HAZARDOUS SUBSTANCE CHECKLIST Form # HSEQ - HSC Rev 2 -.docx
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Project Information Project Name: Location: Company Name: Date : Sl. No Description Yes No N/A Comments 1. Properly stored, labeled, ventilated, isolated, Log and suitable signs displayed. 2. Material Data Safety Sheet (MSDS) available, and communicated to concerned personnel. 3. Adequate/ Sufficient firefighting equipment are in place. 4. Emergency escape and breathing apparatus available, tested and in good condition. 5. Hazardous substances containers/drums have eligible labeling and protected from leakages or spillage. 6. Personnel must be trained in chemical handling. 7. Emergency control plan must be made available, spillage control kits must be available. 8. Empty hazardous substances containers, drums and receptacles should be properly maintained and controlled. 9. Expired chemicals are logged, segregated and disposed properly 10. Others Specify Remarks: Inspected By: Signature: Reviewed By HSE Manager / In charge : Signature:
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Project hse plan kikeh spar
This document outlines the health, safety, and environmental (HSE) plan for the Kikeh Spar hook-up and commissioning project. It details the HSE goals, responsibilities, programs, and activities that will be implemented. The key objectives of the HSE plan are to ensure compliance with regulations and prevent incidents in order to maintain safety during all project phases. The plan describes the HSE management system, training, monitoring, emergency response procedures, and other important elements that will be followed.
Fire Risk Assessment.pdf
This 8-page fire risk assessment document identifies several hazards for a workshop including: lack of permits, improper PPE, manual handling, lone working, poor housekeeping, unloading materials, power tool usage, bending activities, drilling, chemical handling, combustible materials, flammable liquids, and emergency response issues. For each hazard, the document rates the initial risk level, identifies controls to implement, and assigns responsible parties. It then provides the reduced residual risk rating after controls are in place. The overall goal is to reduce initial "High Risk" ratings to "Low Risk" through implementation of proper safety protocols and controls.
2 Fire Risk Assessment Template Risk Assessment Templates.docx
Project Fire Risk Assessment Report
(Quarterly) By: App: Project Relevant legislation:
• Federal Law No. 8 – Chapter 5 Article 92 ;
• DM Code of Construction Practice – Chapter 5;
• Regulation NO. 5 2009 Railways in the Emirate of Dubai (RED);
• Railway Protection Code of Practice (RWPCOP);
• UAE Fire and Life Safety Code of Practice – Chapter 12 (FLSCOP);
• Abu Dhabi Occupational Safety and Health Center – Code of Practise (OSHAD – CoP)
Issued: Rev.
Area: Assessment Date:
Next Assessment date:
Report compiled by:
Designation:
ASSESSMENT CRITERIA FIRE AND EMERGENCY CONTROL MEASURES AND LEGAL REQUIREMENTS RELEVANT LEGISLATION IMPLEMENTED PROJECT CONTROLS FOR COMPLIANCE COMMENTS FROM LAST FIRE ASSESSMENT
1. Site set up of temporary offices and cabins
Incl. Fire risk assessment; • Fire risk assessment undertaken on site set up and maintained/amended as project progresses;
• A copy of the fire risk assessment is maintained by HSE personnel;
• Separation distances between buildings under construction and construction-related structures, such as temporary offices, trailers, sheds, and other facilities for the storage of tools and materials having combustible construction or contents;
• No offices to be erected within the 70m Metro Protection Zone; FLSCOP Chapter 12 Table 12.1
RWPCOP
Section 4.6.1
DM Chapter 5.4
OSHAD CoP 8.0 & 43.0 •
2. Use of Portable gas heating or cutting equipment.
(all areas) • Ensure equipment is used in accordance with MAS and adequately maintained;
• Ensure suitable extraction is in place in confined areas and equipment is suitably maintained, extractors regularly maintained/cleaned;
• Ensure suitable fire- fighting equipment available nearby;
• Ensure use of Hot Works and Permits to Work as per section 5 and OSHAD CoP 21.0 and CoP 28.0;
• Ensure flashback arrestors fitted, hoses and connections sound and leak proof (as per inspection regime);
• Gas cylinder storage detailed in Section 7 and OSHAD CoP 49.0; FLSCOP Chapter 12 Section 7
DM Chapters 5, 15
OSHAD CoP 21.0, 28.0 & 49.0 •
3. Electrical equipment (portable and fixed installation)
• Portable electrical equipment to be tested every 6 months. Test stickers on appliances for date of last testing;
• Ensure fixed/temporary installations are checked by a competent person monthly and that this check is recorded and registered;
• Ensure that socket/DB outlets are not overloaded and connections are correct to standards;
• Correct rated fuses and breakers to be installed;
• DB’s to be waterproof and mounted on metal frames if on site;
• All site supply cables to be armoured;
• Install overhead cable frames where practicable in congested areas;
• Damaged equipment and cords shall be removed from service and quarantined until repaired or destroyed;
• Temporary lights shall not be suspended by their electrical cords unless such cords and lights have been designed for that purpose; FLSCOP Chapter 12 Section 14
DM Chapters 5.6, 16 & 17
O
26 storage of substances under co shh risk assessment templates
PRIOR TO / AT SITE DELIVERY • Hazardous substances
Storage • Storage of Substance potentially hazardous to worker health or to the environment;
Use of substances and chemicals on site • Use of Substances potentially hazardous to worker health or the environment;
Emergency procedures • Action to be taken in an emergency
Disposal of waste skips • Disposal of out of date substances;
• Disposal of used/empty containers;
27 hydrostatic pressure testing inside buildings risk assessment templates
Establishing exclusion zones • Personnel in area • Unauthorized access to test area;
• Workers struck by flying materials;
• Worker struck by High pressure water release;
Signage to test area • Personnel in area • Unauthorized access to test area;
• Inadequate signage to test area;
Pressure testing • High pressure to pipework; • Uncontrolled Stored Energy release;
• Rupture/failure in Pipe lines during testing;
• Valve/connection failure;
• Instrument failure resulting in system over-pressurization;
• End caps/plugs ejecting under high pressure;
• Weld/seal/fitting failure, flying objects;
• High pressure water/air injection.
