First Aid Box Fill List

8/13/2019 First Aid Box Fill List

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Galfar Engineering & Contracting SAOG Form # HSESP-007-F/01

Job # & Name: Date:

Name of Project / Line Manager: Location:

Sl # DESCRIPTION YES NO NA

1 HSE Policies are displayed at prominent locations and contents beingdisseminated through HSE meetings. o o o

2Hazards involved in project activities are being identified & managed and

HEMP Register maintained at site for reference. o o o

3Company, Customer, Legal & other requirements applicable to the project

activities are being monitored regularly for compliance. o o o

4Project HSE Management Plan and the documents referred therein are

available in the project for reference to all concerned. o o o

5Availablity of resources (human, financial, physical, technology, etc.) to

achieve HSE objectives were verified and found adequate. o o o

6Toolbox Talks being conducted regularly; discussed with employees to

confirm its effectiveness. o o o

7 Staff / employees have undergone HSE training identified in HSEManagement Plan. o o o

8Staff / Employees checked at random, are aware of the hazards involved in

their jobs and the controls required. o o o

9HSE Meetings are conducted regularly as planned and the attendence

includes sub-contractor (s) / hired employees. o o o

10Learning points from incidents across the Company are disseminated

through HSE meetings. o o o

11Sub-contractor(s) / hired employees have undergone site HSE induction and

comply with site HSE requirements. o o o

12 Any incident, NCR, CAR - pending action in the project and not closed out? o o o

13

Structured inspections are conducted by site personnel to identify / rectify

unsafe acts / conditions. o o o

14 Appropriate warning signs / barricades are provided at sites. o o o

15 Visited the camp / mess and found maintained in good order. o o o

16 Housekeeping at site & camp found satisfactory. o o o

17Employees checked at random, are aware of their 'Empowerment To Work

Safely & To Stop When It Is Not Safe'. o o o

18Employees checked at random are aware of the action to be taken in case of

any emergency. o o o

Copies to be retained by: Project / Line Manager concerned and Unit HSE Manager

Note: Project / Line Manager concerned shall ensure that the actions needed are captured in Action Tracking

Register for necessary follow-up & close-out and timely completion of actions.

Inspection carried out by: _____________________________________Signature: _______________________

Designation : _________________________________________ Date : ____________________

MANAGEMENT SITE INSPECTION / VISIT REPORT

Comments, if any:

REMARKS

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Galfar Engineering & Contracting SAOG. Form # HSESP-007-F/02

Location:

Sl # Description Yes No NA Remarks

1.0

1.1Sound construction that provides protection

against pests & adverse weather conditions. o o o

1.2Air-conditioners are provided and are in good

working condition. o o o

1.3 Sufficient lighting provided in the rooms. o o o

1.4Furnished with cot, mattresses, pillow, bedsheet,

blanket, cu boards, etc. o o o

1.5Electrical leads / connections are appropriate and

are in good condition. o o o

1.6 Good housekeeping is maintained in the rooms. o o o

2.0

2.1 Spacious and maintained in clean & tidy condition. o o o

2.2 Well ventilated and properly illuminated. o o o

2.3Air-conditioned and hoods are fixed over cooking

ranges / exhaust fans provided and in good order. o o o

2.4Floor is durable, non-absorbent, non-slippery and

without any crevices. o o o

2.5Doors are tight-fitting and self-closing. Windows

are provided with fly screens. o o o

2.6Insect-o-cutors are provided and maintained in

good condition. o o o

2.7 Fire extinguishers & blankets are properlymaintained. o o o

2.8First Aid box is available with appropriate

contents. o o o

2.9Trained personnel available for operation of fire

extinguishers and basic first aid. o o o

2.10Kitchen crew wear uniforms, aprons, caps and

non-slip footwear. o o o

2.11Kitchen crew is aware of the actions to be taken in

case of any emergency. o o o

2.12Medical examination for cooks / helpers are up-to

date. o o o

2.13Kitchen crew is trained in personal & food

hygiene. o o o

2.14Gas stoves / burners are firmly positioned,

connections / hoses are properly maintained. o o o

2.15Full & empty cylinders are stored separately,

secured in upright position. o o o

2.16Emergency shut down valve for gas cylinders is

properly marked and easily accessible. o o o

2.17Cylinder manufacturing / test details marked and

valid. o o o

2.18Cylinders stored in designated area, protected

from direct sunlight away from sources of flame. o o o

2.19Smoking prohibited; warning signs provided,

suitable fire extinguishers available in the vicinity. o o o

2.20Adequate dish washing facility, cleaning solution

are available with proper drainage system. o o o

CAMP INSPECTION CHECKLIST

Job # & Name:

Accompanied By:Inspected By:

Date & Time:

LIVING ACCOMODATION

KITCHEN & GAS CYLINDER STORAGE

Camp Inspection Checklist Page 2 of 34


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2.21Separate chopping boards are available for

vegetables, mutton / chicken, fish, etc. o o o

2.22Cooked food is stored separately from raw food

stuff, in utensils with proper lids. o o o

3.0

3.1 Air-conditioned and provided with sufficientlighting. o o o

3.2Spacious to store sufficient food stuff with safe

access. o o o

3.3Store is maintained clean & dry, free from any

spillage and pests. o o o

3.4Raw food stuff are stored on racks / shelves /

benches and not kept on the floor. o o o

3.5Loose grains / flour, etc are stored in proper

containers with lids and not left open. o o o

3.6Expiry date is clearly marked and stock rotation is

maintained through 'First In; First Out' basis. o o o

3.7Adequate cold storage / refrigeration equipment

are provided and maintained in good condition. o o o

3.8Fish, chicken and meat are properly wrapped and

stored in separate deep freezers. o o o

3.9Refrigerators are kept clean and side walls free

from frozen ice. o o o

3.10Thermometers are in place in the cold storages

and temperatures are recorded twice daily. o o o

3.11Food samples of each prepared item is marked

and kept in the fridge in proper containers. o o o

4.0

4.1 Air-conditioned with sufficient lighting. o o o

4.2Spacious and sufficient seating arrangements are

provided. o o o

4.3Doors are tight-fitting and self-closing. Windows

are provided with fly screens. o o o

4.4 Adequate wash basins with liquid soaps and towelare provided. o o o

4.5Insect-o-cutors are provided and maintained in

good condition. o o o

4.6 Fire exits / escape routes are properly marked. o o o

4.7Fire extinguishers are provided and properly

maintained. o o o

4.8Dining tables, floor, sidewalls, etc. are well

maintained, hygienically. o o o

5.0

5.1Water used in the camp is brought from company

approved sources. o o o

5.2Water storage tanks are provided with safe

access, platform with handrails for safe cleaning. o o o

5.3Water storage tanks are cleaned every month and

next due date for cleaning is marked clearly. o o o

5.4Records available for proper purification /

chlorination of water used for domestic use. o o o

6.0

6.1Adequate sanitary facilities are provided that

includes, toilets, showers, washbasins, etc. o o o

6.2Such facilities are maintained clean, non-slippery,

dis-infected and with no foul smell. o o o

6.3Proper doors, window opening to outside air or

exhaust ventilation are provided. o o o

FOOD STORAGE (DRY & COLD)

