COMMUNITY LIVING WEST NIPISSING
SAFE PURCHASING/MODIFICATION CHECKLIST
This form applies to all purchases of equipment, materials and services except as outlined below. The
form also applies to any modifications of existing processes or equipment.
Section 1: must be completed prior to requesting and making the purchase/modification.
Section 2: must be completed before the purchase is allowed into the worksite.
Section 3: must be completed if contractors are providingservices to the Agency and will be working in the Agency.
The Safe Purchasing/Modification procedure allows purchases of the following non-hazardous items
without the need to complete this checklist for each purchase: stationary, office supplies, books, travel, conference and other membership fees, accommodation, computer software and minor hardware items. The completed checklists are to be kept in the worksite they pertain to and made available for viewing as requested.
SECTION 1This section must be completed prior to requesting and making the purchase/modification.
What is the proposed purchase/modification item:______
______
______
Equipment Manual
Equipment Specification
What safety information has been obtained? CSA Standard
Material Safety Data Sheet
Other______
Noise
Manual Handling
What hazards have been identified? Storage
None
Other______
Elimination
Substitution
How are the identified hazards to be managed? Engineering Controls
N/A
Other______
Is a Safe Working Procedure needed? Yes No
Who will write the SWP? ______
By when? ______
Is training required to ensure safe use? Yes No
Who will provide the training? ______
By when? ______
Requisitioner:______Date:______
Supervisor: ______Date:______
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SECTION 2
This section refers to the admission of goods into the workplace following delivery.
Has the supplier provided all safety information? Yes No
Have Hazardous Substances been recorded in MSDS Yes No N/A
Binder?
Has a Safe Working Procedure been written? Yes No N/A
Have the risk controls identified been implemented? Yes No N/A
Has training been provided? Yes No N/A
Requisitioner:______Date:______
Supervisor: ______Date:______
SECTION 3
This section needs to be completed if the purchase involved services provided by contractors.Has the contractor signed the Contract Away Yes No
ServicesPolicy? Attach a copy to this form.
Has the contractor signed the Contractor’s General Yes No
Safety Work Permit? Attach a copy to this form.
Requisitioner:______Date:______
Supervisor: ______Date:______
Contractor: ______Date:______
JHSC: ______Date:______
EffectiveSeptember 20078-141