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April 5, 2019
PRE-PLACEMENT HEALTH & SAFETY DUE DILIGENCE CHECKLIST
This checklist may be used to identify unsafe exposures in facilities/locations where students may be required to work, study
or perform research activities and also to document safety measures in place to protect students from exposure.
Organization Name
:
Equipment
Yes /
No or
N/A
If yes, please specify what
protective measures are in place.
Hand tools and
equipment
Will the student be working with hand tools or equipment?
(e.g. hammer, screwdriver, blades)
Portable power
tools and
equipment
Will the student be working with portable power tools or
equipment? If yes, has hearing protection been provided?
(e.g. drill, jig saw, rotary tools)
Mobile equipment
Will the student be working with or near mobile
equipment?
If the student will be utilizing mobile equipment, will
training be required and/or provided?
(e.g. forklift, pallet truck)
Stationary power
machines
Will the student be operating stationary power machines?
(e.g. drill press, band saw, table saw)
Electrical
Will the student be exposed to any electrical hazards in
the workplace?
(e.g. electrical panels, lighting, electrical wiring)
Compression
Will the student be working with anything under
compression, such as compressed gases or gas
cylinders?
Pressure systems
Will the student be working in proximity to pressure pipes
or steam boilers?
Human Factors
Y/N
or
N/A
If yes, please specify what
protective measures are in place
Harassment
Is there a policy on harassment that will be provided to the
student?
Violence
Is there a policy on workplace violence that will be
provided to the student?
Has the risk of workplace violence been assessed as
required by the OHSA (s. 32.0.3)?
Are there situations where the student could be exposed
to violence? Could the student become a subject of
violence?
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April 5, 2019
Working alone
Will the student be working alone?
(e.g. working alone in an office or building)
Shift work
Will the student be working shifts?
(e.g. working an irregular work schedule)
Computer Use
Will the student be working at a computer for the majority
of a typical work day?
Work stress
Will there be a high level of stress in the students work?
(e.g. work requiring constant alertness for long periods of
time, such as a security monitor, or work with high levels
of emotional stress such as working in an Emergency
Room)
Musculoskeletal
Disorders (e.g.
Lifting, Repetitive
Actions)
Will the student be using the same muscles over and over
again or for a long time without taking time to rest,
exerting high amounts of force and/or required to work in
an awkward posture?
General
Housekeeping
Will the student work in uncluttered workspace with
minimal distractions?
(e.g. tidy work area)
Entrances, exits
and stairways
Will the student encounter passageways, entrances, exits
(especially fire) or stairways that are not clearly marked or
clear of obstructions?
Working at
Heights
Is the student going to be working at elevation that they
may be susceptible to falling from
If so, is adequate fall protection equipment
provided/required?
Chemical
substances
Will the student use or be exposed to flammable,
corrosive, toxic or reactive chemicals?
(e.g. acetone, nitric acid, toluene, mineral spirits)
Biological
substances
Will the student have contact with any harmful
microorganisms?
Radiation
Will the student be exposed to harmful radiation?
(e.g. x-rays, lasers)
Restricted spaces
Will the student be in proximity to or working in restricted
space, trenches or confined spaces?
(e.g. man hole, silo)
Hot materials or
surfaces
Will the student have contact with hot materials or
surfaces?
(e.g. stove, soldering iron, torch, forging materials,
welding materials)
Ultraviolet light
(Sunlight)
Will the student spend any time working in the sun?
If so, for what duration?
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April 5, 2019
Temperature
Will the student work in very cold or hot conditions?
(e.g. outdoors, kilns, refrigerated areas)
Noise
Will the student be exposed to excessive noise in the work
environment of 85 decibels or greater?
Air quality
Will the student be exposed to excessive dust, fumes or
gases?
(e.g. welding fumes, carbon monoxide)
Other (attach
additional sheet if
necessary)
Completed by:
Signature
:
Date:
click to sign
signature
click to edit
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April 5, 2019
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