SANITARY FACILITIES

DINING HALL

WATER



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6.4Sufficient lighting provided in and around such

facilities. o o o

6.5Both cold & hot water facilities are available in all

showers and washbasins o o o

6.6 Bucket, mug, etc are provided in the facilites. o o o

6.7 Drainage system is proper without any choking /no accumulation of water in the floor. o o o

7.0

7.1Wastes from mess, accommodation are collected

in closed plastic drums at fixed point. o o o

7.2Waste collection point is emptied periodically to

the disposal yard without getting accumulated. o o o

7.3The waste collection point is maintained neat &

clean. o o o

8.0

8.1Inmates are aware of the procedure to be followed

in case of an emer enc . o o o

8.2

Fire bell / alarm for evacuation, assembly point,

escape routes are provided and clearly marked. o o o8.3

Fire extinguishers are provided in easily

accessible locations and properly maintained. o o o

8.4Designated fire fighters are available to tackle any

fire at its initial stages. o o o

8.5Trained first aider and an emergency vehicle are

available for medical emergencies. o o o

9.0

9.1All electrical installations are properly guarded and

earthed. o o o

9.2Laundry facility / sufficient space for washing &

drying is provided and maintained clean. o o o

9.3Sufficient lighting is provided in the camp

premises. o o o

9.4Insecticides are sprayed periodically and records

are available. o o o

Comments, if any:

Forward report to Camp Boss & Line Manager responsible for actions to be taken considering level of intervention required.

Report Forwarded To: 1.) ____________________________________ 2.) __________________________________

Copies to be retained by: Camp Boss, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.

Actions identifed above have been completed

Name: ______________________________________ Signature: ___________________________ Date: __________

the applicable points and the % achieved, to be established for each inspection event.

(To be signed by the Camp Boss / Line Manager concerned on completion of action and returned to the function who carried

out the inspection, for close-out)

WASTE DISPOSAL

EMERGENCY PREPAREDNESS

Guidelines:

INSPECTION RESULT- Possible Score: ______, Actual Score: ______, % Achieved: _______

GENERAL

Inspection carried out by: ______________________________________ Signature with date: _________________

Agreed date for action completion : ______________________

(a.) Each 'Yes' will score one point (b.) Possible score = Total No. of applicable points x 1 (c.) Actual Score against



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Galfar Engineering & Contracting SAOG Form # HSESP-007-

Location:

Sl # Description Yes No NA Remarks1.0

1.1Sound construction that provides protection against

pests & adverse weather conditions. o o o

1.2Floor is durable, non-absorbent, non-slippery and

without any crevices. o o o

1.3Doors are tight-fitting and self-closing (right tension);

Windows are provided with curtains / blinds. o o o

1.4Doors are provided with transparent sections to enable

vision when the door is handled from other side. o o o

1.5Air-conditioners provided and are in good working

condition. o o o

1.6 Sufficient lighting provided in cabins & corridors. o o o

1.7 Corridors are free from spills, litter & obstacles. o o o

1.8 Spacious and maintained in clean & tidy condition. o o o

1.9Good housekeeping is maintained in all cabins /

workstations. o o o

1.10Workstations (Chairs, VDUs, etc.) are ergonomically

designed & appropriately positioned. o o o

1.11Sufficient & stable shelves & cabinats are provided for

storage of files / documents & other materials. o o o

1.12Heavy items are stored in the bottom of shelves &

cabinats and are kept closed when unattended. o o o

1.13Safe access available for materials stored, within easy

reach without the need for stretching. o o o

1.14Stairs are slip free, well lit, provided with handrails and

maintained clear of spills and litter. o o o

1.15Photocopiers are kept away from workstations in well

ventilated areas for to clear-off harmful fumes. o o o

1.16Combustible material not stored near electrical

appliances / heat sources. o o o

1.17Electrical leads / connections are appropriate and are

in good condition. o o o

1.18Three pronged plugs are used for electrical appliances;

power sockets are not overloaded. o o o

1.19Extension cords are used safely; cables are not kinked

and clear of walkways. o o o

2.0

2.1 Air-conditioned and provided with sufficient lighting. o o o

2.2Doors are tight-fitting and self-closing. Windows are

provided with curtains / blinds. o o o

2.3Electrical leads / connections / kettles are appropriate

and are in good condition. o o o

2.4 Spacious to store sufficient food stuff with safe access. o o o

2.5Spacious and sufficient seating arrangements are

provided. o o o

2.6Dining tables, floor, sidewalls, etc. are well maintained,

hygienically. o o o

PANTRY / DINING

OFFICE CONSTRUCTION, LAYOUT & MAINTENANCE

OFFICE INSPECTION CHECKLIST

Date & Time:

Job # & Name:

Inspected By: Accompanied By:

Office Inspection Checklist Page 5 o


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2.7Maintained clean & dry, free from any spillage and