Emergency procedures • High pressure to pipework; • Emergency procedures not briefed to task workers;
• Poor response in the event of an emergency;
Re-testing in the event of failure • Re-testing with high pressure • Injury due to uncontrolled testing;
• Worker injury due to working on pressurized system;
• Injury due to failure to ensure adequate pre-checks undertaken;
ELECTRICAL INSTALLATIONS INSPECTION CHECKLIST Form # HSEQ - EIIC Rev 7.docx
Project Information:
Project Name: Company Name:
Location: Date :
Sl. No Description Yes No N/A Comments
DBs/ SDBs
1. Is earth conducted continued up to DB/ SDB?
2. Whether DBs & extension boards are protected from rain/ water?
3. Is there any overloading of DBs/ SDBs?
4. Are correct rated Circuit breakers provided in all main boards and sub-boards?
5. Is energized wiring in junction boxes, Circuit board panels & similar places covered all times?
CABLES
6. Whether the condition of cable is checked?
7. Are cables received checked for insulation resistance before using them?
8. Are all main cables taken either underground/ overhead?
9. Are main cables protected from sharp/ heavy materials?
10. Is any improper jointing of cable identified?
11. Are all plugs and sockets in good condition?
RCD (ELCB)
12. Is the connections routed through 30mA RCD?
13. EARTHING
14. Are main DB, Generator and other panel’s ear thing done?
15. Earth resistance checked and found within limits?
ELECTRICALLY OPERATED MACHINES/ ACCESSORIES
16. Whether the machine supply cable has industrial type socket and plug?
17. Are all metal parts of electrical equipment and light fittings/ accessories grounded?
18. Is there any shed/ cover for machines?
19. Are flood lights/ task lights fixed properly away from combustibles?
20. Others if any:
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader : Signature:
7 Falsework (Temporary Works) Risk Assessment Templates.docx
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Temporary Falsework for formwork support. Classed as Temporary Works Relevant Applicable MAS:
• 01411 – MEWP’s;
• 00236 - Housekeeping Additional Training required:
Temporary Works Coordinator to be designated NOC’s Required for task:
RISK SCORE CALCULATOR
Use the Risk Score Calculator to Determine the Level of Risk of each Hazard
What would be the
CONSEQUENCE
of an occurrence be? What is the LIKELIHOOD of an occurrence? Hierarchy of Controls
Frequent/Almost certain (5)
Continuous or will happen frequently Often (4)
6 to 12 times a year Likely (3)
1 to 5 times a year Possible (2)
Once every 5 years Rarely (1)
Less than once every 5 years Can the hazard be Eliminated or removed from the work place?
Catastrophic (5)
Multiple Fatalities High 25 High 20 High 15 Medium 10 Medium 5 Can the product or process be substituted for a less hazardous alternative?
Serious (4)
Class 1 single fatality High 20 High 16 High 12 Medium 8 Low 4 Can the hazard be engineered away with guards or barriers?
Moderate (3)
Class2 (AWI or LTI) or Class 1 Permanently disabling effects High 15 High 12 Medium 9 Medium 6 Low 3 Can Administration Controls be adopted
I.e. procedures, job rotation etc.
Minor (2)
Medical attention needed, no work restrictions. MTI Medium10 Medium 8 Medium 6 Low 4 Low 2 Can Personal Protective Equipment & Clothing be worn to safe guard against hazards?
Insignificant (1)
FAI Medium10 Medium 4 Low 3 Low 2 Low 1
No Specific Task Step
(In sequence of works) Hazard Details Consequence/Risk Initial Risk Rating Control Measures Residual Risks Additional Control Measures RR
P S RR
1 Access to work areas by personnel and plant.
Material delivery to work area;
• Vehicles and workers in same working area;
• Storage of materials for falsework;
• Use of plant – forklift etc.; • Collision with plant or vehicles and live traffic;ac
• Workers struck by plant, very high risk of fatality;
• Workers struck by plant;
• Poor or unsafe storage, collapse;
• Untrained operators; 4 5 20
HIGH i. Worker pedestrian routes to be designed and implemented with clear signage;
ii. Instruction to workers at induction on use of access routes around the project;
iii. All plant and operators to be Third Party certificated by approved body;
iv. Flagmen to be used to control personnel (only on roads below 80kph);
v. Falsework materials stored correctly, no more than 2 pallets high and banded together when transporting;
vi. In traffic enclosed areas suitable welfare and first aid facilities shall be implemented to minimized worker movements;
vii. The Logistics plan shall clearly illustrate access and egress points; Workers not complying with controls All supervision to monitor operation;
Regular topic in TBT’s Low
2 Use of powered access equipment for assembly of false-work (if required) • Use of MEWP
(Mobile Elevated
Hse plan
This document outlines an HSE (Health, Safety, and Environment) plan for Alghanim Group of Shipping & Transport. It includes policies on company HSE, specific objectives, zero accident tolerance, and responsibilities of individuals like the Corporate HSE Manager and Operations Manager. The plan details AGST's responsibilities regarding HSE trainings, personnel, work stoppages, inspections, and programs. It also covers requirements for vehicles, marine operations, fire prevention, PPE, and more. The goal is to promote a safe working environment free of risks and ensure compliance with regulations.
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Project hse plan kikeh spar
This document outlines the health, safety, and environmental (HSE) plan for the Kikeh Spar hook-up and commissioning project. It details the HSE goals, responsibilities, programs, and activities that will be implemented. The key objectives of the HSE plan are to ensure compliance with regulations and prevent incidents in order to maintain safety during all project phases. The plan describes the HSE management system, training, monitoring, emergency response procedures, and other important elements that will be followed.
Fire Risk Assessment.pdf
This 8-page fire risk assessment document identifies several hazards for a workshop including: lack of permits, improper PPE, manual handling, lone working, poor housekeeping, unloading materials, power tool usage, bending activities, drilling, chemical handling, combustible materials, flammable liquids, and emergency response issues. For each hazard, the document rates the initial risk level, identifies controls to implement, and assigns responsible parties. It then provides the reduced residual risk rating after controls are in place. The overall goal is to reduce initial "High Risk" ratings to "Low Risk" through implementation of proper safety protocols and controls.
2 Fire Risk Assessment Template Risk Assessment Templates.docx
Project Fire Risk Assessment Report
(Quarterly) By: App: Project Relevant legislation:
• Federal Law No. 8 – Chapter 5 Article 92 ;
• DM Code of Construction Practice – Chapter 5;
• Regulation NO. 5 2009 Railways in the Emirate of Dubai (RED);
• Railway Protection Code of Practice (RWPCOP);
• UAE Fire and Life Safety Code of Practice – Chapter 12 (FLSCOP);
• Abu Dhabi Occupational Safety and Health Center – Code of Practise (OSHAD – CoP)
Issued: Rev.
Area: Assessment Date:
Next Assessment date:
Report compiled by:
Designation:
ASSESSMENT CRITERIA FIRE AND EMERGENCY CONTROL MEASURES AND LEGAL REQUIREMENTS RELEVANT LEGISLATION IMPLEMENTED PROJECT CONTROLS FOR COMPLIANCE COMMENTS FROM LAST FIRE ASSESSMENT
1. Site set up of temporary offices and cabins
Incl. Fire risk assessment; • Fire risk assessment undertaken on site set up and maintained/amended as project progresses;
• A copy of the fire risk assessment is maintained by HSE personnel;
• Separation distances between buildings under construction and construction-related structures, such as temporary offices, trailers, sheds, and other facilities for the storage of tools and materials having combustible construction or contents;
• No offices to be erected within the 70m Metro Protection Zone; FLSCOP Chapter 12 Table 12.1
