Subcontractor Pre-Start Checklist

Subcontractor Pre-Start Checklist

Project: Project#:

This MJ Dixon project will be fast paced and intensive. To simplify the safety administrative

needs, this checklist has been prepared to give subcontractors the opportunity to have

documentation ready upon arrival of workers to site and to be prepared for the site expectations

thereafter.

You may also be required to submit other items to site or to other entities within MJ Dixon.

This list is a start-up and not intended to be an exhaustive list.

Documents required before arrival at site:

Form 1000

Certificate of Insurance

WSIB Clearance

Health & Safety Policy (signed and dated current to within 1 year)

Health & Safety Program

Violence & Harassment Policy (signed and dated current to within 1 year)

Declaration of Competent Supervision (1 declared supervisor/foreman) for each contractor

regardless of crew size)

SDS submitted 24 hours prior to product delivery to site (pertinent only, no generic binders

accepted)

Site Documentation

Daily

Pre-Job Hazard Assessment (PHA) submitted daily within 1 hour of crew arrival

Equipment inspections (cranes, fall protection, EWP, welding, etc.)

Weekly (Submitted Monday following or on last day attending)

Weekly Job Site Report

Tool Box Talk

Disciplinary reports

As Required

MOL reports (to be submitted on the day of issue)

Government issued notices, permits, etc.

Site permits (hot work, lockout, compressed gas, etc.)

Accident/Incident/Near Miss/First Aid reports (within 24 hours of event)

Worker/Task Documentation

Declaration of Employer Orientation for each worker

Certificate of Qualifications/Proof of Training (to be carried on person at all times)

Minimum training

o WHMIS 2015

o Working at Heights

o MOL Worker Awareness (Supervisor Awareness training for site foreman)

o Workplace Harassment & Violence Awareness

o Trade or task specific training

First Aid (1 certified first aider per crew at minimum as well as First Aid Kit appropriate for

crew size)

Safe Work Procedures (fall protection, rescue, LO/TO, traffic control, etc.)

Engineering for safety equipment (life lines, scaffolds, temporary anchors, etc.)

Site Orientations will be held by appointment only. Call site at least 24 hours in advance to reserve.

All workers must receive site orientation prior to commencing work on site.

Ontario Ministry of Labour

Ministère duTravailde l’Ontario

Registration of Constructors and Employers Engaged in ConstructionInscription des constructeurs et des employeurs associés à destravaux de constructionPursuant to section 5 of the Construction Regulations made under the OHSA, “Before beginning work at a project, each constructorand employer engaged in construction shall complete an approved registration form. The constructor shall ensure that each employerat the project provides to the constructor a completed approved registration form; and a copy of the employer’s completed form is keptat the project while the employer is working there.”

Conformément à l'article 5 du règlement intitulé Construction Projects, pris en application de la Loi sur la santé et la sécurité autravail, «les constructeurs et les employeurs associés à des travaux de construction doivent remplir un formulaire officiel avant decommencer leurs travaux. Les constructeurs doivent veiller à ce que tous les employeurs associés au chantier lui remettent unformulaire d'inscription dûment rempli. Une copie du formulaire d'inscription des employeurs doit être gardée au chantier tant et aussilongtemps que les employeurs y travaillent.»

Employers are required to submit the completed form to the Constructor for posting/display at the project.Les employeurs doivent remettre le formulaire dûment rempli au constructeur pour qu'il puisse l'afficher sur le chantier.

Nature of Business (check one) Genre d'entreprise (cochez une case)

IndividualIndividuelle

Joint VentureCoentreprise

Sole proprietorshipÀ propriétaire unique

PartnershipEn nom collectif

CorporationSociété

Average No. of Employees on ProjectNombre moyen d'employés sur le chantier

1 - 5 6 - 19 20 - 49 50 + / 50 et plus

Name and Full Address of Business / Nom et adresse complète de l'entreprise

Names of CorporationsNom des sociétés

1.

Fax:N° de télécopieur

Telephone No.:N° de téléphone

Fax:N° de télécopieur

Telephone No.:N° de téléphone

Fax:N° de télécopieur

Telephone No.:N° de téléphone

2.

Main Business AddressAdresse principale

Names of Directors & Principal Officers Nom des directeurs et des principaux dirigeants

Master Business Licence No.N° du permis principald'entreprise (MCC)

Retail Sales Tax No.N° de taxe de vente au détail

I hereby certify that the above information is correct / J'atteste par la présente que les renseignements donnés plus haut sont exacts.

Position & Title Poste et titre

SignatureSignature

DateDate

WSIB No.N° de compte (CSPAAT)

WSIB Rate No.N° de groupe tarifaire(CSPAAT)

1.

2.

Title Titre

Date Appointed Date d'entrée en fonction

1000 (03/00)This form may be photocopied / Ce formulaire peut être photocopié.

Sample

Clearance Certificate / Certificat de déchargeContractor Legal /Trade Name /Appellationcommerciale ouraison sociale del’entrepreneur

Contractor Address /Adresse del’entrepreneur

ContractorClassification Unitand Description /Unité de classificationde l’entrepreneur etdescription

Principal Legal /Trade Name /Appellationcommerciale ouraison sociale del’entrepreneurprincipal

Principal Address /Adresse del’entrepreneurprincipal

Clearance certificatenumber / Numéro ducertificat de décharge

Validity period (dd-mmm-yyyy) / Périodede validité(jj/mm/aaaa)

M.J. DIXONCONSTRUCTIONLIMITED

2600 EDENHURSTDR., MISSISSAUGA,ON, L5A3Z8, CA

4021-099: Industrial,Commercial, andInstitutionalConstruction

Barry Bryan Associates 250 Water STreet,Whitby, ON, L1N 0G5,CAN

E200000DBPF6 07-Feb-2018 to 19-Feb-2018

Page 1 of 1Sam

ple

DECLARATION OF COMPETENT SUPERVISION

In the matter of contract work performed by (_________________________________) Name of Company

at the (_________________________________________). Name of Project

1. I am the (_____________________) of (________________________________) and as such

Title Name of Company have knowledge of the matters herein stated.

2. (____________________________) is a (_________________________) with its head office

Name of Company choose 1: Proprietorship/Partnership/Corporation

located at (________________________________________) and has carried on business as a Address

Contractor since on or about (_________________) Date

3. (____________________________) has since (___________________) had in place a health Name of Company Date

and safety policy and has developed and maintains on an annual basis a program to implement the written Occupational Health and Safety Policy. A copy of this policy and program is available for inspection upon request.

4. (___________________________) will employ for this project a supervisor or supervisors

Name of Company

who are competent persons, and specifically the following person(s) who: a. are qualified because of knowledge, training and experience to organize the project work and

its performance; b. are familiar with the Act and Regulations for Construction Projects that apply to the Project

work; and c. have knowledge of any potential or actual danger to health and safety at the Project.

5. (___________________________) will employ for the purpose of this Project the following

Name of Company

competent supervisors: 1. ________________________________________________ 2. ________________________________________________ 3. ________________________________________________ No supervisor other than those named above or attached hereto by addendum shall work on the Project in a supervisory capacity.

6. The Supervisor(s) employed by (__________________________________) has/have Name of Company

completed the necessary health and safety courses to be considered a competent person to undertake work described in the Contract. Proof of such training is attached hereto for the persons named above and will be included by addendum for any future supervisors assigned to the Project.

____________________________________ _________________________ Company Official Date

Sample

1) Identify 2) Assess Page

Hazard Risk of

4)

Safely Controls

Site Permits

Y/N

Y

Y

Y

Y Do workers have copies of all up to date mandatory and task specific training on their person?

Y

Y/N

Y CSA Approved Hard Hat Gloves Hearing Protection

Y Minimum 6" green work boots Safety Glass/Full Face Shield Dust Mask/Respirator

Safety Vest/Jacket/Shirt Fall Protection Other

1

2

34

5

6 All workers must

7 acknowledge the contents

8 of this PHA prior to starting

9 shift by printing full name

10 and by signature

11

12

13 All personnel are required

14 to receive site orientation

15 before working on this site.