pests. o o o

2.8Refrigerators are kept clean and side walls free from

frozen ice. o o o

2.9Adequate dish washing facility, cleaning solution are

available with proper drainage system. o o o

2.10Adequate wash basins with liquid soaps, tissue rollsare provided. o o o

2.11 Insect-o-cutors are provided and in good condition. o o o

2.12Office Assistanct / Person responsible for Pantry /

Dining area is trained in hygiene aspects. o o o

3.0

3.1Drinking Water used in the office is brought from

Company approved source. o o o

3.2Suffficient glasses (hygienically maintained or

disposable) are provided for drinking water. o o o

3.3Water used for other domestic purposes is brought

from company approved sources. o o o

3.4 Water storage tanks are provided with safe access,platform with handrails for safe cleaning. o o o

3.5Water storage tanks are cleaned regularly and next

due date for cleaning is marked clearly. o o o

4.0

4.1Adequate sanitary facilities are provided that includes

urinals, toilets & washbasins, etc. o o o

4.2Such facilities are maintained clean, non-slippery, dis-

infected and with no foul smell. o o o

4.3Proper doors, window opening to outside air or exhaust

ventilation are provided. o o o

4.4 Sufficient lighting provided in and around such facilities. o o o

4.5Both cold & hot water facilities are available in the

washbasins o o o

4.6Tissue rolls / bucket, mug, etc are provided in the

facilites. o o o

4.7Drainage system is proper without any choking / no

accumulation of water in the floor. o o o

5.0

5.1Waste / litter collection bins provided at several

locations in the office. o o o

5.2Waste collection point is emptied periodically to the

disposal yard without getting accumulated. o o o

5.3 The waste collection point is maintained neat & clean. o o o

6.0

6.1Fire detectors / bell / alarm are provided for early

warning in event of fire. o o o

6.2Fire extinguishers / hose reels and other fire fighting

equipment are provided & properly maintained. o o o

6.3Fire extinguishers provided are suitable to the fire

hazard involved / type of fire possible. o o o

6.4Escape routes, fire exits, assembly points are

designated, signposted and kept clear of obstacles. o o o

6.5Fire fighting equipment are at easily accessible

locations and clear of obstacles. o o o

6.6First aid box is available at easily accessiible locations

with appropriate contents. o o o

WATER

SANITARY FACILITIES

WASTE DISPOSAL




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6.7 Emergency Response Team established & maintained. o o o

6.8Designated fire fighters & first aiders are available for

basic fire fighting / first aid. o o o

6.9Identity of fire fighters / first aiders and their contact

details are displayed at prominent locations. o o o

6.10Emergency numbers to be contacted (ROP / Civil

Defence / Hospitals) are displayed prominently. o o o

6.11Staff aware of the actions to be taken in case of any

emergency. o o o

9.0

9.1Electrical installations are properly guarded and

earthed. o o o

9.2Sufficient parking area provided, clearly marked &

illuminated. o o o

9.3Access control systems implemented to prevent

unauthorised access into the premises. o o o

9.4Office premises properly signposted to guide the staff &

other visitors. o o o

9.5 Visitors are provided with relevant briefing and / oraccompanied during their presence in office premises. o o o

9.6Insecticides spray carried our periodically around the

office premises. o o o

Comments, if any:

Forward report to Line Manager responsible for actions to be taken considering level of intervention required.

Report Forwarded To: 1.) ____________________________________ 2.) _______________________________

Copies to be retained by: Line Manager, Function who carried out the inspection / HSE Advisor concerned.


Name: ______________________________________ Signature: ______________________ Date: __________

Inspection carried out by: ______________________________________Signature with date:______________


(To be signed by the Line Manager concerned on completion of action and returned to the function who carried out the

inspection, for close-out)



GENERAL

INSPECTION RESULT- Possible Score: ______, Actual Score: ______, % Achieved: _______

Guidelines:



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Location:


1.0

1.1Tool box meeting conducted and is based on Hazards

involved in the job. o o o

1.2 Crew aware of the job being carried out and related hazards o o o

2.0

2.1 Have personnel undergone necessary HSE Training? o o o

2.2 Are personnel employed fit for the job being performed? o o o

2.3Are the drivers / operators in possession of valid ROP

license, Customer / Galfar driving / operating permit? o o o

3.0

3.1Are personnel trained in the use of, provided with and wearing

PPE required for the activity being carried out? o o o

4.0

4.1 Trained First Aiders and First Aid Box are available at site. o o o

5.0

5.1Suitable fire extinguisher having valid inspection stickers are

available at the site. o o o

5.2 Are the personnel trained in use of fire extinguishers? o o o

6.0

6.1 Appropriate Notices / Warning Signs are provided? o o o

6.2 Are necessary barricading provided? o o o

7.0

7.1 PTW, applicable for the task is available at site. o o o

7.2 Permit Holder, approved by the customer is available at site o o o

7.3

Work Crew, is aware of the PTW and adhere to its

requirements. o o o8.0

8.1 Tools are maintained in good condition. o o o

8.2The hand / power tools are used / operated by trained and

authorised personnel. o o o

8.3 Are the tools stored in designated storage areas, after use? o o o

9.0 FIXED EQUIPMENT

9.1All moving parts of the equipment are provided with adequate

guards. o o o


PERSONNEL

PERSONAL PROTECTIVE EQUIPMENT

FIRST AID

WORKSITE INSPECTION REPORT

Date & Time:

Job # & Name:

TOOL BOX MEETING

FIRE FIGHTING

PERMIT TO WORK

WARNING SIGN DISPLAY

HAND / POWER TOOLS

Worksite Inspection Checklist Page 8 o


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9.2All electric connections are as per applicable / acceptable

standards. o o o

10.0

10.1 The vehicles / equipment have necessary valid certification. o o o

10.2Necessary warning devices are fitted in the vehicle /

equipment and are in working condition. o o o

10.3 Daily checks are carried out by the drivers / operators. o o o

10.4Periodic maintenance and servicing for the vehicle /

equipment are carried out. o o o

10.5Seat belts are in working condition and are worn by the driver

/ operator / passengers. o o o

10.6 Banksman is provided for the operation of plant / equipment. o o o

10.7Work area is kept clear of obstruction, for the safe movement

/ operation of vehicle / equipment. o o o

10.8

Lifting accessories have valid certification and are in good

physical condition, without any visible damages. o o o10.9 The lifting accessories are colour coded and SWL identifiable. o o o

11.0

11.1Adequate scaffolding / ladder are provided for safe access to

all part of work situated 1.5 M or more above ground level. o o o

11.2The scaffolding used, is inspected and certified by a

competent person. o o o

11.3Safety Harness is used while working at height greater than 2

M. o o o

11.4Only authorised / trained personnel are engaged for working

at height. o o o

11.5

Tools / equipment are kept in such a way that they do not

pose any tripping hazard, on the work platforms. o o o12.0

12.1All necessary precautions considered and are the personnel

are aware of hazards involved in it? o o o

12.2Is necessary approval / clearance, obtained from the

authorities concerned? o o o

13.0

13.1Excavation areas are barricaded and adequate warning signs

displayed. o o o

13.2Presence of any underground utilities / services is

ascertained before commencing the activity. o o o

13.3Suitable means of access and egress are provided for

personnel working in deep excavations.