RWPCOP
Section 4.6.1
DM Chapter 5.4
OSHAD CoP 8.0 & 43.0 •
2. Use of Portable gas heating or cutting equipment.
(all areas) • Ensure equipment is used in accordance with MAS and adequately maintained;
• Ensure suitable extraction is in place in confined areas and equipment is suitably maintained, extractors regularly maintained/cleaned;
• Ensure suitable fire- fighting equipment available nearby;
• Ensure use of Hot Works and Permits to Work as per section 5 and OSHAD CoP 21.0 and CoP 28.0;
• Ensure flashback arrestors fitted, hoses and connections sound and leak proof (as per inspection regime);
• Gas cylinder storage detailed in Section 7 and OSHAD CoP 49.0; FLSCOP Chapter 12 Section 7
DM Chapters 5, 15
OSHAD CoP 21.0, 28.0 & 49.0 •
3. Electrical equipment (portable and fixed installation)
• Portable electrical equipment to be tested every 6 months. Test stickers on appliances for date of last testing;
• Ensure fixed/temporary installations are checked by a competent person monthly and that this check is recorded and registered;
• Ensure that socket/DB outlets are not overloaded and connections are correct to standards;
• Correct rated fuses and breakers to be installed;
• DB’s to be waterproof and mounted on metal frames if on site;
• All site supply cables to be armoured;
• Install overhead cable frames where practicable in congested areas;
• Damaged equipment and cords shall be removed from service and quarantined until repaired or destroyed;
• Temporary lights shall not be suspended by their electrical cords unless such cords and lights have been designed for that purpose; FLSCOP Chapter 12 Section 14
DM Chapters 5.6, 16 & 17
O
26 storage of substances under co shh risk assessment templates
PRIOR TO / AT SITE DELIVERY • Hazardous substances
Storage • Storage of Substance potentially hazardous to worker health or to the environment;
Use of substances and chemicals on site • Use of Substances potentially hazardous to worker health or the environment;
Emergency procedures • Action to be taken in an emergency
Disposal of waste skips • Disposal of out of date substances;
• Disposal of used/empty containers;
27 hydrostatic pressure testing inside buildings risk assessment templates
Establishing exclusion zones • Personnel in area • Unauthorized access to test area;
• Workers struck by flying materials;
• Worker struck by High pressure water release;
Signage to test area • Personnel in area • Unauthorized access to test area;
• Inadequate signage to test area;
Pressure testing • High pressure to pipework; • Uncontrolled Stored Energy release;
• Rupture/failure in Pipe lines during testing;
• Valve/connection failure;
• Instrument failure resulting in system over-pressurization;
• End caps/plugs ejecting under high pressure;
• Weld/seal/fitting failure, flying objects;
• High pressure water/air injection.
Emergency procedures • High pressure to pipework; • Emergency procedures not briefed to task workers;
• Poor response in the event of an emergency;
Re-testing in the event of failure • Re-testing with high pressure • Injury due to uncontrolled testing;
• Worker injury due to working on pressurized system;
• Injury due to failure to ensure adequate pre-checks undertaken;
ELECTRICAL INSTALLATIONS INSPECTION CHECKLIST Form # HSEQ - EIIC Rev 7.docx
Project Information:
Project Name: Company Name:
Location: Date :
Sl. No Description Yes No N/A Comments
DBs/ SDBs
1. Is earth conducted continued up to DB/ SDB?
2. Whether DBs & extension boards are protected from rain/ water?
3. Is there any overloading of DBs/ SDBs?
4. Are correct rated Circuit breakers provided in all main boards and sub-boards?
5. Is energized wiring in junction boxes, Circuit board panels & similar places covered all times?
CABLES
6. Whether the condition of cable is checked?
7. Are cables received checked for insulation resistance before using them?
8. Are all main cables taken either underground/ overhead?
9. Are main cables protected from sharp/ heavy materials?
10. Is any improper jointing of cable identified?
11. Are all plugs and sockets in good condition?
RCD (ELCB)
12. Is the connections routed through 30mA RCD?
13. EARTHING
14. Are main DB, Generator and other panel’s ear thing done?
15. Earth resistance checked and found within limits?
ELECTRICALLY OPERATED MACHINES/ ACCESSORIES
16. Whether the machine supply cable has industrial type socket and plug?
17. Are all metal parts of electrical equipment and light fittings/ accessories grounded?
18. Is there any shed/ cover for machines?
19. Are flood lights/ task lights fixed properly away from combustibles?
20. Others if any:
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader : Signature:
7 Falsework (Temporary Works) Risk Assessment Templates.docx
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Temporary Falsework for formwork support. Classed as Temporary Works Relevant Applicable MAS:
• 01411 – MEWP’s;
• 00236 - Housekeeping Additional Training required:
Temporary Works Coordinator to be designated NOC’s Required for task:
RISK SCORE CALCULATOR
Use the Risk Score Calculator to Determine the Level of Risk of each Hazard
What would be the
CONSEQUENCE
of an occurrence be? What is the LIKELIHOOD of an occurrence? Hierarchy of Controls
Frequent/Almost certain (5)
Continuous or will happen frequently Often (4)
6 to 12 times a year Likely (3)
1 to 5 times a year Possible (2)
Once every 5 years Rarely (1)
Less than once every 5 years Can the hazard be Eliminated or removed from the work place?
Catastrophic (5)
Multiple Fatalities High 25 High 20 High 15 Medium 10 Medium 5 Can the product or process be substituted for a less hazardous alternative?
Serious (4)
Class 1 single fatality High 20 High 16 High 12 Medium 8 Low 4 Can the hazard be engineered away with guards or barriers?
Moderate (3)
Class2 (AWI or LTI) or Class 1 Permanently disabling effects High 15 High 12 Medium 9 Medium 6 Low 3 Can Administration Controls be adopted
I.e. procedures, job rotation etc.
Minor (2)
Medical attention needed, no work restrictions. MTI Medium10 Medium 8 Medium 6 Low 4 Low 2 Can Personal Protective Equipment & Clothing be worn to safe guard against hazards?
Insignificant (1)
FAI Medium10 Medium 4 Low 3 Low 2 Low 1
No Specific Task Step
(In sequence of works) Hazard Details Consequence/Risk Initial Risk Rating Control Measures Residual Risks Additional Control Measures RR
P S RR
1 Access to work areas by personnel and plant.
Material delivery to work area;
• Vehicles and workers in same working area;
• Storage of materials for falsework;
• Use of plant – forklift etc.; • Collision with plant or vehicles and live traffic;ac
• Workers struck by plant, very high risk of fatality;
• Workers struck by plant;
• Poor or unsafe storage, collapse;
• Untrained operators; 4 5 20
HIGH i. Worker pedestrian routes to be designed and implemented with clear signage;
ii. Instruction to workers at induction on use of access routes around the project;
iii. All plant and operators to be Third Party certificated by approved body;
iv. Flagmen to be used to control personnel (only on roads below 80kph);
v. Falsework materials stored correctly, no more than 2 pallets high and banded together when transporting;
vi. In traffic enclosed areas suitable welfare and first aid facilities shall be implemented to minimized worker movements;
vii. The Logistics plan shall clearly illustrate access and egress points; Workers not complying with controls All supervision to monitor operation;
Regular topic in TBT’s Low
2 Use of powered access equipment for assembly of false-work (if required) • Use of MEWP
(Mobile Elevated
Hse plan
This document outlines an HSE (Health, Safety, and Environment) plan for Alghanim Group of Shipping & Transport. It includes policies on company HSE, specific objectives, zero accident tolerance, and responsibilities of individuals like the Corporate HSE Manager and Operations Manager. The plan details AGST's responsibilities regarding HSE trainings, personnel, work stoppages, inspections, and programs. It also covers requirements for vehicles, marine operations, fire prevention, PPE, and more. The goal is to promote a safe working environment free of risks and ensure compliance with regulations.
13 initial project site office set up risk assessment templates
13 Initial Project Site Office Set-up Risk Assessment Templates
Working adjacent to public areas
Vehicles/Plant Equipment movements
Groundworks / excavations
Excavation in site area
Trial trenches, septic tank excavation etc.
Works at Height
(Office cabin set-up)
Use of Ladders and stepladders
Mobile Crane operation
(Cabin/unit placing)
Temporary electrics - offices
Site generators – offices and site
2 fire risk assessment template risk assessment templates
2 Fire Risk Assessment Template Risk Assessment Templates
1. Site set up of temporary offices and cabins
Incl. Fire risk assessment;
2. Use of Portable gas heating or cutting equipment.
(all areas)
3. Electrical equipment (portable and fixed installation)
4. Smoking prevention, controls and arrangements within the Project
5. Hot Works activity controls
(Grinding, Welding, Cutting etc.)
6. Waste disposal: Combustible materials controlled and disposed of correctly.
(E.g. paper, cardboard plastics or wood.)
7. Storage of Flammable Gas within the project
(Acetylene, propane, butane, LPG etc.)
8. Flammable or highly flammable materials or substances on site and point of use.
(e.g. solvents, paints, adhesives, aerosols etc.)
9. Steps to reduce the potential sources of oxygen to a fire.
10. Any operations (or proposed) that may affect the Fire risk assessment
11. Clear access to electrical components and equipment.
12. Suspended ceilings within temporary buildings
(Offices, cabins etc.)
13. Alterations to structure and installations designed to prevent fire spread
14. Arson Prevention
(including security)
15. Smoke/heat detectors installed in high risk areas
16. Fire call points (break glass) installation.
17. Audible/visual fire alarms.
December -15 Daily Observation Report
The document is a site safety observation report prepared by Mohammed Mubasheeruddin on December 15, 2016. It details three safety observations made at a construction site, including workers following without proper protective equipment, improperly stocked ducting material, and improperly stoked fire fighting pipes. For each observation, the report notes an identified unsafe act and the corresponding correction that was taken.
Monthly Environmental Inspection
This document outlines the requirements for a monthly environmental inspection at a construction site. It lists 12 compliance issues that are to be checked, including appointing contractors, safety training, personal protective equipment, health and safety, excavation and backfilling, dust control, water management, noise, storage and handling of hazardous substances, and waste management. For each compliance issue, the inspector notes whether the activity is acceptable or not, and includes evidence and details any responsible persons and completion dates for corrective actions. The goal of the inspection is to ensure all construction activities comply with environmental regulations and best practices.
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This risk assessment document identifies hazards associated with laying blockwork using access scaffolding and proposes control measures. It addresses six specific tasks: 1) vehicle and plant movements for block delivery, 2) use of access scaffolding and working platforms, 3) loading out blocks and mixing mortar, 4) laying blockwork, 5) disposal of concrete, and 6) worker exposure to direct sun. For each task, the document identifies hazards, assesses initial risk level, lists control measures to reduce risk, and notes any remaining risks. The overall goal is to reduce risks from falls, manual handling injuries, vehicle collisions, cement burns and heat exposure during block laying activities.
19 use of mobile elevated work platforms risk assessment templates
19 Use of Mobile Elevated Work Platforms Risk Assessment Templates
MEWP checks on arrival to site
PRIOR TO SITE ACCESS • Use of Access plant • Unauthorized operation of the plant resulting in incident;
• Failure due to use of un-certificated plant;
MEWP operation
(Operator) • Operator competency;
• Plant / pedestrian interaction;
• Work at Height; • Incident due to use of defective plant or associated equipment;
• MEWP overturning;
• Plant reversing – risk of serious injury to pedestrians;
• Unauthorized use of MEWP by untrained personnel;
• Operators climbing onto hand rails;
• Collision with other plant and live traffic within site boundary;
• Workers struck by working MEWP, very high risk of fatality;
• Falling materials;
MEWP operation (supervision) • MEWP operations around workers;
• Workers in MEWP operating radius;
• Reversing vehicles; • Worker struck by vehicle;•
16 scaffolding (temporary works) risk assessment templates
16 Scaffolding (Temporary Works) Risk Assessment Templates
Access to work areas by personnel and plant.
Scaffold Material delivery to work area;
Scaffold design and erection standards
(Classified as Temporary Structure)
Scaffold erection
(Classified as Temporary Structure)
Dismantling of scaffold
Maintenance of Scaffold
Worker exposure to direct sun whist working on scaffold
(as applicable)
STORE INSPECTION Form # HSEQ - Form 2 Rev 2.docx
Project Information
Project Name: Store No.
Location: Contact Person:
Company Name: Arabtec Construction LLC. Date:
Sr. Description Yes No N/A Comments
1. Is access to stores are restricted to authorized personnel only?
2. Are there clear spaces around racks and stacks of stored materials and are adequate gangways provided between them?
3. Are stacks and storage kept clear of light fittings and hot surfaces?
4. Are all stocks of flammable liquids kept in purpose-built flammable storage liquid stores?
5. Are storage areas generally cleaned and tidy?
6. Are flammable liquids kept away from all possible sources of ignition?
7. Emergency exit signs are available in right locations
8. Smoke detectors/fire alarm are visible and accessible.
9. Fire extinguishers are available are serviced regularly
10. Are free standing shelves and cupboards secured for stability?
11. Are heavy items stored at a suitable height?
12. Are chemical containers used for storage suitable and clearly labelled?
13. Is there adequate light in the storage area?
14. Are all small loose items secured in appropriate storage?
15. Are warning notices, prohibiting smoking and naked lights prominently displayed?
16. Others if any:
Remarks:
Inspected by: Signature:
Reviewed by Project Manager/HSE Manager Signature:
Sterile container system
Today, surgical site infections have become common complications
Leading cause of postoperative morbidity and mortality
Preventing infection in the surgical site is a primary goal for all members of the operative team.
One key measure for reducing the risk for surgical site infection is to provide surgical instruments and devices that are sterile at the time of use;
This requires appropriate packaging of the items for sterilization.
HSE policy
This document outlines an organization's health, safety, security and environment (HSE) management system. It describes the system's objectives, scope, framework, policies, leadership and accountability structures, planning processes, and implementation and execution requirements. The key goals of the system are to identify and manage risks, set clear targets, ensure continual improvement, demonstrate leadership commitment, and engage stakeholders.
Internal EHS Audit check sheet
This document provides an internal health, safety, and environment (HSE) audit checklist for a monthly organizational audit. It contains over 200 questions across 20 categories related to HSE policies, training, the work environment, amenities, housekeeping, special work procedures, hazards, equipment, and other factors. The audit is intended to evaluate compliance with HSE standards and identify any nonconformities requiring corrective action. No audit results are provided in the sample document.
Asset Integrity Management
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5 trial trenches (temporary works) risk assessment templates
This risk assessment document summarizes the hazards, risks, control measures, and residual risks associated with conducting trial trench excavations by hand to locate underground utilities at a construction site. Key steps include planning excavations based on utility drawings, scanning the work area to locate services, clearly marking identified and unidentified utilities, implementing traffic management plans if near roads, and using hand digging and excavators with spotters to expose utilities. Control measures such as permits, competent machine operators, exclusion zones around utilities, fall protection in trenches, illumination and signage are required. Residual risks include damage to undetected utilities and machine breakdown.
OFFICE INSPECTION Form # HSEQ - Form 1 Rev 2.docx
Project Information
Project Name: Office No.
Location: Contact Person:
Company Name: Date:
Sr. Description Yes No N/A Comments
1. Emergency exit signs are available in right locations
2. Fire alarms and fire extinguishers are visible and accessible.
3. Fire doors (e.g. in stairways) are kept closed unless equipped with automatic closing device
4. Fire extinguishers are serviced regularly
5. Corridors and stairways are kept free of obstruction
6. Fire escape/ evacuation plan available and posted
7. First aid box available
8. Floor surfaces are kept dry and free of slip hazards
9. Electrical cords and plugs are in good condition with proper Grounding
10. Kitchen equipment checked
11. Fire blanket available in the pantry
12. Heat detector available in the pantry
13. Toilets floor clean and dry
14. Are staff trained to use Fire Extinguishers
15. Hand wash/ soap solution available in the toilet
16. Civil Defense or Authority approval
17. Others if any:
Remarks:
Inspected By: Signature:
Reviewed By Project Manager/HSE Manager Signature:
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
This document is a sub-contractor pre-start HSE checklist that must be filled out daily before starting any activity. It collects project information, task details including description, location, workers and duration. It also checks that various HSE prerequisites are in place such as safety inductions, risk assessments, PPE availability, inspection of tools and equipment, and that unsafe conditions have been rectified. The sub-contractor must acknowledge that all precautions and control measures have been taken and the workers have been deemed competent to perform the task safely.
HSE Management Plan
VIETNAM MACHINERY INSTALLATION CORPORATION
(LILAMA CORPORATION) SITE SAFETY, HEALTH AND
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Project EHS Plan
This document provides an Environmental Health and Safety (EHS) plan for Sandvik Asia Pvt Ltd's JSW Jaigarh conveyor project in India. It outlines the project details and EHS objectives to ensure safety of employees, contractors, and visitors. Key responsibilities are defined for the project manager, EHS manager, site EHS officer, and other roles to implement the EHS program and comply with applicable legal requirements. Elements of the plan include risk assessment, emergency response, training, and management of contractor EHS performance.
Weekly generator check list
This generator daily inspection checklist documents routine inspections for a generator used on Project098-C58. It lists 14 items to check such as oil, fuel, and water levels, emissions, wiring connections, instruments, grounding, output power, and safety equipment. The contractor supervisor signs off after inspecting the generator each date, noting any remarks.
FIRE EXTINGUISHER INSPECTION Form # HSEQ - FEI Rev 4.docx
This document is a fire extinguisher inspection form to be completed twice weekly. It includes details of fire extinguishers such as their number, type, location, seal, lock, pin, pressure gauge, and discharge hose and nozzle. Inspectors check each fire extinguisher for cracks, breaks, seals and other defects, and note any required repairs or replacements in the remarks section. The inspection is reviewed and noted by safety and project management.
Industrial Safety Training by Author Stream
The document discusses the history and evolution of industrial safety. It begins by defining industrial safety as measures implemented to reduce risk of injury in manufacturing facilities. It then discusses how industrial safety has evolved from a focus on compensation to prevention and addressing long term hazards. Key aspects covered include categories of workplace hazards, legislation like OSHA, and the modern view of safety measures as an investment. Overall, the document provides a comprehensive overview of the development and current approach to industrial safety.
Sds
The document discusses Material Safety Data Sheets (MSDS) and their replacement by Safety Data Sheets (SDS) according to the Globally Harmonized System of Classification and Labeling of Chemicals. By June 1, 2015, MSDS will be replaced by SDS which have a standardized 16-section format providing critical safety information on handling chemicals like hazards, protective measures, and emergency procedures. Manufacturers must update their sheets and labels to match the new global standard format and include pictograms and signal words for recognized hazards.
Manufacturing Operations and Controls
This document discusses good manufacturing practices for manufacturing operations and controls in the pharmaceutical industry. It covers several key topics:
1. Sanitation of manufacturing premises is important to ensure good hygiene of facilities, equipment, processes, and personnel. Cleaning and validation procedures should be established and records maintained.
2. Proper controls must be established to prevent mix-ups and cross-contamination during production. This includes separation of products, labeling, cleaning procedures, and qualified personnel.
3. Waste and scrap from manufacturing must be properly handled, collected, stored, and disposed of according to established guidelines. Hazardous and pharmaceutical wastes require special treatment and disposal.
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(all areas)
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PRIOR TO SITE ACCESS • Use of Access plant • Unauthorized operation of the plant resulting in incident;
• Failure due to use of un-certificated plant;
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• Operators climbing onto hand rails;
• Collision with other plant and live traffic within site boundary;
• Workers struck by working MEWP, very high risk of fatality;
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• Reversing vehicles; • Worker struck by vehicle;•
16 scaffolding (temporary works) risk assessment templates
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STORE INSPECTION Form # HSEQ - Form 2 Rev 2.docx
Project Information
Project Name: Store No.
Location: Contact Person:
Company Name: Arabtec Construction LLC. Date:
Sr. Description Yes No N/A Comments
1. Is access to stores are restricted to authorized personnel only?
2. Are there clear spaces around racks and stacks of stored materials and are adequate gangways provided between them?
3. Are stacks and storage kept clear of light fittings and hot surfaces?
4. Are all stocks of flammable liquids kept in purpose-built flammable storage liquid stores?
5. Are storage areas generally cleaned and tidy?
6. Are flammable liquids kept away from all possible sources of ignition?
7. Emergency exit signs are available in right locations
8. Smoke detectors/fire alarm are visible and accessible.
9. Fire extinguishers are available are serviced regularly
10. Are free standing shelves and cupboards secured for stability?
11. Are heavy items stored at a suitable height?
12. Are chemical containers used for storage suitable and clearly labelled?
13. Is there adequate light in the storage area?
14. Are all small loose items secured in appropriate storage?
15. Are warning notices, prohibiting smoking and naked lights prominently displayed?
16. Others if any:
Remarks:
Inspected by: Signature:
Reviewed by Project Manager/HSE Manager Signature:
Sterile container system
Today, surgical site infections have become common complications
Leading cause of postoperative morbidity and mortality
Preventing infection in the surgical site is a primary goal for all members of the operative team.
One key measure for reducing the risk for surgical site infection is to provide surgical instruments and devices that are sterile at the time of use;
This requires appropriate packaging of the items for sterilization.
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OFFICE INSPECTION Form # HSEQ - Form 1 Rev 2.docx
Project Information
Project Name: Office No.
Location: Contact Person:
Company Name: Date:
Sr. Description Yes No N/A Comments
1. Emergency exit signs are available in right locations
2. Fire alarms and fire extinguishers are visible and accessible.
3. Fire doors (e.g. in stairways) are kept closed unless equipped with automatic closing device
4. Fire extinguishers are serviced regularly
5. Corridors and stairways are kept free of obstruction
6. Fire escape/ evacuation plan available and posted
7. First aid box available
8. Floor surfaces are kept dry and free of slip hazards
9. Electrical cords and plugs are in good condition with proper Grounding
10. Kitchen equipment checked
11. Fire blanket available in the pantry
12. Heat detector available in the pantry
13. Toilets floor clean and dry
14. Are staff trained to use Fire Extinguishers
15. Hand wash/ soap solution available in the toilet
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Remarks:
Inspected By: Signature:
Reviewed By Project Manager/HSE Manager Signature:
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
This document is a sub-contractor pre-start HSE checklist that must be filled out daily before starting any activity. It collects project information, task details including description, location, workers and duration. It also checks that various HSE prerequisites are in place such as safety inductions, risk assessments, PPE availability, inspection of tools and equipment, and that unsafe conditions have been rectified. The sub-contractor must acknowledge that all precautions and control measures have been taken and the workers have been deemed competent to perform the task safely.
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26 Storage of Substances under CoSHH Risk Assessment Templates.docx
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Storage of substances classified under CoSHH on project sites, such as paints and associated thinners and cleaners, protective coatings, additives, adhesives and sealants, chemical sprays, fuels and oils, etc. Relevant Applicable MAS:
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RISK SCORE CALCULATOR
Use the Risk Score Calculator to Determine the Level of Risk of each Hazard
What would be the
CONSEQUENCE
of an occurrence be? What is the LIKELIHOOD of an occurrence? Hierarchy of Controls
Frequent/Almost certain (5)
Continuous or will happen frequently Often (4)
6 to 12 times a year Likely (3)
1 to 5 times a year Possible (2)
Once every 5 years Rarely (1)
Less than once every 5 years Can the hazard be Eliminated or removed from the work place?
Catastrophic (5)
Multiple Fatalities High 25 High 20 High 15 Medium 10 Medium 5 Can the product or process be substituted for a less hazardous alternative?
Serious (4)
Class 1 single fatality High 20 High 16 High 12 Medium 8 Low 4 Can the hazard be engineered away with guards or barriers?
Moderate (3)
Class2 (AWI or LTI) or Class 1 Permanently disabling effects High 15 High 12 Medium 9 Medium 6 Low 3 Can Administration Controls be adopted
I.e. procedures, job rotation etc.
Minor (2)
Medical attention needed, no work restrictions. MTI Medium10 Medium 8 Medium 6 Low 4 Low 2 Can Personal Protective Equipment & Clothing be worn to safe guard against hazards?
Insignificant (1)
FAI Medium10 Medium 4 Low 3 Low 2 Low 1
No Specific Task Step
(In sequence of works) Hazard Details Consequence/Risk Initial Risk Rating Control Measures Residual Risks Additional Control Measures RR
L C RR
1 PRIOR TO / AT SITE DELIVERY • Hazardous substances • Poor or incorrect substance storage due to lack of manufacturer’s specification; 3 3 9 MED i. Store operatives to ensure a Hazard Data Sheet is supplied ideally prior to substance delivery, if not supplied when delivered to site; Documentation unavailable for review Substance quarantined until evidence provided Low
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• Build-up of flammable vapor in confined area;
• Fire;
• Inadequate cooling and ventilation of storage resulting in ill health or combustion;
• Inadequate signage and substance identification;
• Poor controls over distribution of substances/chemicals;
• Excessive quantities issued to work areas;
3 4 12 HIGH i. HLG Workplaces storing hazardous substances/chemicals, using hazardous materials and/or generating hazardous waste shall have a hazardous materials management system;
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LAUNDRY HEALTH INSTRUCTION Form # HSEQ - LSI- Rev 2.docx
Project Information
Accommodation Name:
Location: Company Name:
Date: Time :
Sl No. ITEMS TO BE CHECKED Yes No N/A Comments
Audit Check List for Laundry
1 The premises are cleaned & situated in an environment which has minimum risk for contamination.
2 Sufficient area for storage of unwashed clothes & washed clothes.
3 Washing & drying premises was found cleaned & in good condition.
4 There are arrangements to control the entry of rodents, insects and birds.
5 Clothes are collected washed & dried separately.
Infection Control Checklist Laundry Personnel
1 Clean, neat, untorn and appropriate clothing is worn
2 Closed toe shoes with safety soles and in good repair are worn
3 Good personal hygiene (including hair and body cleanliness) is practiced
4 Fingernails are clean and trimmed
5 Hair is neat and protected by covering
6 Strict clothing and linen handling procedures are followed to avoid contamination
7 Direct resident contact is avoided except in emergency situations
8 Rubber gloves and protective covering are worn when handling and loading soiled linen
9 Disposable gloves are worn when handling isolation supplies
10 Injuries and suspected infections are reported immediately
11 Personnel are oriented to infection control policies on hiring; this is documented
12 Personnel attend department/facility-wide infection control in services monthly
13 Personnel are screened for infectious diseases on hiring and at further facility discretion
14 Personnel are informed of potential dangers/toxicities of cleaning compounds
15 Personnel, when informed of these potential dangers, follow safety procedures/precautions
16 Personnel are aware of methods to handle supplies and disposal of globes/equipment
Washing/Folding/Cleaning/Storage
1 Wash/rinse temperatures are maintained at a minimum of _____of for regular linen
2 Dryer temperatures are set at _____of for linen and regular clothes
3 Clean linens are transported in covered containers and stored in covered areas
4 Dirty linens are separated from clean ones at all times
5 Soiled linens are kept in a covered barrel at all times
6 Linen barrels are lined with plastic bags which cover the inside surface at all time
7 Isolation linen is transported as outlined in the Infection Control Manual
8 Linen folding surfaces are cleaned with a detergent germicide solution
9 All laundry appliances (washers/dryers, carts) are cleaned daily with detergent germicide solution
10 Supplies for clothing/equipment cleaning approved by Infection Control Committee
11 Equipment and supply problems are immediately reported to the administrator
………………………………………………….………………………………………………………………………………………………………………………………………..
Laundry Condition & Specific Location if needed: Initial
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PRE-START BRIEFING Form # HSEQ - PSB Rev 2 -.docx
Project Information:
Project Name:
Location: Supervisor :
Company name : Date:
Task Description:
Before work starts, the following must be in place
Induction Supervision Test Certificates Communication in same language Method Statement Risk Assessment Permit To Work Area Lighting
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Fall from height Training Access Ladder Access Handrail Edge Protection Secure Ladder Adequate Work Platform Guards for Openings Safety Harness Life Lines
Others( Specify)
Manual Handling Training Check Weight Mechanical Aids Access Route Team Lifting Wrong method Right Method
Power tools Training Color code inspection tag Check Cable Wheel guards Safe plug & sockets Cable Protection Proper Scaffold Cable Overhead Rotatory part guards
Scaffold Scaffold Tag Edge Protection Check Overhead works Access Ladder Adequate Work Platform Weather condition Out riggers Ladder 3 feet above platform Safety Harness
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Risk Assessment
Lifting Plan Tag Lines Lifting points / hooks Banks man Load stability Check Lifting gear Examination /Inspection Sharp edges protected
Lifting operations Weather/ Wind Speed Ground conditions Exclusion zone Communication Loading/ unloading vehicles Spreader Beams Check Ground conditions Check outriggers Others
Fire Fire Extinguisher Fire Hose Fire Exit Assembly point others
Slip/Trip Clean before you go Barricade the waste Waste Management Clean Access Housekeeping Clean liquid spillage Access signs Maintain access/ Egress
PPE
Safety Harness
Safety Helmet Coveralls Hi vis Jacket Safety Shoe Face Shield Ear Protection
Dust mask Respiratory Equipment Life line/ harness anchorage Hand Gloves Goggles/ Glass
Pre start Briefing done by: Signature:
Reviewed By HSE Manager/ In charge: Signature:
FIRE PREVENTION REQUIREMENTS Form # HSEQ - Rev 2.docx
Code of Practice
C.O.P # 01
Fire Prevention Requirements
(Management of Combustible Materials & Electrical Inspections)
Rev. 01, Mar 23
WITNESS STATEMENT FORM.docx
This document records a statement for a project located at an unspecified location. The statement is provided and written by an individual who acknowledges that the information is true to the best of their recollection. The individual provides their name, signature, position and date at the end of the statement.
PROJECT LEADER INCIDENT BRIEFING Form # HSEQ - PLIB Rev 2 -.docx
1. Project Information:
Project Name: Click here to enter text.
Report No.: Click here to enter text.
Project Location: Click here to enter text.
Property No.: Click here to enter text.
☐ Fatality ☐ Major Injury ☐ Minor Injury ☐ Property Damage ☐ Environmental ☐ Other
2. Describe the Incident in detail:
Answer who, what, why, where, when & how in this section: (Attach additional pages if required)
3. Incident Root Causes:
Describe direct, indirect & root cause: (Attach additional pages if required)
4. Key Corrections Taken Immediately after the Incident:
Attach additional pages if more space is required:
5. Key Corrective Actions to Prevent Recurrence:
Describe the corrective actions with timeframe: (Attach additional pages if required)
Corporate Office Remarks:
HSE FORMS (COVER PAGE)2 Form # HSEQ - Rev 2.docx
This document pertains to health, safety, environment, and quality forms from an HSEQ department. The HSEQ department handles forms related to health, safety, environment, and quality assurance. No other details are provided about the specific forms or purpose of the HSEQ department.
LIFT SHAFT ENTRY PERMIT Form # HSEQ - LSEP Rev 2 -.docx
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location:
Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Detail of Surroundings:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Control Measures: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement & Risk assessment developed, approved & communicated? ☐ ☐ ☐
Availability of rescue procedure and equipment? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Workplace appropriately illuminated ☐ ☐ ☐
Any high risk activity associated that requires PTW (i.e. hot work, CSE)? ☐ ☐ ☐
Forced ventilation provided? ☐ ☐ ☐
Are all necessary Permit approved and displayed at work location? ☐ ☐ ☐
Means of communication available? (Mobile, radio etc.) ☐ ☐ ☐
Safe access / Working Platform provided? ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
Availability of barricades/protection to prevent unauthorized or accidental entry? ☐ ☐ ☐
Life Line provided? ☐ ☐ ☐
Warning signs posted? ☐ ☐ ☐
Fall Protection equipment (e.g. full body harness) available? ☐ ☐ ☐
Availability of Fall protection arrangement? ☐ ☐ ☐
Other(s): ☐ ☐ ☐
Adequate Lighting provided? ☐ ☐ ☐
☐ ☐ ☐
4. Acknowledgement by Initiator and Evaluator:
☐ Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives, and I consider them competent to do it safely.
Initiator/Originator Name: Designation:
Signature: Time:
☐ Acknowledge that I have checked above control measures and consider the work area safe to carry out the activity
Evaluator (HSE Team): Designation:
Signature: Time
Comments (if any):
5. Authorization (PM/CM):
Name: Designation:
Signature: Time:
6. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I have checked the area and been restored to a safe and orderly condition.
Evaluator Signature: Time:
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location:
Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Location / Area :
Panel No : Voltage:
Permit Validity:
Time (from): _______Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
No: Checks Yes-No-NA Checks Yes-No-NA
ENERGIZATION (“Power On”) ISOLATION (“Power Off”)
1. Safety tool box briefing done. ☐ ☐ ☐
Method statement/Risk assessment in place. ☐ ☐ ☐
2. Authorized personnel / operators available. ☐ ☐ ☐
Authorized personnel / operators available. ☐ ☐ ☐
3. Method statement/Risk assessment in place. ☐ ☐ ☐
Adjacent live areas protected. ☐ ☐ ☐
4. Safety Barriers in place and safety signage Displayed. ☐ ☐ ☐
PPE available, high voltage rubber gloves, Safety goggles and floor mat. ☐ ☐ ☐
5. Working area is well lighted. ☐ ☐ ☐
Isolation/Lock-out in place. ☐ ☐ ☐
6. Electrical instruments are available for any Purpose. ☐ ☐ ☐
Electrical circuits “proved” by calibrated Instrument and found out to be no power. ☐ ☐ ☐
7. Correct PPE available, high voltage rubber Gloves, safety goggles and floor mat. ☐ ☐ ☐
Unauthorized workers are cleared from the Area. ☐ ☐ ☐
8. Approved WIR for installation, testing and Termination are attached to the permit. ☐ ☐ ☐
Standby operatives in the event of contact With live circuits. ☐ ☐ ☐
9. Emergency light (Flashlight) available. ☐ ☐ ☐
Emergency light (Flashlight) available. ☐ ☐ ☐
10. Is live work absolutely necessary? ☐ ☐ ☐
Emergency response plan available ☐ ☐ ☐
11. Unauthorized workers are cleared from the area.
☐ ☐ ☐
Other ( Specify): ☒ ☐ ☐
12. Power cable route from panel board to plant & equipment has been checked ☐ ☐ ☐
13 Emergency response plan available ☐ ☐ ☐
14 Other ( Specify): ☐ ☐ ☐
4. Acknowledgement by Initiator and Evaluator:
☐ Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives, and I consider them competent to do it safely.
Initiator/Originator Name: Designation:
Signature: Date /Time:
☐ Acknowledge that I have checked above control measures and consider the work area safe to carry out the activity
Evaluator (HSE Team): Designation:
Signature: Date /Time
Comments (if any):
5. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
6. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I have checked the area and been restored to a safe and orderly condition.
Evaluator Signature: Time:
MOBILE PLANT REGISTER Form # HSEQ - MPR Rev 3.docx
Project Information
Project Name:
Date: Location:
Sr. Equipment type / Name Registration No & Exp Date Company Name
Operator Name / Mb. No Operator Third party competency certificate expiry date Operator License expiry date Equipment & Plant 3rd Party Inspection Certificate expiry date SWL / Capacity Signalman /Rigger name & TPC Exp Comment
1
2
3
4
5
6
7
8
9
10.
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge: Signature:
LABOR ACCOMMODATION CHECKLIST Form # HSEQ - LAC Rev 2.docx
This 5-page document is a checklist for inspecting labour accommodation on a weekly basis. It contains over 100 questions across various categories including access/egress, housekeeping, septic tanks, food preparation, living quarters, firefighting, emergency procedures, first aid, record keeping, environment, and civil defence requirements. Inspectors are to verify that accommodation meets standards for safety, sanitation, emergency preparedness and regulatory compliance by completing the checklist and noting any needed corrective actions or due dates.
INCIDENT INVESTIGATION REPORT Form # HSEQ - IIR Rev 9 -.docx
INCIDENT INVESTIGATION REPORT
(To be submitted to the HSEQ Corporate Office within 7 days of incident.)
1. Project Information:
Project Name: Click here to enter text.
Report No.: Click here to enter text.
Project Location: Click here to enter text.
Property No.: Click here to enter text.
☐ Fatality ☐ Major Incident ☐ Minor Incident
2. Describe the Incident in detail:
Answer who, what, why, where, when & how in this section: (Attach additional pages if required)
Click here to enter text.
☐ Photos Attached
3. Incident Root Causes:
Describe direct, indirect & root cause: (Attach additional pages if required)
Click here to enter text.
4. Key Corrective Actions to Prevent Recurrence:
Describe the corrective actions with timeframe: (Attach additional pages if required)
Click here to enter text.
5. Key Corrections Taken Immediately after the Incident:
Attach additional pages if more space is required:
Click here to enter text.
6. Witnesses:
I declare that I witnessed the incident and the information provided above is true, correct and complete.
No. Name Designation Signature Date
1. Click here to enter text.
Click here to enter text.
Click here to enter text.
2. Click here to enter text.
Click here to enter text.
Click here to enter text.
7. Incident Information:
Initial Incident Report No.: Click here to enter text.
Date Reported: Click here to enter text.
Date of Incident: Click here to enter text.
Time of Incident: Click here to enter text.
Type of Incident: ☐ Near Miss
☐ Major Environmental Incident
☐ Serious Dangerous Occurrence
☐ Equipment / Property Damage
☐ Medical Treatment Case (MTC)
☐ Restricted Work Case (RWC)
☐ Lost Workday Case (LWC)
☐ Serious Occupational Illness/Disease
☐ Class 1 Injuries
☐ Permanent Partial Disability (PPD)
☐ Permanent Total Disability (PTD)
☐ Fatality (F)
Recordkeeping: ☐ Reportable ☐ Recordable
Incident Location on Site: Click here to enter text.
Applicable Reports: ☐ Police
☐ Medical
☐ Other (Specify)
Click here to enter text.
Attached: ☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
8. Injured Person’s Personal Details:
In case of an incident with more than one injured person, complete the information for each person using separate forms.
Name: Click here to enter text.
Occupation: Click here to enter text.
Company: Click here to enter text.
MB / Oracle No.: Click here to enter text.
Nationality: Click here to enter text.
Date of Birth: Click here to enter text.
Passport Number: Click here to enter text.
Length of Service: Click here to enter text.
Gender: ☐ Male ☐ Female
Labour Card No.: Click here to enter text.
9. Incident Causes Details: To be supported with factual evidence
Immediate Cause
(Unsafe Acts) ☐ Failure to secure
☐ Failure to warn
☐ Removing / Defeating Safety Devices
☐
HSE INDUCTION Form # HSEQ - HSEI Rev 2 -.doc
HSE INDUCTION
(Workers)
Name: _________________________________ Trade: ____________________________
M.B. No./Company Name : ________________
Date of Joining: __________________________
SL. N SUBJECT ON INDUCTION PREVIOUS SAFETY EXPOSURE FURTHER SAFETY TRAINING NEED ANALYSIS
1. Introduction Safety Requirements
2. Working Safety is of Primary Importance
3. General Safety Rules
4. Basic Safety Requirements
5. House Keeping
6. Health, Hygiene & Welfare Facilities
7. Fire Extinguisher / Fire Fighting
8. Emergency Procedure
9. Safety Violations & Penalty
10. Safety Award
11. Manual Handling
Induction Given By: Name: ___________________________
Designation: ___________________________
HSE WARNING LETTER-DISCIPLINARY NOTICE Form # HSEQ - HSEWL Rev 6.doc
1st Warning 0 Ref. No. ______________
2nd Warning 0
3rd Warning 0
4th Warning 0 Date: ________________
Employee’s Name : ______________________________________ M.B No. : __________
Occupation : _____________________________________________________________________
Location / Project Site: _____________________________________________________________________
You have committed the following HSE violation/s:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….….
The employee is hereby warned that if the violation is repeated further disciplinary action can be
taken as per the company Code of Conduct.
ORIGINATOR APPROVED BY (MANAGER IN CHARGE / ARABTEC HSEQ & ORG. RISK Manager)
Name: _______________________________ Name: _____________________________
Designation: _______________________________ Designation: _____________________________
Signature:
_______________________________ Signature:
_____________________________
Employee Acknowledgement:
I the undersigned have received this Safety warning letter / disciplinary notice and I admit that I have understood the contents.
0 Received on: ………………………….. (Date) Signature: ………………………………..…..
OFFICE PORTA CABIN INSPECTION Form # HSEQ - OPC Rev 2.docx
Project Information
Project Name: Porta Cabin No:
Location: Contact Person:
Company Name: Date :
Sr. Description Yes No N/A Comments
1. Emergency exit signs are available in right locations
2. Fire alarms and fire extinguishers are visible and accessible.
3. Fire doors (e.g. in stairways) are kept closed unless equipped with automatic closing device
4. Fire extinguishers are serviced regularly
5. Corridors and stairways are kept free of obstruction
6. Fire escape/ evacuation plan available and posted
7. First aid box available
8. Floor surfaces are kept dry and free of slip hazards
9. Electrical cords and plugs are in good condition with proper Grounding
10. Kitchen equipment checked
11. Fire blanket available in the pantry
12. Heat detector available in the pantry
13. Toilets floor clean and dry
14. Are staff trained to use Fire Extinguishers
15. Hand wash/ soap solution available in the toilet
16. Civil Defense or Authority approval
17. Others if any:
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
MEDICAL REPORT FORM Form # HSEQ - MRF Rev 3 -.docx
MEDICAL REPORT FORM
Day _____________
Date ____________
Time ____________
To: _________________________________________________________________________________________________________
Dear Sir,
We would kindly request you to give necessary treatment to our following employee who had met with an accident and provide us with your diagnosis.
Name of injured __________________________________________________________ Age ( ) years.
Occupation __________________________________________________________ M.B. No. _______________________________
Date of Accident ____________________________________________ Time of Accident __________________________________
Place of Accident (Project Name) _______________________________ Location _________________________________________
Nature of Accident ____________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
First Aider Name: ________________________________ SE Manager/Incharge: ________________________________
Signature: ________________________________ Signature: ________________________________
(If Medical Certificate is attached, this portion is not required.)
MEDICAL REPORT
Nature and extent of Accident / Injury____________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Fit for duty___________________________________________________________________________________________________
Unfit for duty_________________________________________________________________________________________________
Remarks_____________________________________________________________________________________________________
____________________________________________________________________________________________________________
Signature of Medical Officer Date _______________
LIFTING TACKLE VISUAL INSPECTION & REGISTER Form # HSEQ - LTVIR Rev 3.docx
Project Information
Project Name:
Company Name: Date :
ID NO TYPE OF LIFTING GEARS LOCATION VISUAL INSPECTION THIRD PARTY INSPECTION VALID TILL MONTHLY COLOUR CODE
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
☐ OK ☐ Not OK
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
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