Personal Health and Safety Conduct

Owner/Operator

______is committed to an injury and accident free workplace. I understand that I am accountable to comply with the current occupational health and safety legislation and perform my tasks in a manner that supports my responsibilities.

No job is so important that it cannot be done in the safest manner.

The importance of a safe work site is beyond measure as there is no amount of money that can compensate for a disabling injury or take the place of a family member killed or seriously injured in the workplace. I will conduct myself in the safest possible manner so everyone leaves the workplace at the end of the day.

______
(Signature) (Date)

______

(Printed name)

HAZARD ASSESSMENT POLICY

Owner/Operator

______will utilize a hazard assessment plan to ensure work activities are completed in a safe manner and that all potential health and safety hazards are identified and controlled prior to work commencing.

A Field Level Hazard Assessment will be completed prior to the start of all new projects, as job processes and conditions change and on a regular basis throughout the duration of the project.

All corrective actions shall be implemented in a timely manner and documented.

Hazard Control

When a hazardous condition is identified, I will assign a value based on ProbabilityConsequence

Starting with WORST FIRST, I will determine control methods to eliminate, reduce or control the hazard.

If it is not possible to eliminate the hazard, then I will attempt to reduce or control the hazard using these 3 methods in this order.

1)Engineering – plan and design, isolate by distance, ventilate, heat or cool

2)Administrative – shorten exposure time, perform work at lower risk time of day, break the job down and provide a SJP

3)Personal Protective Equipment – last line of defense and should always be used in combination with Engineering or Administrative

The following jobs are examples of when to use the Field Level Hazard Assessment:

• Jobs with high frequency of accidents or near misses which pose a significant threat to health and safety;

• Jobs that have the potential to produce fatalities, disabling injuries, illnesses or environmental harm;

• Newly established jobs whose hazards may not be evident because of lack of experience;

• Jobs that are to be performed in hazardous and/or unfamiliar environments i.e. confined spaces, restricted access, excavations, heavy equipment, elevated work surfaces, unfamiliar work site.

______
(Signature) (Date)

______
(Printed Name)

Hazard Assessment

Owner/Operator

______will utilize a hazard assessment program to ensure work activities are completed in a safe manner and that all potential health and safety hazards are identified and controlled prior to work commencing. I will complete a detailed Hazard Assessment prior to the commencement of all new projects, as job processes and conditions change and on a regular basis throughout the duration of the project.

All corrective actions shall be implemented in a timely manner, recorded, and kept on file. Findings of the Hazard Assessments will be communicated to all others on the job site and posted.

Hazard Control

When a hazardous condition is identified, corrective actions will be promptly implemented in a timely manner according to the hazard. The following list highlights preferred methods of control in descending order:

  1. Elimination: Remove the hazard or hazardous situation whenever reasonably practicable
  2. Substitution: Substitute the hazardous product or element with a less hazardous one
  3. Engineering: Implement engineering designs and controls measures whenever reasonably practicable
  4. Administrative: Implement safe work policies, procedures and practices to ensure the hazardous element is controlled adequately
  5. Personal Protective Equipment (PPE): Implement adequate PPE to ensure the hazardous does not affect the exposed workers

______
(Signature) (Date)

______
(Printed Name)

Personal Protective Equipment

Owner/Operator

______believes that all other reasonable means of controlling hazards shall be considered before the use of personal protective equipment. However, the use of the following personal protective equipment is required as a minimum on all worksites; this includes but is not limited to:

  • CSA approved footwear
  • CSA approved hard hat
  • High-vis clothing (where required)

All personal protective equipment will be appropriately selected for the hazards identified and site-specific procedures. All equipment and devices must meet, at a minimum, applicable government regulations and approval standards. All personal protective equipment must be used and maintained according to the manufacturer’s specifications including care, fit and regular inspection.