o o o

13.4Excavated material is stored atleast 1 mtr., from the edge of

the excavation to prevent falling back into the trench. o o o

13.5Is adequate shoring / sloping to a safe angle of repose

provided, to prevent collapse of the side walls? o o o

13.6Personnel / vehicle / equipment, are protected from moving

close to the edge of the trench / excavation. o o o

13.7Adequate temporary crossings are provided for persons to

cross over safely. o o o

14.0

14.1Welders are provided with face shields and aprons in addition

to the other PPE required. o o o

OVERHEAD LINE

VEHICLE / EQUIPMENT

WORKING AT HEIGHT

TRENCHING & EXCAVATION

WELDING & CUTTING



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14.2Fire resistant screens are provided to shield the persons

working nearby, from the welding arc. o o o

14.3Welding / cutting sets, gas cylinders & accessories are

maintained in safe working condition. o o o

14.4 No flammable material or any wastes are found in the vicinity. o o o

14.5 Fire watch available at site. o o o

15.0

15.1 Is good housekeeping maintained at work site? o o o

15.2Suitable arrangement for waste collection / disposal are

provided. o o o

15.3Suitable space is maintained for storing materials, without

posing any hazard? o o o

16.0

16.1Are personal aware of emergency telephone number and

action to be taken in case of emergency? o o o

16.2Is safe access and exit available at the work site, for use incase of any emergency? o o o

17.0

17.1Supervisors / Crew Leaders are aware of and can access the

Project HSE Plan and documents referenced therein. o o o

17.2Are personnel aware of their Empowerment To Stop Unsafe

Work? o o o

17.3Necessary precautions are taken for working in hazardous

areas / handling hazardous substances. o o o

17.4Noise level at work site is within acceptable limits and

protective devices are provided. o o o

17.5Are the personnel aware of the Health hazards in their

activities and take necessary precautions for the same? o o o

17.6 Working hours of the personnel engaged are as per the laiddown standards. o o o

17.7Are adequate toilet / rest, water facility, provided at the work

area? o o o

Comments, if any:

Report Forwarded To: 1.) ____________________________________ 2.) _____________________________

Copies to be retained by: Line Mgr. / Engineer / Supervisor, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.

INSPECTION RESULT - Possible Score: ____, Actual Score: ____, % Achieved: _____

GENERAL

Forward report to Line Manager / Engineer / Supervisor concerned, considering level of intervention required.

Inspection carried out by: _____________________________________ Signature with date: _____________

Guidelines:


Name: _____________________________________Signature: ________________________ Date: __________

HOUSEKEEPING




(To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the

function who carried out the inspection, for close-out)

EMERGENCY RESPONSE



11/34


Location:

Sl # Description Yes No NA

1.0

1.1Adequate space is provided for easy entry & exit of vehicles

/ equipment and for its movement inside. o o o

1.2Each activity is performed in a designated area such that

the activity doesn't interfere with the other. o o o

1.3Segregated & adequate storage areas for different kind of

materials. o o o

1.4Walkways are clearly defined, marked and are

unobstructed. o o o

1.5Requirement to wear PPE and other necessary HSE related

information are displayed prominently. o o o

1.6Employees are provided with / aware of the proper usage of

PPE required for the job being carried out. o o o

1.7Adequate lighting and ventilation are provided in all work

places. o o o

1.8All work benches / surfaces are fit for the purpose with

sound construction and adequate safety. o o o

1.9 Provision for drinking water is available in the work area. o o o

1.10Adequate toilet facilities are provided for the employees in

the premises. o o o

1.11Provision is made for collection, segregated storage and

disposal of wastes generated from the workplace. o o o

1.12Good housekeeping is maintained in the yard / workshop

premises. o o o

2.0

2.1Eye wash facility is provided wherever required and are

maintained in good condition. o o o

2.2Adequate number of fire extinguishers & first aid boxes

provided at strategic locations. o o o

2.3Emergency escape routes, assembly point, f irst aid / f ire

fighting arrangement are clearly displayed. o o o

2.4Escape routes, alarm points, first aid kits, fire extinguishers,

etc are kept clear and in good order. o o o

2.5Designated fire fighters are available to tackle any fire at its

initial stages. o o o

2.6Trained first aider and an emergency vehicle are available

for medical emergencies. o o o

2.7Personnel are aware of the action to be taken in case of

any emergency. o o o

3.0

3.1Tools are subjected to periodical inspections and

maintenance as per manufacturer's guidelines. o o o

3.2Use of tools are strictly controlled and access allowed only

to authorised persons. o o o

3.3Tools are carried in suitable containers and are stored in

designated places when not in use. o o o

HAND / PORTABLE POWER TOOLS

WORKSHOP / INDUSTRIAL / STORAGE YARD INSPEC

Inspected By: Accompani

FACILITY LAYOUT & MAINTENANCE

Date & Time:


Job # & Name:

WS / Industrial / Storage Yard Inspection Checklist Page 11 of 34


12/34



3.4

Personnel are aware of the safe operating methods of the

tools and its maintenance. o o o

3.5Cables, hoses, joints, etc are free from any visible damage

or defects. o o o

3.6

Plug adaptors are not in use. Tools are provided with

appropriate plugs to fit in the socket. o o o

4.0

4.1Fixed equipment are subjected to periodical inspections

and maintenance as per manufacturer's guidelines. o o o

4.2Electrically powered equipment are properly earthed and

are provided with circuit breakers for isolation. o o o

4.3Moving parts of the equipment are provided with

appropriate guards to prevent personal injury. o o o

4.4Signboard indicating the PPE required for the safe

operation of that equipment is displayed prominently. o o o

4.5Temporary / permanent screens are provided around the

equipment to protect personnel working nearby. o o o

4.6 Job pieces are adequately secured to prevent any injurydue to kickback while drilling, grinding, etc. o o o

4.7Small tongs / fixtures are used to hold jobs while grinding or

drilling, instead of holding it in hand. o o o

4.8Circular saws are provided with both fixed guard over the

upper half and a movable guard on lower half. o o o

4.9Long handled brushes are used to clean the equipment and

not by hands or air nozzles. o o o

5.0

5.1Welding & Cutting activities are carried out only by

authorised persons and in dedicated areas. o o o

5.2Welders are provided with face shields and aprons in

addition to the other PPE required.

