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Physical Plant (807) 343-8208 (807) 343-8938

Contractor's Safety Checklist

Project Title: Name of Contractor:

*Not Applicable

Project No.:

Requirement 1 1.01 1.02 1.03 1.04 1.05 2 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Contractor's Documents Submitted to the Owner WSIB Clearance Certificate Effective Date: MOL Notice of Project--O. Reg. 213/91 S. 6(1) Number: Health and Safety Policy--OH&S Act S. 25(2)(j) Workplace Emergency Response Procedure--O. Reg. 213/91 S. 17(1) Material Safety Data Sheets--O. Reg. 860 S. 17(1) Owner's Documents Issued to the Contractor Contractor's Safety Checklist Physical Plant Contact List Hot Work Permit procedure Lockout / Tagout procedure--O. Reg. 213/91 S. 188 Smoking on Premises Contractors/Visitors Sign-In Procedure Harassment and Discrimination Asbestos in Non-Construction Area procedure Designated substance reports Pre-Start Health and Safety Review reports--O. Reg. 851 S. 7(14)

Y

N

N/A*

2.11 Other (describe): 3 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 Contractor's Awareness of Workplace Hazards Fall from a height of 2.4 m (8 feet) or more--O. Reg. 213/91 S. 21 Work in confined space--O. Reg. 632/05 S. 2 Electrical hazards--O. Reg. 213/91 S. 183 Work in trenches--O. Reg. 213/91 S. 223 Hoisting--O. Reg. 213/91 S. 151 Welding--O. Reg. 213/91 S. 123 Elevating work platform--O. Reg. 213/91 S. 148 Operation of vehicles, machines and equipment--O. Reg. 213/91 S. 66, 104 Hot tar or bitumen for roofing--O. Reg. 213/91 S. 211

3.10 Other (describe): Pre-construction Meeting Date: Initials: Page 1 of 3

Contractor's Safety Checklist

Requirement 4 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 Safety Training Received by the Workers First aid--O. Reg. 1101 S. 8(2) Use of fire extinguishing equipment--O. Reg. 213/91 S. 52(1)(1.1) WHMIS--O. Reg. 860 S. 7 Fall protection--O. Reg. 213/91 S. 26.2 Confined space--O. Reg. 632/05 S. 8 Trenching/excavation Hoisting--O. Reg. 213/91 S. 150, 153 Elevating work platform--O. Reg. 213/91 S. 147 Y N N/A*

4.09 Other (describe): 5 5.01 5.02 5.03 Authorities Having Jurisdiction for Health and Safety Requirements Municipal Planning & Building Dept. Building Permit required: Electrical Safety Authority Inspections required: Technical Standards and Safety Authority Inspections required:

5.04 Other (describe): 6 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 Requirements for Workplace Management by the Contractor Report fire, injuries and accidents immediately to Security Services at 343-8911. Provide and maintain a first aid station--O. Reg. 1101 S. 8(1). Provide & identify fire extinguishing equipment--O. Reg. 213/91 S. 52(1).

Provide and maintain personal protective equipment for workers--O. Reg. 213/91 S. 21.

All persons at a construction project workplace shall wear protective headwear--O. Reg. 213/91 S. 22(1). Demarcate a construction area with barricades and signs. Maintain a clean & tidy workplace--O. Reg. 213/91 S. 35(1). Inspect the workplace with reasonable frequency--O. Reg. 213/91 S. 14(3). Protect vehicles and pedestrians in the vicinity of operating equipment. Maintain flexible electrical cords in a safe and proper working condition.

6.11 Other (describe):

Project Title: Name of Contractor: Pre-construction Meeting Date:

May 06 (Revised Nov 08)

Project No.:

Initials:

Page 2 of 3

955 Oliver Road Thunder Bay Ontario Canada P7B 5E1 www.lakeheadu.ca

Contractor's Safety Checklist

Action Required of the Contractor for Compliance with Health and Safety Requirements Date Description Required 7 Date Completed

8 Certification of Compliance by the Contractor 8.01 The undersigned representatives of the Contractor hereby agree to adhere to all applicable legislation and standards, and to Lakehead University policies and procedures, relating to health and safety. Contractor's representative:

Name (please print)

Supervisor:

Name (please print)

Signature

Signature

Date signed

Date signed

Phone numbers:

Business Residence Business Cellular

8.02 The undersigned representative of Lakehead University hereby certifies that the health and safety requirements referred to in this document were duly reviewed with the Contractor's signatories hereto at a pre-construction meeting held on the date indicated. Owner's representative:

Name

Signature

Date Signed

Phone number: 8.03 Distribution of copies: Owner's representative (original) Contractor's representative Human Resources Officer--Health & Safety Project No.:

Project Title: Name of Contractor: Pre-construction Meeting Date:

May 06 (Revised Nov 08)

Initials:

Page 3 of 3

955 Oliver Road Thunder Bay Ontario Canada P7B 5E1 www.lakeheadu.ca

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