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Search for:
pre-contract hazard application
Karla Shannon
2024-09-23T10:59:54-07:00
Pre-Contract Hazard Assessment Form
Appendix D of Demolition Package
Village Contract Administrator to Complete This Section:
Village Contract Administrator
(Required)
Contract/Project (Name & Number)
(Required)
Date of Pre-Start Meeting
(Required)
MM slash DD slash YYYY
Hours of Operation From:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of Operation To:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Multiple Contractors on Site
(Required)
Yes
No
Prime Contractor Identified
(Required)
Yes
No
Name of Contractor (Prime)
(Required)
Prime Contractor Workplace Safety Coordinator Name
(Required)
Project Start Date
(Required)
MM slash DD slash YYYY
Length of Project
(Required)
Project Location
(Required)
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Notice of Project Required (WCB Regulation 20.2)
(Required)
Yes
No
Description of Work
(Required)
Identify All Known Pre-Existing Hazards: (such as electrical, confined space, fall protection, Asbestos, Chlorine)
Work to be completed has a low level of risk and no pre-existing hazards
(Required)
Contractor to Complete This Section:
The Contractor Must:
Communicate hazards to anyone who may be affected
Understand that in any conflict of directions, the Workers Compensation Act and OH&S Regulations shall prevail
Ensure that all workers are trained and competent to perform the duties for which they have been assigned
Action Required to Eliminate or Control Hazards
(Required)
Contractor Representative (Prime) Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
Assessment Performed By (Signature)
(Required)
Date
(Required)
MM slash DD slash YYYY
Notes
(Required)
Sketch
(Required)
Accepted file types: jpg, jpeg, png, gif.
Please note to have a completed demolition package and application, you will also have to submit the
Contractor Compliance Application
as part of the demolition package application. We also suggest you review page 4-23 of our
Demolition-Package
to ensure you aren’t missing any steps. Review Appendix A on page 4 to go over the contractor health & safety checklist and program guide. Review page 5 for details on how to submit a
Notice of Project form – WorkSafeBC.
We also recommend reviewing pages 16-20 of the
Demolition-Package
for Fire Safety Planning for construction and demolition sites, and pages 21-23 for our Decommissioning Septic Tanks Information guide.
Personal information requested on this form is collected under the authority of Section 26 of the Freedom of Information and Protection of Privacy Act, as amended. The information gathered will be used to deliver or evaluate the program or activity of the Village of Anmore that is associated with this form. Questions about the collection, use, and disclosure of this information should be directed to
village.hall@anmore.com
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