o o o

5.3No flammable material or any wastes are found in the

vicinity. o o o

5.4Fire resistant screens are provided to shield the persons

working nearby, from the welding arc. o o o

5.5 Power cables are properly protected and earthed. o o o

5.6Earth connections are bolted / clamped directly to the job to

ensure good electrical contact. o o o

5.7Welding electrodes are kept properly in appropriate

containers. o o o

5.8Welding / cutting sets are equipped with flash back

arrestors & check valves and are in good condition. o o o

5.9 Gas cylinders are colour coded and are with punch marksshowing cylinder identification & validity details. o o o

5.10Hoses and couplings are free from damage, securely

fastened and are laid properly without posing any risk o o o

5.11Cylinders are fitted with pressure regulators along with high

and low pressure manometers. o o o

5.12Fling guns or piezo-electric igniters are used to ignite the

torch and not matches or smouldering ropes. o o o

5.13Cylinders are stored in upright position and secured with

chain and hook. o o o

6.0

FIXED POWER TOOLS / EQUIPMENT

WELDING & CUTTING

ABRASIVE BLASTING



13/34



6.1

Designated blasting area away from other activities is

maintained where only authorised persons can enter. o o o

6.2Adequate warning signs are displayed to keep personnel

informed about the blasting operation. o o o

6.3

Blasting tool is fitted with self-releasing valve to cut-off air &

grit supply when the operator loses his grip. o o o

6.4Lid of the blasting pot is in position and not opened during

blasting operation. o o o

6.5Couplings on the air hose are secured properly to prevent

accidental dis-connection under pressure. o o o

6.6Personnel engaged in blasting are provided with adequate

PPE like, blasting hood, protective suit, etc. o o o

6.7Blasters are effectively monitored / supervised to ensure

their safety and that of the operation. o o o

6.8Waste grit is removed frequently to avoid the hazard of

exposure of personnel to the waste grit. o o o

7.0

7.1 Spray painting is carried out in detached area, away fromother activities. o o o

7.2Adequate space & ventilation are provided to prevent

formation of explosive mixtures of vapour and air. o o o

7.3Regular cleaning schedule is maintained to eliminate the

possibility of fire due to spray deposits. o o o

7.4Spray gun, pot and the hose connections are free from any

defects / damages. o o o

7.5 Spray pot is earthed against generation of static electricity. o o o

7.6Painting area is free from any naked flame or ignition

sources. o o o

7.7

Painters are provided with adequate PPE like, face shield,

respiratory masks, etc and are well maintained o o o7.8

Adequate precautions are taken to avoid entry of harmful

aerosols into the body. o o o

8.0

8.1Adequate ventilation is provided in the charging area for

rapid dispersion of any flammable hydrogen gas. o o o

8.2Separate racks are provided for keeping charged and

uncharged batteries, 1 mtr away from charging bench. o o o

8.3Electrically connections are properly maintained and the

supply to battery is securely clamped. o o o

8.4Adequate provisions for draining, collection & proper

disposal of battery acid. o o o

8.5 SHOC card of electrolyte is displayed and adequate PPEare worn by personnel concerned. o o o

9.0

9.1Date of manufacture / last date of pressure test marked and

valid. o o o

9.2Details of the gas stored are legibly marked in the cylinder

and appropriately coloured. o o o

9.3Cylinder valve assemblies in good condition, protective cap

in place. o o o

9.4Cylinders lifted using flat band slings;

(chains or metal slings not used). o o o

BATTERY CHARGING & STORAGE

HANDLING & STORAGE OF GAS CYLINDERS

SPRAY PAINTING



14/34



9.5

Cylinders are transported in designated vehicles, in upright

position. o o o

9.6Cylinders are stored in designated areas protected from

direct sunlight with name of gas displayed prominently. o o o

9.7 Flammable gases are segregated from oxidising gases (6maway or by fire resistant wall). o o o

9.8 Empty and full cylinders are stored separately. o o o

9.9Cylinders are stored in upright position and secured with

chain and hook. o o o

9.10Location free from flammable substances; naked flames /

smoking prohibited in the vicinity. o o o

9.11Gas cylinders handled only by authorised personnel aware

of its properties. o o o

9.12 Gas cylinder trolleys used for movement of cylinders o o o

9.13

Warning signs, suitable fire extinguishers provided in the

vicinity. o o o10.0

10.1Fuel, oil & other chemicals are stored in designated areas,

segregated from each other when not compatible. o o o

10.2Secondary containment facility provided for storage and is

adequate for the quantity stored. o o o

10.3 Chemicals stored are protected from direct sunlight. o o o

10.4 Containers with volatile compounds are kept closed. o o o

10.5Arrangements in place for immediate clean-up in case of

any spillage. o o o

10.6 MSDS of the material stored are available in the vicinity andthe personnel handling are aware of its contents. o o o

Comments, if any:

Report Forwarded To: 1.) ________________________________ 2.) ________

Copies to be retained by: Line Mgr. / Engineer / Supervisor, Function who carried out the inspection / HSE A

(a.) Each 'Yes' will score one point (b.) Possible score = Total No. of applicable poi

the applicable points and the % achieved, to be established for each inspection eve

Guidelines:

HANDLING & STORAGE OF FUEL, OIL AND OTHER CHEMICALS

INSPECTION RESULT - Possible Score: ____, Actual Score: ____,

Inspection carried out by: __________________________________ Signatur

(To be signed by the Line Manager / Engineer / Supervisor concerned on compl

function who carried out the inspection, for close-

Actions identifed above have been complete

Name: ___________________________________ Signature: ______________

Forward report to Line Manager / Engineer / Supervisor concerned, considerin




15/34


Remarks

ION CHECKLIST

d By:



16/34


Remarks



17/34


Remarks



18/34


Remarks

__________________________

visory Staff in the Project / Unit.

ts x 1 (c.) Actual Score against

nt.

% Achieved: ______

with date: ________________

tion of action and returned to the

ut)

___________ Date: __________

g level of intervention required.



19/34


Date

Locat

Inspected By:


1.0

1.1Seat Belts - fitted / in good condition / locking mechanism

functioning properly. o o o

1.2 Rollover Bar fitted (for LVs only) o o o

1.3

Tyre condition - not worn, tread not less than 1/16 inch, no

deep cracks / visible damages / embedded objects in between

treads, right pressure (as marked on wheel arch)o o o

1.4Speed limiter - fitted & functioning properly (80 - 100 / 120

Kmph). o o o

1.5Head lamps (both in low & high beam), indicators and high

intensity rear lights are in proper working condition.

o o o

1.6 Brake lights / rotating amber lights functioning properly. o o o

1.7Windscreen / mirrors are clean, in good condition, no cracks

and are positioned properly / wiper in working condition. o o o

1.8 Seats are in good condition & suitably positioned. o o o

1.9Fire Extinguishers / First Aid Box secured & maintained in

proper order. o o o

1.10 Air Conditioner fitted and in good working condition. o o o

1.11 Reverse Alarm / Horn fitted and in working condition. o o o

1.12Spare wheels available as required (2 in interior LVs and 1 in

others). o o o

1.13Wheel chocks, Jack, necessary tools, hazard warning triangle,

etc., are available in the vehicle. o o o

1.14Odometer, fuel / oil gauges & other instruments working

properly. o o o

1.15 Fuel / oil / other fluids from the vehicle not found leaking. o o o

1.16 Noise and exhaust emissions are within normal levels. o o o

1.17 General cleanliness of the vehicle found satisfactory. o o o

1.18 Others (specify): o o o

2.0

2.1 Steering o o o

2.2 Engine o o o

2.3 Transmission o o o

2.4 Suspension o o o

2.5 Braking o o o


VEHICLE INSPECTION / ROAD SAFETY C

Vehicle Condition - A (visual / practical checks)

Vehicle Make, Regn # / CC #:

Job # & Name:

Accompanied By:

Vehicle Condition - B (check with the Driver; complaints shall be communic

Vehicle Inspection Checklist Page 19 of 34


20/34



3.0

3.1 Safe Journey Management Plan o o o

3.2 Valid Driving Permit available with the Driver o o o

3.3 Vehicle Registration Copy, Minor RTA Form available in thevehicle. o o o

3.4 Health Certificate for the Driver available (for water tankers) o o o

3.5MSDS / TREM Card (transporting harzardous substance)

available and the Driver aware of the contents. o o o

3.6Vehicle maintenance / inspection stickers are available and

valid. o o o

3.7Lifting equipment / mobile cranes - inspection / load test

particulars available and valid. o o o

3.8Cabin / passenger compartment are free from loose materials

that can pose a risk. o o o

3.9 Load within limits and well secured. o o o


4.0

4.1 Wearing seat belts (including passengers) o o o

4.2 Tailgating / Unsafe overtaking o o o

4.3 Unsafe speed (High / Low) o o o

4.4 Dangerous manoeuvres o o o

4.5 Passengers beyond authorised capacity o o o

4.6 Driving without due care & attention o o o

4.7 Wearing coverall / safety shoes (professional drivers) o o o


Comments, if any:

Report Forwarded To: 1.) ______________________________________ 2.) _____

Copies to be retained by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function wh

Advisory Staff in the Project / Unit.


Name: ______________________________________ Signature: _______________

(To be signed by the Line Manager / Responsible Supervisor / Workshop In-charge

returned to the function who carried out the inspection, for clo

Important Note: 1.) Vehicles found with defects that have high potential to cause an in

1.3, 1.4, 2.0 and 3.8, shall either be stopped for repair / rectification on the spot or instr

workshop in consultation with the Responsible Supervisor / Workshop In-charge. 2.) V

further use and sent to workshop for repair / rectification in case of other defects.


Forward report to Line Manager / Responsible Supervisor / Workshop In-charge, considerin

Procedural Compliance

Driver Behaviour

Inspection carried out by: __________________________________ Signature wi



21/34


& Time:

ion:

Remarks

ECKLIST

ted to Supervisor concerned)



22/34


Remarks

_______________________

o carried out the inspection / HSE

________Date: _________

on completion of action and

se-out)

ident such as in Sl # 1.1, 1.2,

cted to be escorted to nearest

hicle shall be stopped from


th date: ________________



23/34


Date

Locat

Inspected By:


1.0

1.1 Rollover Protection Structure fitted. o o o

1.2Seat Belts - fitted / in good condition / locking mechanism

functioning properly. o o o

1.3Cabin protected to shield operator from falling / flying objects

(grills, canopies, screens, etc.) o o o

1.4Tyre condition - not worn, no deep cracks of damages / right

pressure (as marked on wheel arch) / wheel chocks provided. o o o

1.5 Track chain / links are in proper condition o o o

1.6 Work attachments such as bucket, blade, ripper, chisel, etc.,are in good condition. o o o

1.7 Gauges & other instruments are functioning properly. o o o

1.8 Lamps, Rotating Amber light functioning properly. o o o

1.9Safe means of access / egress provided (non-slippery

footsteps, handholds, etc.). o o o

1.10Windscreen / mirrors are clean, in good condition, no cracks

and are positioned properly / wiper in working condition. o o o

1.11Rotating parts (gears, drums, shafts, belts, etc) and hot

surfaces (such as exhaust pipes) are guarded. o o o

1.12 Seats are in good condition & suitably positioned. o o o

1.13 Fire Extinguishers / First Aid Box secured & maintained inproper order. o o o

1.14 Air Conditioner fitted and in good working condition. o o o

1.15 Reverse Alarm & Horn fitted and in proper working condition. o o o

1.16 Fuel / Oil / other Fluids from the equipment not found leaking o o o

1.17Equipment kept clear of spilt fuel, oil & other fluid, in particular

near exhaust & electical parts. o o o

1.18 Noise & exhaust emissions are within normal levels. o o o

1.19 General cleanliess found satisfactory. o o o


2.0

2.1Lifting equipment inspection (every 12 months) / load test

(every 48 months) certificates available and valid. o o o

2.2Safe Working Load (SWL), due date for inspection & due date

for load test marked on the boom. o o o

2.3Load chart indicating various operational configurations / limits

available and visible prominently from the operator position. o o o

2.4Lifting equipment equipped with Boom Angle Indicator. Level

Indicator, Safe Load Indicator and are in working properly. o o o

EQUIPMENT INSPECTION CHECKL

Equipment Condition (visual & practical checks)

Equipment Make, Regn # / CC #:

Job # & Name:

Accompanied By:

Checks Specific to Lifting Equipment

Equipment Inspection Checklist Page 23 o


24/34



2.5Overrun prevention devices, over hoist & over load cut out

alarm, swing alarm available & working properly. o o o

2.6Ropes, pulleys & drum are properly lubricated are free from

signs of wear & tear / any damages. o o o

2.7 Hook block provided with safety catch. o o o

2.8 Outriggers functioning properly. o o o


3.0

3.1Physical observation of forks satisfactory (no cracks, bend or

physical deformity). o o o

3.2Lift mechanism operates smoothly (check by raising forks to

maximum height then lowering completely) o o o

3.3Tilt mechanism operates smoothly (check by tilting mast all the

way forward and backward). o o o

3.4Date of inspection (every 6 months) / load test (every 48

months) certificates available and valid. o o o

3.0

3.1Operations / User Manual & other relevant manufacturer

instructions available for reference. o o o

3.2 Valid Operating Permit available with the Operator o o o

3.3Equipment maintenance / inspection stickers are available and

valid. o o o

3.4Equipment logbook that contain the operating hours,

maintenance / repair history, etc., being updated regularly. o o o

3.7 Operator cabin free from loose materials that can pose a risk. o o o

3.8Operating / Swing radius is clear off men / material / other

machinery, vehicle & equipment. o o o


Comments, if any:

Report Forwarded To: 1.) ___________________________________ 2.) ________

Procedural Compliance

Important Note: 1.) Inspections carried out on lifting equipment using this checklist wil

thorough inspection carried out by authorised agencies on an annual basis, and not int

Equipment found with any defect shall be stopped for repair / rectification in consultatio

Supervisor / Workshop In-charge.

Checks Specific to Forklifts

Inspection carried out by: __________________________________ Signature wi


(To be signed by the Line Manager / Responsible Supervisor / Workshop In-charge

returned to the function who carried out the inspection, for clo


Name: ______________________________________ Signature: _______________

Copies to be retained by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function wh

Advisory Staff in the Project / Unit.

Forward report to Line Manager / Responsible Supervisor / Workshop In-charge, considerin



25/34


& Time:

ion:

Remarks

IST



26/34


Remarks

_______________________

l only be supplementry to

nded to substitute the same. 2.)

with the Responsible

th date: ________________

on completion of action and

se-out)

_________Date: _________

o carried out the inspection / HSE




27/34


Location:

Sl.No. Description Yes No NA Remarks

1.1Personnel involved in erection and dismantling of scaffolding

trained and experienced in that work. o o o

1.2Trained and experienced supervisors provided for the control of

erection and dismantling of scaffolds. o o o

1.3Personnel involved in the erection and dismantling of scaffold

wear safety harness, helmet with chinstrap, gloves & shoes. o o o

1.4Scoffold erection has taken into consideration the structures,

overhead lines and other activities in the vicinity. o o o

1.5Scaffolding materials are of proprietary make, free from defects

/ damages and used in accordance with its designed purpose. o o o

1.6 Standards placed on hard ground, steel, concrete, etc. or suitable sole plates / base plates provided. o o o

1.7Sole plates where provided support at least two standards;

either two adjacent or two opposite standards. o o o

1.8

intended load.

Type of work Spacing Maximum Load

Access 2.7 M 0.75 KN / M2

Light Duty 2.4 M 1.50 KN / M2

General Purpose 2.1 M 2.00 KN / M2

Heavy Duty 2.0 M 2.50 KN / M2

Special Duty 1.8 M 3.00 KN / M2

o o o

1.9 Ledger joints are staggered and not on the same bay. o o o

1.10

Board Thickness Transoms Spacing

32 mm 0.9 m

40 mm 1.5 m

51 mm 2.5 m

63 mm 3.2 m

o o o

1.11Intermediate transoms are provided where the transoms

spacing exceeds the limit (every 1.5m for 40 mm thick plank). o o o

1.12Ledger (shorter dimension) / faade (longer dimension) bracing

provided from bottom up to top lift. o o o

1.13 Platform is fully boarded without any gaps between hand rails. o o o

1.14The spacing between platform and the structure being worked

on does not exceed 300 mm, without any need for stretching. o o o

1.15Work platform is free from projecting nails, bends, cracks, gaps,

overlaps, etc. o o o

1.16 Planks are securely fastened. o o o

1.17Overhanging of wooden planks of working platforms is restricted

between 50 150 mm. o o o

1.18 Guard Rails are provided on top of the work platform. o o o

SCAFFOLDING INSPECTION CHECKLIST

Date & Time:

Job # & Name:


Scaffolding Inspection Checklist Page 27 o


28/34


Sl.

No.Description Yes No NA Remarks

1.19Middle Rails are provided in between guard rail and working

platform (at a height of 0.5 M above the platform). o o o

1.20Toe boards (secured inside the standards; height not above 150

mm from the platform) are provided around all open sides. o o o

1.21 The gap between the toe board and the guard rail does notexceed 750mm. o o o

1.22Ties provided fixing the scaffolding to fixed structures (one tie

for every 40 m sq). o o o

1.23Scaffold area barricaded to prevent movement of vehicle /

equipment / personnel, in the vicinity. o o o

1.24

Fans or catchment platforms of adequate strength and

dimension are provided to protect passing men / vehicle /

equipment, etc., below the scaffold, when permitted.o o o

1.25Proper ladder of proprietary make is provided for ascending &

descending and reaching all part of the scaffold (above 1.5 m). o o o

1.26 Ladder made of timber (timber not painted) or aluminium. o o o

1.27

Series of ladders with intermediate platforms properly protected

with guard rails and toe boards, are provided, where more than

9 m height to be climbed.o o o

1.28The base to height ratio of ladder maintained as 1 : 4 such that

the angle is 75 from horizontal and 15 from vertical. o o o

1.29The ladder is adequately secured with a minimum vertical

protrusion of 1 m above Platform. o o o

1.30 Scafftag provided in the scaffold indicating its suitability for use. o o o

Comments, if any:

Report Forwarded To: 1.) ___________________________________ 2.) _______________________________

Copies to be retained by: Line Mgr. / Engineer / Supervisor, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.


Forward report to Line Manager / Engineer / Supervisor concerned, considering level of intervention required.

(To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the

function who carried out the inspection, for close-out)


Name: ______________________________________ Signature: _________________________Date: _________

Inspection carried out by: __________________________________ Signature with date: ________________

Scaffolding Inspection Checklist Page 28 o


29/34

Galfar Engineering & Contracting SAOG

Job # & Name:

Good

housekeeping

in the

surrounding

Tool firmlypositioned and

provision for job

piece to be

secured.

On / Off / isolationswitch, Operating

lever in good

condition within

safe access

Moving /

rotating

parts

guarded

Bit, Wheel, Blade,

etc., in good

condition and

suitable to the job

& rated capacity

of the machine

Coolingsystem (self

feed) without

exposing the

operator

Three

pronged plug

used; power

source

connected to

ELCB

Ca

sa

c

Signature of the function who carried out the inspection(upon verification of action completion): __________________________

Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advis

Inspection carried out by: ___________________________________________________________ Signature with Date

Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions / level of in

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the


Name of the responsible Line Mgr./ Supr.: ________________________________________ Signature: _________________

Agreed date for actiReport Forwarded To:___________________________________________________________

FIXED POWERTOOLS INSPECTION RECORD

Sl #Type / Description of the Tool(Fixed drill, grinder, lathe, saw, grooving /

cutting machine, etc.)

