Instructions to use this form:
Read the question then determine the status of Yes it's in place and your company can produce evidence that the system element is in place or No your company isn't able to provide a evidence. If you plan to take action on that element, complete the Action taken box for things you will need to do to bring you company up to compliance.
PT 1 - (a) Has a chemical inventoery been prepared?
PT 1 - (b) Copy on record?
PT 1 - (c) Has inventory been checked
to ensure each controlled product
has a corresponding
MSDS or an SDS?
PT 1 - (d) Are MSDS or SDS's avalable
to workers?
PT 1 - (e) Is there a central catalogue
of all MSDS or SDS's?
PT 1 - (f) All MSDS no more than
3 years old?
PT 1 - (g) Is there a "Bring Forward"
system to check MSDS dates?
PT 1 - (h) Is there a system to
ensure that new controlled
products are accompanied by
an MSDS or SDS?
PT 1 - (i) A system of checks is
done to ensure supplier MSDS
has all information required?.
Pt 2 - (a) Controlled products are all received
and checked for supplier labels?
PT 2 - (b) A system of workplace labeling
exists on site for decanted products?
PT 2 - (c) Labels have all required
information?
PT 2 - (d) Labels are legiable?
PT 2 - (e) A method of education and coding
/ identification is available for:
1. pipes and piping systems
2. process vessels
3. reaction vessels
4. tank cars, tank trucks, conveyor belts
5. all forms of conveyance
PT 2 (f) A system of placarding or posting
work areas where controlled products are
not in or could be edited from equipment,
processes, etc.
PT 3 - (a) Do the workers know what
hazardous materials are present?
PT 3 - (b) Are they aware of the
requirements of WHMIS and of their
own provincial health and safety
legislation?
PT 3 - (c) Do they know how to
safety handle, store and dispose
of the hazardous materials with
which they work according to
legislation where applicable?
PT 3 - (d) Are they aware of the
potential hazardous effects of the
materials with which they are
working?
PT 3 - (e) Are they familiar with
emergency and first aid?
PT 3 - (f) Do they understand
the use and purpose of control
systems, including ventalation
and personal protective
equipment?
PT 3 - (g) Do they know how to
interpret a supplier or
workplace label and what it
means in terms of doing their
jobs safely?
PT 3 - (h) Do they know where
they can get a copy of MSDS
or SDS's?
PT 3 - (i) Do they know how to
interpret the information on a
MSDS or SDS and how to use
it to carry out their jobs safely?
PT 3 - (j) Are they aware of their
right to refuse to do unsafe work?
PT 3 - (k) Are they aware of their
responsibility to use the
information they have learned
to work safely with hazardous
materials?
PT 3 - (l) Do they accept personal
responsibility of using hazardous
materials safely?
PT 3 - (m) Have workers
completed job specific
hazardous materials
training?
PT 3 - (n) Are workers able to
understand the information
delivered to them during
PT 3 - (o) Are workers well
motivated and committed
to safety and health on
the job?
PT 3 - (p) Are provisions made
for training new, part-time and
casual workers?
PT 3 - (q) Are contractors and
visitors to the area
protected?
PT 3 - (r) Is there evidence
that the objectives of an
effective training program
have been met?
PT 3 - (s) Is there a system of
initiating safe work procedures
from MSDS or SDS information?
Training in Safe Work Practices?
PT 3 - (t) Does the worker have
adequate education in labeling
systems of WHMIS?
PT 4 - (a) Is there an outline of
the program in writing which is
job specific?
PT 4 - (b) Are there standard
safe work procedures on site?
PT 4 - (c) Are there emergency
procedures for: