This the presentation of HSE.

1. Think Safety
Project
Date
Audit &
Support
Team
Site
PM
HSE manager
HSE AUDIT REPORT
Notes: NCR shall be finalized and feedback to HSE Group after 03 days

2. Pr-HSE-07-32
I. INTRODUCTION
Pjt name Work scope Contract amount No. of workers
Safety budget
(plan/actual)
Progress
(plan/actual)
 SITE INFORMATION
Overview Current work Current work

3. Pr-HSE-07-32
1. ENVIRONMENT PERFORMANCE
NO Items Subcontractor
Resul
Remark
Before last
month
Last month This month
1 Material yard (arrangement)
2
Housekeeping (working area
and non-working area)
Note: 03 monthly continuously un-improvement, action plan shall be conducted by site
I = Improved; U = Unimproved
II. SITE HSE SITUATION

4. Pr-HSE-07-32
NO
Subcon’
(SM)
Work scope
(location)
Site Manager
CE/SE
in charged
Before After
NC/Unsafe
Description
/Suggestion
Improved
measure
# ENVIRONMENT PERFORMANCE BAD PRACTICE

5. Pr-HSE-07-32
2. BEAUTIFUL SITE PERFORMANCE
Items Detail Requirement Checked items
Result
Comments
OK NC
Toilet
Equipment Equipment installation (door knob, paper box and paper, water, soup, tissue )
Hygiene Housekeeping inside, surrounding and floor hygiene
Rest place
Equipment Table, chair, bed, water providing
Hygiene Maintaining situation
Way of
change
Installed Install following standard (signboard, led, handle bar)
Maintaining Using and maintaining situation
Compliance Workers use the handle bar when access
Internal
access way
(if provided)
Installation Access way installed at the jobsite for worker and vehicle
Worker management Workers follow the designated access way
Guide center
Situation Installed follow standard, cleaning situation
Security staff Security’s uniform (helmet, shoes), hygiene and attitude
Material
yard
Layout
Designating material storage yard, separate each kind of materials and access
way for yard situation
Storage management Storage with safe height, fixed and well displaced
Housekeep-
ping
Before work
(preparation)
Checking and using suitable quantity for work
During & after work Rearrange material, cleanup
Canteen (if
provided)
Hygiene (food safety) Canteen floor, food displace table …
Cooking staff Attitude, hygiene uniform
Health check
/ medical
(if provided)
Health check
Health check when recruit, yearly check and monitoring health of worker for
dangerous work
Medical box Provision medicine sufficiently
Medical device Blood pressure meter, alcoholic meter, monitoring temperature and humid

6. Pr-HSE-07-32
NO 1
Subcon’
(SM)
Work scope
(location)
Site Manager
CE/SE
in charged
Before After
NC/Unsafe
Description
/Suggestion
Improved
measure
# BEAUTYFUL SITE BAD PRACTICE

7. Pr-HSE-07-32
3. BASIC SAFETY PERFORMANCE
NO Items Subcontractor
Result
Remark
Before last
month
Last month This month
1
Providing PPE (helmet, shoes,
uniform, belt)
2
Scaffolding (working platform,
cross bracing, base, support)
3 Safety handrail
4 Opening area and cover
5 Electric safety control
Note: 03 monthly continuously un-improvement, action plan shall be conducted by site
I = Improved; U = Unimproved

8. Pr-HSE-07-32
NO 1
Subcon’
(SM)
Work scope
(location)
Site Manager
CE/SE
in charged
Before After
NC/Unsafe
Description
/Suggestion
Improved
measure
# SAFETY PERFORMANCE BAD PRACTICE

9. Pr-HSE-07-32
No Items
Result
Comments
Feedback by site
(evidence attached)
OK NC N/A
1
One-out & Three out commitment of
Subcontract’s director
2
One-out & Three out commitment of
workers
3
One-out & Three out: Training for
violated workers (list & picture)
4
One-out & Three out: Discipline
conducted (record)
5
One-out & Three out: Status checking
board (Installing the board in office &
monitoring)
6 Participation of CM, CE, SE
4. CONDUCTING THE ONE OUT – THREE OUT REQULATION

10. Pr-HSE-07-32
5. DOCUMENTATION PERFORMANCE
Type Items to be checked
Check
Comments
Feedback by site
(evidence attached)
OK NC N/A
1.
Documentation
requirements
1 Risk assessment record & JSA
2 Joint management patrol report / record
3 PTW record
4
HSE committee minute meeting (Safety Day 3rd)
record
5
HSE committee minute meeting (weekly & monthly)
record
6
Safety Inspection Day report / record (including tools
and electric devices)
7 The Environment Day (every Saturday) report / record
8
Training newcomer (induction) and annual, special,
one out – three out, hazard,… record
9 HSE Organization chart record
10 Daily & weekly report
11 HSE plan
12 Safety facilities installation plan
13 TBM registered list and manpower update record
14 HSE feedback patrol report
15
Accident status & report (near miss, incident,
accident) & manpower accumulation record
16 Entrance card for employees / tag
17 HSE campaign record

11. Pr-HSE-07-32
5. DOCUMENTATION PERFORMANCE
Tasks Items to be checked
Check
Comments
Feedback by site
(evidence attached)
OK NC N/A
2.
Legal
requirement
1 Subcon's safety plan / method statement
2 Subcon's worker info: ID, contract, health check, certificate
3 Subcon's WCI
4
Subcon's equipment safety document: operator license,
signalman, banksman, rigger safety training certificates,
verification certificate, insurance
5
Dangerous equipment (vehicle, bottle) report: daily, monthly checking
– maintenance – repair record
6 Earth / ground and lighting resistant testing
7 Medical contract
8 First aid kit and facilities
9 Hazardous waste registration
10
Hazardous waste transportation & disposal contract and waste source
registration
11 Underground water using and discharge license
12 MSDS for chemical
13 Fire drill plan / other emergency drill record
14 Drinking water test certificate
15 Vector control record
16 Toilet, tissue, washing water, soap provided
17 Health check record (yearly – engineer)
18
Environment Impact Evaluation document (Including environment
protection commitment)
19 Environmental monitoring report (4 times/ year)
20 Labor & hygiene monitoring report (2 times/year)
21 Authority inspection periodically record (DOLISA, DOC )
22 Other issues