Identification# Monthly Inspection Details (Yes / No / NA)

Fixed Power Tools Inspection Record


30/34


ob # & Name: Mon

Tool edge

free fromburrs /

damages

Handlle with

proper grip &in good

condition

Sharp edges

protectedwhen not in

use

Tool / handle

Insulated /

non-sparking

Moving /

rotating parts

guarded

Three pronged

plug used;cables in good

condition

Tool suitable

to the rated

capacity

Users of

tool identi

/ controlle

Name of the responsible Line Mgr./ Supr.: ________________________________________ Signature: ____________________

Signature of the function who carried out the inspection(upon verification of action completion): ____________________________Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advisor

HAND / PORTABLE POWERTOOLS INSPECTION RECORD

Sl #

Type / Description of the Tool(hammer, spanner, screwdriver, pl ier, chisel,

hacksaw, portable buffing machine / power drill

/ grinder / cutter, wrench, etc.) Qua

ntity

inspe

cted Monthly Inspection Details (Yes / No / NA)

Inspection carried out by: ___________________________________________________________ Signature with Date: __Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions / level of interv

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the insp


Report Forwarded To:_______________________________________________________ Agreed date for action c

Hand Tool Inspection Record


31/34


Job # & Name:

Equipmentfirmly

positioned in

level ground.

On / Off /

isolationswitches in

good condition

with safe

access

Pressure

gaugefunctioning

properly

within

permissible

Moving /rotating

parts

guarded

Noise &

exhaust

emissions

are within

normal levels

Earthingproper /

resistance

checked

Cables /

hoses routedproperly

without

obstructing

the pathways.

Equipment &

surroundingsmaintained

clean & free

of dust / spilt

oil, etc.

S

e(D

pr

e

Signature of the function who carried out the inspection(upon verification of action completion): __________________________

Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advi

Inspection carried out by: ___________________________________________________________ Signature with Date

Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions / level of in

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the


Name of the responsible Line Mgr./ Supr.: ________________________________________ Signature: _________________

Report Forwarded To:____________________________________________________ Agreed date for act

STATIC EQUIPMENT INSPECTION RECORD

Sl # Description of the Equipment(Static equipment such as Compressors,Diesel Generators, etc.)

Identificat

ion# Monthly Inspection Details (Yes / No / NA)

Static Equipment Inspection Record


32/34

alfar Engineering & Contracting SAOG

ob # & Name: Colour Code for the month: Month:

Inspection

Date

Due Date for

Next Inspection

Certificate

#

Colour Code

Marked (Yes/No)

^ Physical Observation

Satisfactory (Yes / No)

Inspection carried out by: ___________________________________________________________ Signature with Date: __________

Forward report to Line Manager / Engineer / Supervisor responsible for actions to be taken, considering the criticality of actions / level of interve

(To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the function who carried out the inspe


Name of the responsible Line Mgr./ Engr. / Supr. : ________________________________________ Signature: ___________________________

Signature of the function who carried out the inspection(upon verification of action completion): ______________________________________

Copies to be sent to / retained by: 1. Line Mgr./ Engr. / Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manag

Report Forwarded To:____________________________________________________ Agreed date for action completion:__

ote: 1.) No physical damage; wear & tear not more than 5% of the original dimension ^.

LIFTING ACCESSORIES INSPECTION RECORD

Sl #Lifting Accessories - Type

(Slings, Hooks, Bolts, etc.)

Identification

#

Safe Working

Load (Ton)

Third Party (1/2 Yearly) Inspection Details In-house Monthly Inspection Details

R

fting Accessories Inspection Record


33/34


ob # & Name: Month:

Inspection

Date

Due Date for

Next Inspection

(1) Clear

Access

Maintained

(2) Physical

Observation -

satisfactory

(3) Pressure /

Weight

satisfactory

(4) Inspection /

Validity Details

Marked

Signature of the function who carried out the inspection (upon verification of action completion): _________________________________Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advisor.

In-house Monthly Inspection Details (Yes / No)

Note: 1.) Check location for positioning and confirm easy access; 2.) Check for signs of corrosions, damage to cylinder, delivery hose / nozzle for ch

bulging / sponging; damage to coupling and condition of safety pins / plastic tie / activating lever / handle 3.) Pressure gauge to indicate green for ri

ype check weight by approximate assessment 4.) Labels mentioning date of inspection & due date for next inspection and punch mark in monthly in

Inspection carried out by: ___________________________________________________________ Signature with Date: _____Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions / level of intervention

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the inspection


Name of the responsible Line Mgr./ Supr.: ________________________________________ Signature: _________________________

Report Forwarded To:____________________________________________________ Agreed date for action comp

FIRE EXTINGUISHERS INSPECTION RECORD

Sl # Extinguisher TypeIdentification

#

Location

Identification

Annual Inspection Details

ire Extinguisher Inspection Record


34/34


Job # & Name: QLM ODC 07/798 Month: 31-Jan

Clear

access

maintained

Maintained

clean &

hygienically

* Contents

adequate

1 CAPE SITE JOBY NIL2 77943 TRAILER YOHANNAN NIL

3 81916 CANTHER VINOTH NIL4 105295 R O PLANT MOSHIN NIL

5 CAPE SITE RAJESH SINGH NIL

6 6030 SITE PARAZ BISWAS NIL

7 15902 JCP PRBAKARAN NIL

8 CCS LAUNDARY MOHD SALIM NIL

9 ALROMAL HIYAB RAJAKHAN NIL

10 81855 SITE MOHD NIL

11 17031 SITE MUTHUMANIKANDAN NIL

12 69768 J.OFFICE GIREESH NIL

13 CCS MESS M.SURESH NIL

14 61470 HIYAB AYOOB NIL

15 ccs KITCHEN PRABU DEVARAJ NIL

16 DRAT AL SAHRA SAJU B JOHN NIL

17 112327 CANTHER AMRITHSINGH NIL

18 CC -15625 TIPPER SUBU NIL

19 2729 CANTHER PERUMAL NIL

Name of the responsible Line Mgr./ Supr.: ________________________ Signature with Date: ______________

Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advisor.

Location

Identification

First Aid Box Contents (Typical - may vary w.r.t. the site & clinic location): Sterile Cotton Bandage 5 cm (6 rolls),

Crepe Bandage 7.5 cm (6 rolls), Triangular Bandage (6 rolls), Safety Pins (6 nos), Adhesive Plaster - 1.25 cm (1 roll),

Eye Pad (5 pads), Assorted Plasters (1 packet), Gauze Swabs (20 pieces), Scissors (1), Protective Gloves (2 pairs),

Oropharyngeal Airway (1 item) or Mask or Airway Shield.

* To be sent for re-fill, if not found adequate.

Inspection carried out by: M.SELVAN/Malenurse Signature with Date:___________31.01.13

Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions required.

Report Forwarded To:___________________________________ Agreed date for action completion:_________

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the inspection for close-

out)


FIRST AID BOX INSPECTION RECORD

Sl #Identification

#Name of First Aider Identified

Monthly Inspection Details (Yes / No)

Remarks /

Actions, if any

First Aid Box Fill List

Documents

Transcript of First Aid Box Fill List