Small Employer Certificate of Recognition Program
PRIME CONTRACTOR INFORMATION
Questions to be asked of the Prime Contractor
1.
YES
NO
Under your health and safety program, is there a contact person for health and safety issues?
Contact
Name:
(Please Print)
Office Phone:
Cell/Pager:
Fax Number:
2.
Do you have safety inspection tours that will review our work on your site? How
often?
3.
a) Are there procedures we can follow to report hazards?
b) Are we notified when the hazards have been corrected?
c) Are there specific health and safety hazards we should be aware of on your site?
d) Are there WHMIS controlled products on your site that we should be aware of?
4.
Are there specific job procedures that we are required to follow?
5.
Will we be given a copy of the site rules that we are expected to follow?
6.
a) Is there any specific PPE required on your worksite?
b) Do you provide the PPE?
7.
Will we be given a copy of the Emergency Response Procedures we have to follow for:
a)
Site Evacuation (Responsibilities, Signals, Communications)?
b)
Medical Emergency Evacuation?
c)
First Aid for Serious Injury?
May 12, 2010
Page 43
www.enform.ca
Small Employer Certificate of Recognition Program
PRIME CONTRACTOR INFORMATION
Questions to be asked of the Prime Contractor
8.
YES
Is Site Orientation required to work at your site?
Date to attend:
9.
10.
NO
Time:
Do we require specific training for work performed on your site? (e.g.: H2S Alive, WHMIS, TDG, etc.)
Will we be required to attend Safety Meetings at your site? If so when:
Date:
Time:
11.
Are there specific procedures to follow for incident (near miss) reporting?
12.
Are there specific procedures to follow for accident investigation?
13.
Are there any health monitoring procedures that we need to be involved in while at your site? (e.g.: lead levels,
hearing tests, drug & alcohol etc.)
Company Name:
Company
Representative:
Phone:
(Please Print)
(Signature)
Prime Contractor Company
Name:
Representative:
Signature:
(Optional)
Contact #:
May 12, 2010
Page 44
www.enform.ca
Small Employer Certificate of Recognition Program
PRIME CONTRACTOR HAZARD ALERT
List all workplace health and safety hazards, possible risks, chemical hazards and environmental concerns.
WORKSITE
LOCATION:
ORIENTATION DATE:
PERFORMED BY:
REPRESENTATIVE OF:
ATTENDEES:
May 12, 2010
(Print/Sign)
Page 45
www.enform.ca
Small Employer Certificate of Recognition Program
MULTIPLE SITE / CONTRACTOR HAZARD ALERT
LOCATIONS
SITE CONTACT NAME(S)
ALL
CONTRACTORS AT
WORK SITE
(POSSIBLE CONFLICT)
List all sites that this contractor has been orientated for.
List all other contractors that are or will be working at the location listed for this contractor.
Establish possible conflicts between contractors at sites listed.
May 12, 2010
Page 46
www.enform.ca