conditions prior to start of work?
*
YES
NO
N/A
(Comment)
*
* If your answer above is "No" or "N/A", please write "No" or "N/A" on Comments as well.
2. Do you have WCB Notice of Project? (if applicable – ex. asbestos exposure) (WorkSafeBC Part 20)
*
YES
NO
N/A
(Comment)
*
3. Do you have WCB Clearance Letter?
*
YES
NO
N/A
(Comment)
*
4. Do you have Personal Optional Protection (POP) Coverage? (ex. self-employed)
*
YES
NO
N/A
(Comment)
*
5. Do you have Certificate of Insurance?
*
YES
NO
N/A
(Comment)
*
6. Do you have written OHS Program for your employees? (WorkSafeBC Part 3)
*
YES
NO
N/A
(Comment)
*
7. Do you have a copy of the OHS Act & Regulations available to your employees?
*
YES
NO
N/A
(Comment)
*
8. Do you provide Safety Orientation training for your employees?
*
YES
NO
N/A
(Comment)
*
9. Do you have written fire/emergency safety procedures for the project site (BC Fire Code)
*
YES
NO
N/A
(Comment)
*
10. Are you prepared to provide First Aid for your employees while on site? (WorkSafeBC Part 3)
*
YES
NO
N/A
(Comment)
*
11. Will this project require access to a roof? If work will be performed within the safety zone (2 meters from edge) a fall protection plan must be set-up and available for inspection.
*
YES
NO
N/A
(Comment)
*
12. Will this project involve working on raised work platforms? (WorkSafeBC Part 13)
*
YES (if yes, please complete question #12a.)
NO
N/A
(Comment)
12a. (Only if selected 'yes' on question #12) Please select the type of raised work platforms.
movable work platforms
scaffolds
ladders
elevated work platforms
other (please specify on the comment below)
(Comment)
13. Will this project involve work from which a fall of 3m (10Ft) may occur, or where a fall from less than 3m involves risk of injury greater than the risk of impact on a flat surface? (WorkSafeBC Part 11).
*
YES
NO
N/A
(Comment)
*
14. Will this project require entry into a confined space? (WorkSafeBC Part 9)
*
YES
NO
N/A
(Comment)
*
15. Will this project require de-energization and/or lockout? (WorkSafeBC Part 10)
*
YES
NO
N/A
(Comment)
*
16. Will this project involve work on high voltage equipment or within high voltage vaults? (WorkSafeBC Part 19)
*
YES
NO
N/A
(Comment)
*
17. Will this project require the shutdown of any utility systems?
*
YES
NO
N/A
(Comment)
*
18. Will the activities of this project (staging, vehicles, odors, noise, equipment, tool use, dust/debris etc.) impact building occupants or others?
*
YES
NO
N/A
(Comment)
*
File Upload for Any Supplementary Document
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Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 8 MB.
Additional Information:
• Any accidents/incidents should be properly investigated & a copy of the report provided to your Landlord c/o AWM Liaison as soon as possible, requirements and alert WCB to be observed at all times.
• The contractor will maintain a copy of the Pre-Job Safety Checklist
• The contractor is responsible for maintaining documentation at the project site as indicated above.
• The contractor must review this checklist and all designated documentation with their sub-contractors (as applicable)
Property Address c/o AWM Liaison Name
*
Name
Date
By checking this box, I AGREE that my electronic signature is the legally binding equivalent to my handwritten signature. I AGREE that the information in this form is true and I have the authority to complete the pre-job safety checklist on behalf of the contractor.
*
I Agree.
Contractor Name
*
Name
Date
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