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Managers/Supervisors Worksite Safety Practices Review

 
 

Visit Specifics

Date:

Department/Division:

Location:

Worksite Activity:

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Met with the following staff:

1.

2.

3.

4.

5.

6.

7.

8.

9.

Please add additional staff here separated with a semi-colon.

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Practices Review

All staff at workplace were following our regular safe work practices

Staff were observed not less then two meters (six feet) away from one another or they had protective contact measures in place. If workers are unable to work greater then two meters apart depending on the task i.e. working in a trench on a specific task- are workers wearing half face respirators

Do staff have any of the following on site:
- Disposable disinfectant cloth or spray disinfectant and/or paper towel
- Water jug filled with water and access to soap
- Hand sanitizer
- Washrooms with soap and water

Staff at the work location were not displaying any flu like symptoms (coughing/sneezing, fever, difficult breathing,..)

The following good safety behaviours or safety concerns were observed:

The following coaching was provided:

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Reviewed/Discussed Key COVID-19 Preventative Measures:

Select all you discussed.

Comments

Text 24

Sign-off & Submission

Text 24

Name:

Email:

Please sign this form.


Upon submission a copy of this review will be emailed to you and OHS. 
Text 24

Information we collect, and why we collect it.

Personal information is collected for the purposes of analyzing your participation in the CoVID-19 Managers/Supervisors Worksite Safety Practices Review. The City of Surrey is collecting this information under s. 26(c) of the Freedom of Information and Protection of Privacy Act. For questions regarding the collection of personal information, please contact the Manager of Marketing and Communications at 13450 104 Avenue, Surrey, BC V3T 1V8, 604‑591‑4011.

 





CoVID-19 Managers/Supervisors Worksite Safety Practices Review form originally developed for the City of Surrey by TheWGroup.ca, powered by ClikHere.ca.