______
(Signature) (Date)

______
(Printed Name)

Preventative Maintenance

Owner/Operator

______will ensure that all tools, vehicles, and equipment shall be properly maintained so as to reduce the risk of damage to property and injuries to myself and others.

I will achieve this by ensuring that all preventative maintenance is carried out by qualified personnel according to established schedules and that records are maintained.

I will regularly check all tools, vehicles, and equipment that I work with following manufacturers recommendations. I will remove from service any tools, vehicles, or equipment that pose a hazard due to a need for repair or replacement.

______
(Signature) (Date)

______(Printed Name)

Reporting of accidents and injury

Owner/Operator

I understand it is my responsibility to report serious accidents to occupational health and safety. Examples of serious accidents are:

  • an uncontrolled explosion,
  • failure of a safety device on a hoist, hoist mechanism, or hoist rope,
  • collapse or upset of a crane,
  • collapse or failure of a load-bearing component of a building or structure regardless of whether the building or structure is complete or under construction,
  • collapse or failure of a temporary support structure,
  • collapse or cave-in, of a trench, excavation wall, underground working, or stockpile,
  • accidental release of a controlled product,
  • brake failure on mobile equipment that causes a runaway,

I also know that I must report any accident that had potential to cause serious injury.

I will also report any serious injury that occurs on the worksite. Examples of serious injury that I will report to occupation health and safety are:

  • an injury that results in death
  • a broken bone
  • amputation
  • loss of sight of an eye,
  • internal bleeding,
  • third degree burns,
  • concussion
  • electrical contact
  • lack of oxygen

I recognize that the purpose of reporting the above examples to determine the cause and develop way to prevent reoccurrence.

______
(Signature) (Date)

______
(Printed Name)

Emergency Information

Owner/Operator

*Note the location of the worksite muster station ______

Ambulance: ______Police: ______

Poison Control: ______Fire Department: ______

Water Utility: ______Electrical Utility: ______

Gas Utility: ______Cable Utility: ______

Occupational Health & Safety: ______

Other

Nearest Hospital

Is Located at/in (address)______

Town/City Phone Number______

Nearest Clinic

Is located at/in (address)______

Town/City Phone Number______

InCase ofEmergency (ICE) Contact: ______

POST NEAR PHONES & KEEP COPY IN VEHICLE FIRST AID KIT

______
(Signature) (Date)

______
(Printed Name)

Owner/Operator

Emergency Situation Control/Management

Owner/Operator

______will ensure that all property, the environment, and the general public be protected from any harm that may occur as a result operations.

The preservation of life is most important. All measures will be carried out in such a manner as to minimize risk to emergency personnel. Rescue and medical activities have priority over all other actions.

I recognize and will carry out my basic responsibilities in an emergency.

______
(Signature) (Date)

______
(Printed Name)

Ongoing Training and Audio Metric Testing

Owner/Operator

______will make all efforts to participate in current training requirements relevant to my industry.

I will also ensure that I am in compliance with the Occupational Health Regulations; Section 6, Noise Control, should I be routinely exposed to noise levels in excess.

Training / Date / Date / Date / Date
Audio Metric Testing / Date / Date / Date / Date

______
(Signature) (Date)

______(Printed Name)

Working Alone Procedure

Owner/Operator

Before commencing work alone, ______will ensure:

1)Potential hazards of the job are considered and hazard control measures are available

2)A contact person is identified and made aware of the lone worker’s destination and a mutually agreed upon check in or return time

3)A procedure and time frame for emergency response is identified, should the lone worker fail to check in at the agreed upon time

4)The lone worker will verify their vehicle is equipped with a first aid kit, flashlight, blanket, supply of non-perishable snacks, drinking water and shovel

5)The following details will be documented on the ‘Contractor Orientation Checklist’ : 1) name of contact person 2) lone workers destination 3) expected time of return to home or camp 4) the emergency response procedure should the lone worker fail to return 5) signature of the lone worker & contact person’s name and phone number

______
(Signature) (Date)

______
(Printed Name)