Contractor Health and Safety Agreement Checklist

Contractor Name:

Contractor’s Rep: Phone/Fax No:

Address:

()Check as
Reviewed/ Review Miscellaneous Notes
Received
Signed Contractor Health and Safety
Responsibility Agreement
Received WSIB Clearance Certificate (no more
than 60 days old)
Received a copy of the Contractor’s accident
history (for one year).
Received up-to-date liability insurance certificate
(Company listed as certificate holder with a min.
of 2 million coverage)
Signed Pre-Meeting Form for Contractors
Licensees & certificates of contractor employees
or other applicable training requirements, e.g. AZ
license, welding ticket(s)
Forward the Company’s Rules and Regulations
to Contractor
Forward the Company’s Equipment Lockout
Policy/ Procedure to Contractor
Contractor to provide MSDS for any WHMIS-
controlled products
Advise of any special hazards connected with
the workplace i.e., emergency response
procedures, hazardous areas, etc.
Advise Contractor to report all occupational
injuries that occur on property immediately
Review Company personal protective equipment
requirements (PPE). It is the Contractor’s
responsibility to ensure that their employees
possess and use all required PPE for their work

Company Project Coordinator: Date:

Contractor’s Rep: Date:

Once completed, this form and all attachments are to be sent to the Occupational Health and
Safety Coordinator’s Office.