Evacuation List and PHA Sign Off

Assess The Risk! Daily Pre-Job Hazard Assessment (PHA)Date:

Project:

Work 3) Introduce Use additional pages for Company:

Inspect work area for possible hazards before commencing with tasks? Reassessment may need to occur after inspection.

Trade: additional information

Specific Task Location: and/or signatures

Concrete Cutting/Coring

Hot Work

Fire Suppression/Alarm Shutdown

Confined Space Entry

Lockout/Tagout

Other

CONTROLS

Foreman: (print)

Foreman: (sign)

Signature

PPE Requirements (All PPE must be inspected prior to use each shift at a minimum)

First Aider

Location of First Aid Kit

Print name(s) below:

Am I physically prepared and mentally focused?

Do workers have copies of all MSDS for products used or stored?

Have all equipment and PPE inspections been completed? Equipment inspection sheets must be kept on the equipment

TASKS HAZARDS

FALL PROTECTION DAILY PRE-USE INSPECTION SHEET Competent Worker must complete checklist prior to use at start of each shift

Worker Name: Contractor:

Project: Project #:

Week Ending:

InitialsOK N/A OK N/A OK N/A OK N/A OK N/A OK N/A OK N/A

WebbingStitchingBucklesGrommetsStrap KeepersD-RingLocking Snap HooksHookLock SpringsLanyardWebbingStitchingJacket

StretchingConnectionKnotsRope GrabFailsSpringsGateLocking PinSafety LatchTeethLifelineRope Matches GrabPolypropylene or EqualLengthRope ConditionDiscolourationAnchor AttachmentStretchingEdge ProtectionRetractableHousingLifelineSwivel ConnectorBrakingAnchor CapacityDeformationOne per LifelineComments:

Harness Serial#: Expiry Date(m/y) :Lanyard Serial#: Expiry Date(m/y) :Lifeline Serial#: Expiry Date(m/y) :

Full Body Harness

End Loops

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Supervisors Weekly Job Site Report

Site: Job #: Week Ending:

Company: Supervisor: Signature:

SAFETY INSPECTION

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1. Personal Protective Equipment 8. Tools & Equipment

a. Hard Hats ☐ ☐ ☐ ☐ a. Condition ☐ ☐ ☐ ☐

b. Eye/Ear Protection ☐ ☐ ☐ ☐ b. Guarded ☐ ☐ ☐ ☐

c. Fall Protection/Travel Restraint ☐ ☐ ☐ ☐ c. Power Cords ☐ ☐ ☐ ☐

d. Respirators ☐ ☐ ☐ ☐ d. Inspections ☐ ☐ ☐ ☐

e. Proper Clothing ☐ ☐ ☐ ☐ e. Other ☐ ☐ ☐ ☐

f. Footwear ☐ ☐ ☐ ☐

g. Other ☐ ☐ ☐ ☐ 9. Site & Public Protection

a. Excavation/Trenches ☐ ☐ ☐ ☐

2. Housekeeping b. Earthmoving Equipment ☐ ☐ ☐ ☐

a. Access, Egress, & Stairwells Clear ☐ ☐ ☐ ☐ c. Forklifts ☐ ☐ ☐ ☐

b. Piling & Stacking ☐ ☐ ☐ ☐ d. Fences/Hoardings/Walkways ☐ ☐ ☐ ☐

c. Debris Removal and Dust Control ☐ ☐ ☐ ☐ e. Lighting ☐ ☐ ☐ ☐

d. Hazardous Material Storage ☐ ☐ ☐ ☐ f. Barricades/Traffic Control ☐ ☐ ☐ ☐

e. Secure Loose Material ☐ ☐ ☐ ☐ g. Signs ☐ ☐ ☐ ☐

h. Protrusion/Rebar Protection ☐ ☐ ☐ ☐

3. Ladders & Stairs i. Mobile/Tower Cranes ☐ ☐ ☐ ☐

a. Ladder Conditions/Practices ☐ ☐ ☐ ☐ j. Air Quality/Ventilation ☐ ☐ ☐ ☐

b. Ladder Tied Off ☐ ☐ ☐ ☐ k. Moving/Reversing Equipment ☐ ☐ ☐ ☐

c. Ladder 3’ Above Landing ☐ ☐ ☐ ☐ l. Other ☐ ☐ ☐ ☐

d. Stairs ☐ ☐ ☐ ☐

e. Job Made Ladders ☐ ☐ ☐ ☐ 10. Man/Material Hoists

a. Operator Inspections ☐ ☐ ☐ ☐

4. Railings/Covers b. Regulatory Inspections ☐ ☐ ☐ ☐

a. Perimeter ☐ ☐ ☐ ☐

b. Floor Openings ☐ ☐ ☐ ☐ 11. First Aid/Hygiene

c. Stairs/Ramps ☐ ☐ ☐ ☐ a. Trained Personnel ☐ ☐ ☐ ☐

d. Walkways ☐ ☐ ☐ ☐ b. Kits/Supplies ☐ ☐ ☐ ☐

e. Elevator Door Openings ☐ ☐ ☐ ☐ c. Sanitation/Water/Washrooms ☐ ☐ ☐ ☐

5. Scaffolds/Swingstage/Lifts 12. Programs/Information

a. Guardrails/Toeboards ☐ ☐ ☐ ☐ a. Orientations ☐ ☐ ☐ ☐

b. Tied to Building/Locked In Place ☐ ☐ ☐ ☐ b. Safety Meetings ☐ ☐ ☐ ☐

c. Planks & Platforms/Access ☐ ☐ ☐ ☐ c. Postings/Documentation ☐ ☐ ☐ ☐

d. Scissor /Genie Lift ☐ ☐ ☐ ☐ d. Form 1000 ☐ ☐ ☐ ☐

e. Swing stage ☐ ☐ ☐ ☐ e. Training Up To Date ☐ ☐ ☐ ☐

f. Other ☐ ☐ ☐ ☐ f. H&S Programs & Procedures ☐ ☐ ☐ ☐

6. Electrical 13. Pre-Job Hazard Analysis

a. Temporary Lighting ☐ ☐ ☐ ☐ a. Daily Submittals ☐ ☐ ☐ ☐

b. GFCI ☐ ☐ ☐ ☐ b. Safe Work Procedures ☐ ☐ ☐ ☐

c. Cords, Plugs & Receptacles ☐ ☐ ☐ ☐

d. Temporary Power Boxes ☐ ☐ ☐ ☐ 14. Weekly Tool Box Talks ☐ ☐ ☐ ☐

7. Fire Protection 15. WHMIS 2015/SDS

a. Extinguishers/Standpipes ☐ ☐ ☐ ☐ a. Training Up To Date ☐ ☐ ☐ ☐

b. Flammable Material/Fuel Storage ☐ ☐ ☐ ☐ b. SDS Up To Date ☐ ☐ ☐ ☐

c. Hot Work Permits ☐ ☐ ☐ ☐ c. SDS In Proximity of Work ☐ ☐ ☐ ☐

Item# Comments/Actions/Follow Up/Disciplinary Actions

Weekly Workforce Information

# of Workers

Worker Hours

Near Misses

First Aids

Medical Aids

Lost Time

# of Workers Currently OnModified Duties

MOL

Orders

Site Tool Box Safety Talk Page___of___

Project: Project#:

Contractor: Supervisor:

Subject(s) Discussed:

Attendance: (Print Name) Initial (Print Name) Initial

1. 6.

2. 7.

3. 8.

4. 9.

5. 10.

Supervisor Comments (regarding tool box talk)

Worker Comments (regarding tool box talk)

Accidents/Incidents/First Aids/Near Misses From The Past Week

Site Concerns From The Past Week

Supervisor Signature: Date:

NOTE: Tool box talks are to be submitted to MJ Dixon weekly unless otherwise required. Topics should relate to safety concerns on the site or as identified by the Joint Health & Safety Committee or Site Superintendent.