Contractor Work Checklist

							                                    Safe Work Checklist
                 CONTRACTOR HEALTH AND SAFETY CHECKLIST

    PREPARED BY:                       REVIEWED BY:                  EFFECTIVE:                  SUPERSEDES:
    HSS                                HSS                           March 24, 2009              March 19, 2009
Purpose
To outline the responsibilities of the College as a constructor, owner or an employer of contractors and subcontractors, and
to define the safety and best practice requirements for those contracted.

Contractor Health and Safety Contact Information
Project Title or Service Provided:                                                             Project Number:

Related P.O. Number:                                              One Time Project         Ongoing Annually

Project Start Date:                                             Project Location:

Fanshawe College Contact Person:
Phone Number(s):                                Cell Number:

E-mail:
Contractor or Contracted Service Vendor:
Company Contact Person:
Phone Number:                                                           E-mail:
Name of Subcontractor 1:                                                Phone Number:
Name of Subcontractor 2:                                                Phone Number:

Name of Subcontractor 3:                                                Phone Number:

Shaded Area For Constructors and Construction Projects Only

Site Supervisor:                                                        Contact Number:

Alternate Site Supervisor:                                              Contact Number:

Company Health and Safety Coordinator:
Site Health and Safety Rep:
(If applicable; more than 3 months or more than 19 workers)
Emergency 24/hr Number:

Date:

Fanshawe College Contact Name:                                                    Signature:

Constructor/Contractor Name:                                                      Signature:

Distribution
  Contractor         Project File
  FM office administration (Facilities Management vendors) OR        HSS (all others)
Contractor Health and Safety Checklist
Section 1: Contractor Documents to be submitted
  * All selected boxes require supporting information to be submitted to Project Co-ordinator prior to start of project
  commencement. The lead Contractor is required to verify and submit all Sub-Contractor information to the
  Project Co-ordinator.

Level 1 and 2                                                      Level 2 Only
RQ N/A                                                             RQ N/A
        Health and Safety Program                                           Registration and Notice of Project
        Emergency Procedures and Communication                              Posted Information
        WSIB Clearance Certificate                                          Appointment of Supervisor
        Waiver for WSIB coverage
        Proof of Liability Insurance
        WHMIS (MSDS for any chemicals brought on site)
        Designated Substances being brought on site
        Transportation of Dangerous Goods (proof of training)
        Minimum Age exemption approval
        Other (describe):

Section 2: Contractor’s Awareness of Workplace Hazards & College Procedures
*all selected boxes require proof of training be submitted to the Project Co-ordinator prior to the project commencing.
Level 1 and 2                                                      Level 2 Only
RQ N/A                                                             RQ N/A
        Fall Protection                                                     Roofing
        Elevating Work Platforms                                            Cranes, Hoisting and Rigging
        Equipment on Job Site                                               Hot Tar, Bitumen and Roadtankers
        Scaffolds and Work Platforms                                        Trenching, Excavating and Shoring
        Electrical Hazards                                                  Confined Space Entry
        Designated Substance locations                                      Welding and Cutting
        Other (describe):

Section 3: Requirements for Workplace Management by Contractor

Level 1 and 2                                                      Level 2 Only
RQ N/A                                                             RQ N/A
        Protective Clothing, Equipment and Devices                          Fencing and Public Way Protection
               ________________________________                             Signs
        Housekeeping
        Reporting Fire, Injuries and Incidents
        First Aid
        Other:

Section 4: Fanshawe College Documents Indicate whether given              hard copy      online at www.fanshawec.ca
Level 1 & 2 – Minimum Requirements                         Level 1 & 2 – as applicable
RQ                                                               RQ N/A
                Contractor Health and Safety Checklist                        Use and Sale of Tobacco Products on College
                                                                              Property 1-F-01
                Corporate Health and Safety Policy 1-D-03                     Lockout/Tag out Procedure
                Respectful College Community 1-B-46                           Asbestos Abatement Program
                Incident Report Form and Instructions                         Confined Space Entry Program
                Parking and Traffic Policy 1-F-05                             College Electrical Rules and Regulation
                PPE Guideline                                                 Notification of Designated Substances
                Emergency Preparedness & Response 1-D-09                      Acknowledgement of Receiving Notification of
                                                                              Designated Substance Report
                Safe College Campus Policy 1-D-05                             High Risk Work Permit (Live Electrical, Hot Work
                                                                              Work from Height, Fire System Impairment)
                Other (describe):
                       Do not forget to sign cover page – Valid for one year (unless scope of work changes)