LADDER PERMIT REV 1 MARCH 28 2018 Form # HSEQ - LP Rev 2.docx
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LADDER PERMIT DAILY ONE TIME -ONE TASK USE 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: Area / Location of ladder use: Type of ladder requested Ladder: _______ Length: _______ Step Ladder: _______ Height: ______ Please state why the use of ladder is the ONLY means to perform the task and the use of Mobile Elevated Work Platforms, Scaffolds are IMPOSSIBLE to use. ☐ PERMIT REFUSED, USE OTHER MEANS ☐ SPECIAL DISPENSATION GIVEN IN THIS INSTANCE ☐I have discussed the task with the Arabtec engineer/supervisor ☐ or, I have visited the area ☐ or, I have studied the drawings ☐ or, I understand the task to be performed I hereby confirm that in my professional judgement that there is no other possible means to carry out the task and that the risk in the use of a ladder has been assessed, and with the control measures in place the risk level is deemed acceptable 3. HSE’S DETERMINATION Name Sign: Date: Permit Validity: Time (from): _______Hrs. Time (To): ________Hrs. Date: Serial No. of Ladder: 3. Supervision Details: (To be filled by initiator/originator) Site Engineer responsible for the activity: Contact: Supervisor responsible for the activity: Contact: 4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator) Checks Yes-No-NA Checks Yes-No-NA Risk assessment/ method statement developed, approved and communicated ☐ ☐ ☐ Area where ladder is being used is not close to edge and appropriate fall prevention measures are in place ☐ ☐ ☐ Ladder inspection has been done and an inspection tag is available with clear identification number of the ladder ☐ ☐ ☐ Emergency evacuation procedures communicated to all workers ☒ ☐ ☐ Ladder is being set on a flat, stable surface and secured ☐ ☐ ☐ Can 3 point of contact b maintained? If not, can a harness be worn and anchored to a secure point above shoulder height? ☐ ☐ ☐ Tool Box Talk conducted ☐ ☐ ☐ Others (specify): ☐ ☐ ☐ A second person is available at all times to hold/secure the ladder ☐ ☐ ☐ ☐ ☐ ☐ Area is barricaded and signage are posted ☐ ☐ ☐ ☐ ☐ ☐ Ladder safety devices like leg levelers, anti-slip gutter guards and stabilizers are in place and in good condition ☐ ☐ ☐ ☐ ☐ ☐ 5. 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 use ladder 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 using lad
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WORK AT HEIGHT PERMIT Form # HSEQ - WHP Rev.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:
Type :
Work at height without guardrails
Work at height on fragile surfaces
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator) Yes-No-NA
Method Statement and Risk Assessment developed, approved and communicated? ☐ ☐ ☐
Area barricaded & proper signage are posted? ☐ ☐ ☐
Qualified and briefed workers? ☐ ☐ ☐
PPE of workers available & inspected as per MS/RA? ☐ ☐ ☐
Tools/Equipment inspected? ☐ ☐ ☐
Safe means of access/ Egress? ☐ ☐ ☐
Lifeline available and inspected? ☐ ☐ ☐
Fragile surface covered / work surface protected? ☐ ☐ ☐
Dimensions of platform and restrain lanyard match safety requirement? ☐ ☐ ☐
Harness with double lanyard provided and its use briefed to workforce? ☐ ☐ ☐
Harness anchorage point checked? ☐ ☐ ☐
Load bearing capacity of anchoring point checked? ☐ ☐ ☐
Load bearing capacity of fragile service checked? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Others ( 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:
HOT WORK PERMIT Form # HSEQ - HWP Rev 7 -.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. Hot Work Details: (To be filled by initiator/originator)
Hot Work Operator Contact:
Fire Watcher Contact:
Type of Hot Work: ☐ Welding
☐ Oxy Acetylene ☐ Electric Arc
☐ Gas Cutting
☐ Oxy Acetylene ☐ LPG
☐ Grinding :
☐ Disc Cutting:
☐ Other:
Fire Fighting Equipment Required: ☐ Fire Extinguisher:
☐ Hose Reel:
☐ Fire Blanket:
☐ Water:
☐ Sand:
☐ Other(s):
Specific PPEs Required: ☐ Hearing Protection:
☐ Ear Plug ☐ Ear Muff
☐ Face Shield/ Visor:
☐ Welding Suit:
☐ Gloves (Type):
☐ Dark welding goggles with appropriate lens number: ____________ ☐ Mask
☐ Dust ☐ Chemical ☐ Respirator
☐ Safety Boots:
☐ Full Body Harness:
☐ Apron:
☐ Others: __________________
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Arc welding machine is in good condition ☐ ☐ ☐
Operator is competent and certified ☐ ☐ ☐
welding cable, connector, clamp and rod holder are in good condition ☐ ☐ ☐
Stand-by fire watcher is trained & competent ☐ ☐ ☐
Cutting/Grinding machine discs fitted with guards ☐ ☐ ☐
Area immediately below the wok spot is cleared from all Combustible materials ☐ ☐ ☐
Power tools monthly inspection done and color coded ☐ ☐ ☐
All flammable materials/chemical cleared from the hot work area ☐ ☐ ☐
Power tools accessories available & in good condition (key, extension cord, sockets etc.) ☐ ☐ ☐
Firefighting equipment available at welding area ☐ ☐ ☐
Environmental aspect, impacts and control measures are in place ☐ ☐ ☐
Tin sheet/Fire blanket are provided to prevent sparks from spreading ☐ ☐ ☐
Provision of vigilance supervision ☐ ☐ ☐
Welding Area screening done to prevent UV rays ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Flask back arrester installed to the gas cylinders ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Gas cylinders and fittings are free from cracks, grease etc. ☐ ☐ ☐
Is confined space PTW required & obtained? ☐ ☐ ☐
Gas cylinders are kept upright and secured ☐ ☐ ☐
Other(s) if Any
☐ ☐ ☐
5. 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
EXCAVATION PERMIT Form # HSEQ - EP Rev 3.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. Excavation Details: (To be filled by initiator/originator)
Location of Excavation:
Click here to enter text.
Excavation Dimensions:
☐ Depth: Enter Depth
☐ Width: Enter Width
☐ Length: Enter Length
☐ Other(s): Enter Others
Type of Excavation: ☐ Ditches
☐ Trenches
☐ Shafts
☐ Tunneling (drilling /Boring)
☐ Well
☐ Post Driving
☐ Other(s): Enter Others
Excavation Tools/ Equipment ☐ Hand Shovel
☐ Pickaxe
☐ Excavator
☐ Shovel
☐ Skid steer Loader
☐ Backhoe Loader
☐ Other(s): Enter Others
Identified Underground Service(s): ☐ Electrical
☐ Sewer/ Water
☐ Drainage
☐ Communication/Data
☐ Gas
☐ Other(s): Enter Others
Underground Condition(s): ☐ Water Table, Depth: Enter Depth
☐ Tanks
☐ Vaults
☐ Wells
☐ Void & structure
☐ Chemicals
☐ Volatile Fuels
☐ Toxic Gases
☐ Other(s): Enter Others
Excavation Protection(s) By: ☐ Slope, (in degrees from horizontal) Enter Angle as per soil condition
☐ Benching
☐ Sheet, Waling, Strutting
☐ Soldier piling
☐ Void & structure
☐ Proprietary support system
☐ Other(s): Enter Others
Notification(s) given to( If Required): ☐ Relevant Authorities: Click here to enter text.
☐ Utility Service Provider(s): Click here to enter text.
☐ Owner Of Adjoining Properties :
☐ Other(s): Click here to enter text.
4. Control Measures: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Applicable NOCs available ☐ ☐ ☐
Safe means of access/egress provided ☐ ☐ ☐
Method statement & Risk assessment developed, approved & communicated? ☐ ☐ ☐
Ladder are secured, fixed & maintained ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Workplace appropriately illuminated ☐ ☐ ☐
Site is surveyed correctly, marked and identified ☐ ☐ ☐
Ventilation means are available ☐ ☐ ☐
All underground services checked & validated ☐ ☐ ☐
Proper signage are posted ☐ ☐ ☐
Certified cable detector used to verify above ☐ ☐ ☐
Adequate barricade to prevent fall of person/vehicle ☐ ☐ ☐
Ground conditions are examined with bore/trial pit ☐ ☐ ☐
Flash light are fixed on the barricades ☐ ☐ ☐
Water table is located ☐ ☐ ☐
Trained flagman deputed to caution traffic ☐ ☐ ☐
Adjacent properties/services exist? Inspected? ☐ ☐ ☐
Adequate traffic diversion is provided ☐ ☐ ☐
Stability of adjacent property structure ensured/secured ☐ ☐ ☐
Trained banksman available for plants ☐ ☐ ☐
Adequate arrangement to prevent Cave-in ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
Dewatering arrangem
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:
PORTABLE TOOLS CHECKLIST Form # HSEQ - PTC Rev 2 -.docx
Project Information
Project Name:
Location:
Company Name: Date :
Sl. No Description Yes No N/A Comments
General
1. Power cables present no hazard or obstruction. Connections are appropriate, earthed and provided with fuse.
2. User competent and authorized
3. Guard is fitted, adjusted and tool in good condition.
4. Emergency stop is available and operational.
5. Manufacturer instructions available and followed.
Pneumatic Tools
6. All hoses, couplings and fittings of correct rating.
7. Hoses, couplings and fittings inspected and maintained regularly.
8. Whip arrestor are placed to hoses.
9. Air supply lines protected from damage, maintained and inspected regularly.
10. Safety devices are provided for air hose with large diameter.
11. Manufacturer instruction is available and followed.
Manual un powered Tools
12. Tools checked and inspected before use
13. Right tool for the right job, no improvised tool
14. Others specify
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
LIFE LINE INSPECTION RECORD Form # HSEQ - LLIR Rev 2.docx
Project Information
Project Name: Level/ Floor:
Location: Grid line:
Company name : Date:
Life line check point Line No. Line No. Line No. Line No:
Life line to be installed by competent erector and inspected prior use
Wire rope free from damage / broken wires
Minimum 12 mm diameter wire rope with breaking strength of 89 kN
Wire rope not corroded/ rusted
No kinks available
No reduction in diameter
No birdcage available
Both vertical pipes at ends provided at diagonal bracing
Platform secured with ladders
3 bull dog clips provided at end joints and properly clamped
No joints available in life line
No deformity on formwork scaffold
Safe Distance between two life lines is maintained.
Away from electrical lines
Valid third party certificate available for installed lifeline
Others ( Specify)
Remarks:
This checklist to be completed for both Shift
Inspector Name: Signature:
Reviewed By HSE Manager / In charge Signature:
Height work permit
This document is a work permit for working at heights or on fragile roofs. It provides details of the location and duration of work, as well as a list of safety requirements that must be met like using harnesses, ladders, lighting, and having standby attendants. The contractor supervisor and an STL engineer must both sign off to approve the permit and safety plans, and again when closing out the permit to confirm the site is safe.
LIFTING WORK PERMIT Form # HSEQ - LWP 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:
Weight of Load : Max Height of Lift:
Max. Radius of Lift: Lifting Equipment ID/Registration No.:
Crane Capacity (SWL) Lift shall not be carried out if the load chart capacity exceeds 80% (Capacity …………)
Lifting Point Defined: ☐ Yes ☐ No
Road Closure/ Isolation required: ☐ Yes ☐ No
Underground services identified (if applicable):
☐ Yes ☐ No
Load Centre of Gravity Calculated: ☐ Yes ☐ No
3. Lifting Operation Details: (To be filled by initiator/originator)
Crane Operator Contact:
Rigger-1 Contact:
Rigger-2 Contact:
Type of Lifting Crane: ☐ Mobile Crane
☐ Wheel crane ☐ Crawler Crane
☐ All Terrain
☐ Loader/Hiab Crane
☐ Excavator
☐ Elevated working Platform
☐ Mobile Concrete Pump
☐ All Winch
☐ Other :
Lifting Crane Specification: ☐ Year of make (<25 years): __________
☐ Lifting Capacity: __________
☐ No. of rope fall wraps: ___________
☐ SWL: ______________
☐ Boom Reach: __________
☐ Fly Jib Reach: ___________
☐ Other(s): _____________
Type of lifting Gear(s): ☐ Chain Sling,
No. Of Legs: ___________
Each Leg Capacity: ____________
SWL: ______________
☐ Webbing Sling, SWL: ____________
☐ Wire Rope, SWL: _____________
☐ Lifting Beam, SWL: ___________
☐ Shackle, SWL: _____________
☐ Chain Blocks, SWL: ____________
☐ Hook with latch, SWL: ___________
☐ Eye Bolt/Nut, SWL: ____________
☐ Other(s): _________________
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement and Lifting Plan developed, approved and communicated? ☐ ☐ ☐
Crane outriggers fully extended and spreading pads in place ☐ ☐ ☐
Operatives are consulted and trained? ☐ ☐ ☐
All wheels are off the ground. ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
SWL and radius indicators in working order with visual and audible warning ☐ ☐ ☐
Has the crane valid certification ☐ ☐ ☐
Wind indicator is fitted & in working order ☐ ☐ ☐
Has the lifting gears valid certification ☐ ☐ ☐
load(s) slung correctly by a competent rigger ☐ ☐ ☐
Riggers/slinger competent and certified ☐ ☐ ☐
Tag-line(s) are connected with the load ☐ ☐ ☐
Correct crane selected for the load(s) and radius ☐ ☐ ☐
Suspended Load slewing path is cleared from people and barricaded ☐ ☐ ☐
Ground suitable, even, firm and prepared ☐ ☐ ☐
Destination of load(s) is cleared and prepared sufficiently ☐ ☐ ☐
Safe means of access/egress provided
Recommended
WORK AT HEIGHT PERMIT Form # HSEQ - WHP Rev.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:
Type :
Work at height without guardrails
Work at height on fragile surfaces
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator) Yes-No-NA
Method Statement and Risk Assessment developed, approved and communicated? ☐ ☐ ☐
Area barricaded & proper signage are posted? ☐ ☐ ☐
Qualified and briefed workers? ☐ ☐ ☐
PPE of workers available & inspected as per MS/RA? ☐ ☐ ☐
Tools/Equipment inspected? ☐ ☐ ☐
Safe means of access/ Egress? ☐ ☐ ☐
Lifeline available and inspected? ☐ ☐ ☐
Fragile surface covered / work surface protected? ☐ ☐ ☐
Dimensions of platform and restrain lanyard match safety requirement? ☐ ☐ ☐
Harness with double lanyard provided and its use briefed to workforce? ☐ ☐ ☐
Harness anchorage point checked? ☐ ☐ ☐
Load bearing capacity of anchoring point checked? ☐ ☐ ☐
Load bearing capacity of fragile service checked? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Others ( 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:
HOT WORK PERMIT Form # HSEQ - HWP Rev 7 -.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. Hot Work Details: (To be filled by initiator/originator)
Hot Work Operator Contact:
Fire Watcher Contact:
Type of Hot Work: ☐ Welding
☐ Oxy Acetylene ☐ Electric Arc
☐ Gas Cutting
☐ Oxy Acetylene ☐ LPG
☐ Grinding :
☐ Disc Cutting:
☐ Other:
Fire Fighting Equipment Required: ☐ Fire Extinguisher:
☐ Hose Reel:
☐ Fire Blanket:
☐ Water:
☐ Sand:
☐ Other(s):
Specific PPEs Required: ☐ Hearing Protection:
☐ Ear Plug ☐ Ear Muff
☐ Face Shield/ Visor:
☐ Welding Suit:
☐ Gloves (Type):
☐ Dark welding goggles with appropriate lens number: ____________ ☐ Mask
☐ Dust ☐ Chemical ☐ Respirator
☐ Safety Boots:
☐ Full Body Harness:
☐ Apron:
☐ Others: __________________
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Arc welding machine is in good condition ☐ ☐ ☐
Operator is competent and certified ☐ ☐ ☐
welding cable, connector, clamp and rod holder are in good condition ☐ ☐ ☐
Stand-by fire watcher is trained & competent ☐ ☐ ☐
Cutting/Grinding machine discs fitted with guards ☐ ☐ ☐
Area immediately below the wok spot is cleared from all Combustible materials ☐ ☐ ☐
Power tools monthly inspection done and color coded ☐ ☐ ☐
All flammable materials/chemical cleared from the hot work area ☐ ☐ ☐
Power tools accessories available & in good condition (key, extension cord, sockets etc.) ☐ ☐ ☐
Firefighting equipment available at welding area ☐ ☐ ☐
Environmental aspect, impacts and control measures are in place ☐ ☐ ☐
Tin sheet/Fire blanket are provided to prevent sparks from spreading ☐ ☐ ☐
Provision of vigilance supervision ☐ ☐ ☐
Welding Area screening done to prevent UV rays ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Flask back arrester installed to the gas cylinders ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Gas cylinders and fittings are free from cracks, grease etc. ☐ ☐ ☐
Is confined space PTW required & obtained? ☐ ☐ ☐
Gas cylinders are kept upright and secured ☐ ☐ ☐
Other(s) if Any
☐ ☐ ☐
5. 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
EXCAVATION PERMIT Form # HSEQ - EP Rev 3.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. Excavation Details: (To be filled by initiator/originator)
Location of Excavation:
Click here to enter text.
Excavation Dimensions:
☐ Depth: Enter Depth
☐ Width: Enter Width
☐ Length: Enter Length
☐ Other(s): Enter Others
Type of Excavation: ☐ Ditches
☐ Trenches
☐ Shafts
☐ Tunneling (drilling /Boring)
☐ Well
☐ Post Driving
☐ Other(s): Enter Others
Excavation Tools/ Equipment ☐ Hand Shovel
☐ Pickaxe
☐ Excavator
☐ Shovel
☐ Skid steer Loader
☐ Backhoe Loader
☐ Other(s): Enter Others
Identified Underground Service(s): ☐ Electrical
☐ Sewer/ Water
☐ Drainage
☐ Communication/Data
☐ Gas
☐ Other(s): Enter Others
Underground Condition(s): ☐ Water Table, Depth: Enter Depth
☐ Tanks
☐ Vaults
☐ Wells
☐ Void & structure
☐ Chemicals
☐ Volatile Fuels
☐ Toxic Gases
☐ Other(s): Enter Others
Excavation Protection(s) By: ☐ Slope, (in degrees from horizontal) Enter Angle as per soil condition
☐ Benching
☐ Sheet, Waling, Strutting
☐ Soldier piling
☐ Void & structure
☐ Proprietary support system
☐ Other(s): Enter Others
Notification(s) given to( If Required): ☐ Relevant Authorities: Click here to enter text.
☐ Utility Service Provider(s): Click here to enter text.
☐ Owner Of Adjoining Properties :
☐ Other(s): Click here to enter text.
4. Control Measures: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Applicable NOCs available ☐ ☐ ☐
Safe means of access/egress provided ☐ ☐ ☐
Method statement & Risk assessment developed, approved & communicated? ☐ ☐ ☐
Ladder are secured, fixed & maintained ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Workplace appropriately illuminated ☐ ☐ ☐
Site is surveyed correctly, marked and identified ☐ ☐ ☐
Ventilation means are available ☐ ☐ ☐
All underground services checked & validated ☐ ☐ ☐
Proper signage are posted ☐ ☐ ☐
Certified cable detector used to verify above ☐ ☐ ☐
Adequate barricade to prevent fall of person/vehicle ☐ ☐ ☐
Ground conditions are examined with bore/trial pit ☐ ☐ ☐
Flash light are fixed on the barricades ☐ ☐ ☐
Water table is located ☐ ☐ ☐
Trained flagman deputed to caution traffic ☐ ☐ ☐
Adjacent properties/services exist? Inspected? ☐ ☐ ☐
Adequate traffic diversion is provided ☐ ☐ ☐
Stability of adjacent property structure ensured/secured ☐ ☐ ☐
Trained banksman available for plants ☐ ☐ ☐
Adequate arrangement to prevent Cave-in ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
Dewatering arrangem
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:
PORTABLE TOOLS CHECKLIST Form # HSEQ - PTC Rev 2 -.docx
Project Information
Project Name:
Location:
Company Name: Date :
Sl. No Description Yes No N/A Comments
General
1. Power cables present no hazard or obstruction. Connections are appropriate, earthed and provided with fuse.
2. User competent and authorized
3. Guard is fitted, adjusted and tool in good condition.
4. Emergency stop is available and operational.
5. Manufacturer instructions available and followed.
Pneumatic Tools
6. All hoses, couplings and fittings of correct rating.
7. Hoses, couplings and fittings inspected and maintained regularly.
8. Whip arrestor are placed to hoses.
9. Air supply lines protected from damage, maintained and inspected regularly.
10. Safety devices are provided for air hose with large diameter.
11. Manufacturer instruction is available and followed.
Manual un powered Tools
12. Tools checked and inspected before use
13. Right tool for the right job, no improvised tool
14. Others specify
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
LIFE LINE INSPECTION RECORD Form # HSEQ - LLIR Rev 2.docx
Project Information
Project Name: Level/ Floor:
Location: Grid line:
Company name : Date:
Life line check point Line No. Line No. Line No. Line No:
Life line to be installed by competent erector and inspected prior use
Wire rope free from damage / broken wires
Minimum 12 mm diameter wire rope with breaking strength of 89 kN
Wire rope not corroded/ rusted
No kinks available
No reduction in diameter
No birdcage available
Both vertical pipes at ends provided at diagonal bracing
Platform secured with ladders
3 bull dog clips provided at end joints and properly clamped
No joints available in life line
No deformity on formwork scaffold
Safe Distance between two life lines is maintained.
Away from electrical lines
Valid third party certificate available for installed lifeline
Others ( Specify)
Remarks:
This checklist to be completed for both Shift
Inspector Name: Signature:
Reviewed By HSE Manager / In charge Signature:
Height work permit
This document is a work permit for working at heights or on fragile roofs. It provides details of the location and duration of work, as well as a list of safety requirements that must be met like using harnesses, ladders, lighting, and having standby attendants. The contractor supervisor and an STL engineer must both sign off to approve the permit and safety plans, and again when closing out the permit to confirm the site is safe.
LIFTING WORK PERMIT Form # HSEQ - LWP 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:
Weight of Load : Max Height of Lift:
Max. Radius of Lift: Lifting Equipment ID/Registration No.:
Crane Capacity (SWL) Lift shall not be carried out if the load chart capacity exceeds 80% (Capacity …………)
Lifting Point Defined: ☐ Yes ☐ No
Road Closure/ Isolation required: ☐ Yes ☐ No
Underground services identified (if applicable):
☐ Yes ☐ No
Load Centre of Gravity Calculated: ☐ Yes ☐ No
3. Lifting Operation Details: (To be filled by initiator/originator)
Crane Operator Contact:
Rigger-1 Contact:
Rigger-2 Contact:
Type of Lifting Crane: ☐ Mobile Crane
☐ Wheel crane ☐ Crawler Crane
☐ All Terrain
☐ Loader/Hiab Crane
☐ Excavator
☐ Elevated working Platform
☐ Mobile Concrete Pump
☐ All Winch
☐ Other :
Lifting Crane Specification: ☐ Year of make (<25 years): __________
☐ Lifting Capacity: __________
☐ No. of rope fall wraps: ___________
☐ SWL: ______________
☐ Boom Reach: __________
☐ Fly Jib Reach: ___________
☐ Other(s): _____________
Type of lifting Gear(s): ☐ Chain Sling,
No. Of Legs: ___________
Each Leg Capacity: ____________
SWL: ______________
☐ Webbing Sling, SWL: ____________
☐ Wire Rope, SWL: _____________
☐ Lifting Beam, SWL: ___________
☐ Shackle, SWL: _____________
☐ Chain Blocks, SWL: ____________
☐ Hook with latch, SWL: ___________
☐ Eye Bolt/Nut, SWL: ____________
☐ Other(s): _________________
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement and Lifting Plan developed, approved and communicated? ☐ ☐ ☐
Crane outriggers fully extended and spreading pads in place ☐ ☐ ☐
Operatives are consulted and trained? ☐ ☐ ☐
All wheels are off the ground. ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
SWL and radius indicators in working order with visual and audible warning ☐ ☐ ☐
Has the crane valid certification ☐ ☐ ☐
Wind indicator is fitted & in working order ☐ ☐ ☐
Has the lifting gears valid certification ☐ ☐ ☐
load(s) slung correctly by a competent rigger ☐ ☐ ☐
Riggers/slinger competent and certified ☐ ☐ ☐
Tag-line(s) are connected with the load ☐ ☐ ☐
Correct crane selected for the load(s) and radius ☐ ☐ ☐
Suspended Load slewing path is cleared from people and barricaded ☐ ☐ ☐
Ground suitable, even, firm and prepared ☐ ☐ ☐
Destination of load(s) is cleared and prepared sufficiently ☐ ☐ ☐
Safe means of access/egress provided
CONFINED SPACE ENTRY PERMIT Form # HSEQ - CSE Rev 3.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 is not extendable)
Description of Task:
Detail of Surroundings:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement and Risk assessment developed, approved and communicated? ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Means of communication available? ☐ ☐ ☐
Proper signage are posted? ☐ ☐ ☐
Workplace appropriately illuminated? ☐ ☐ ☐
Electrical equipment & connections safe? ☐ ☐ ☐
Ventilation means are available & used before entry? ☐ ☐ ☐
Gases/ hazardous material Isolation is done (LOTO)? ☐ ☐ ☐
Will ventilation be continued during work? (LEV) ☐ ☐ ☐
Mechanical & electrical equipment isolation done (LOTO)? ☐ ☐ ☐
Harness/lifeline/ mechanical retrieval system (tripod) available? ☐ ☐ ☐
Will any other equipment be used/ running in the space? ☐ ☐ ☐
SCBA is maintained & available? ☐ ☐ ☐
Will any chemical be used in the space? ☐ ☐ ☐
Trained stand-by man available? ☐ ☐ ☐
Was the space been found unacceptable? ☐ ☐ ☐
Others( Specify) ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
☐ ☐ ☐
4. Trained Authorized Individuals: (To be filled by initiator/originator)
Entry Supervisor:
Stand-by Man:
First Aider(s)
Rescuer: 1. 2.
Authorized Entrants: 1. 2.
3. 4.
Equipment/ Materials details to be used
Details of Chemicals to be used (MSDS attached)
5. Atmospheric Conditions: (To be tested by authorized tester)
Authorized Tester(s):
Time O2 LEL H2S CO Heat (C) Other
Pre-entry 1. O2 – 19.5% to 23.5%
2. LEL – less than 10%
3. H2S – below 10 ppm
4. CO – PEL-below 35 ppm
Pre-entry after Vent
During Work
Others
Others
6. 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) :
7. Authorization (PM/CM):
Name: Designation:
Signature: Time:
8. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I
PRESSURE TESTING PERMIT Form # HSEQ - PTP 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 TEST AND IS NOT EXTENDABLE
Description of Task:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
Design Pressure of Pipeline: Operating Pressure:
Testing Pressure: Pressure Time:
3. Pressure Testing Details: (To be filled by initiator/originator)
Type of Work Request ☐ Hydrostatic
☐ Pneumatic
☐ Gravity Testing
☐ Other :
Type of Equipment testing: ☐ Pipeline
☐ GRP ☐ AC ☐ others:
☐ Tanks
☐ Hose
☐ Other(s)
Dimensions: Pipeline/Tank/Hose
☐ Diameter:
☐ Thickness:
☐ Length:
☐ Other(s):
Attachment(s): ☐ Plan
☐ Sketch
☐ Drawing (approved)
☐ Method Statement & Risk Assessment
☐ Authority Approvals (NOCs)
☐ Road Traffic Approval (if applicable)
☐ Other(s)
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Is the segment of pipeline under testing isolated from service by closing nearest valves? ☐ ☐ ☐
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Is the Liquid/Gas vented/removed from the pipeline? ☐ ☐ ☐
Testing & monitoring of the environment prior to entry? ☐ ☐ ☐
Test Head and End plug/end point are properly sealed/secured/tighten. ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Is Air vented completely by pumping and filling the water in the testing segment pipeline without pressurizing? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Pressure testing equipment in good condition with available safe guards ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
Flexible pipe/hose are in good condition and connections are safely clamped ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Pressure testing gauge have valid calibration. ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Pressure testing gauge/ valve are in safe & accessible place outside restricted/isolated area ☐ ☐ ☐
Means of communication available? ☐ ☐ ☐
Is the testing pipeline/vessel/tank are properly isolated ☐ ☐ ☐
Electrical equipment & connections safe? ☐ ☐ ☐
Is confined space PTW required & obtained? ☐ ☐ ☐
Other(s) ☐ ☐ ☐
5. 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):
6. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
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;
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:
8 lifting operations with mobile crane risk assessment templates
8 Lifting Operations with mobile crane Risk Assessment Templates
Crane checks on arrival to site
PRIOR TO USE
Access of crane to work areas
Siting and setting up of crane
Lifting of equipment and material
(Mobile crane Operator)
Crane supervision
Crane Maintenance
(revised 06-06-2018)
RA for Hot works at MOE-Ghim Moh (Ceiling support works).pdf
This document is an activity-based risk assessment form for hot works (ceiling support works) being conducted at the MOE at Ghim Moh project by Create Logic Pte Ltd. It identifies 5 major hazards - improper manual handling, hot works causing fires/explosions, arc welding electrocutions and fires, gas cutting and arc welding fires, and trip and fall hazards from gas hoses and cables. For each hazard, it evaluates the existing and additional risk controls and assigns risk probability numbers. It also provides a risk level matrix to define acceptable risk levels and recommended actions.
23 casting of concrete slabs risk assessment templates
Concrete Pump checks on arrival to site
PRIOR TO SITE ACCESS
Formwork for slab for temporary support
Falsework to provide temporary support to formwork
Rebar to slabs
Access of mobile pump and delivery trucks to work areas
Siting and setting up of concrete pump
Pumping concrete
(Pump Operator)
Pumping operation supervision
Dismantling of form-work
Striking of false-work
20 use of suspended access cradles and platforms (temporary works) risk asses...
20 use of suspended access cradles and platforms (temporary works) risk asses...Dwarika Bhushan Sharma
20 Use of Suspended Access cradles and Platforms (Temporary Works) Risk Assessment Templates
Cradle checks on arrival to site
PRIOR TO USE • Use of Access equipment • Failure due to use of un-certificated plant;
Pre-use checks of suspended access cradle or platform • Work at Height; • Collapse of cradle through damage or failure of equipment;
• Falling materials;
Cradle operation ; • Work at Height; • Fall from height;
• Material fall from height;
• Machine malfunction at height;
• Workers trapped at height;
SECURITY CHECKLIST Form # HSEQ - SC Rev 2 -.docx
Project Information
Project Name:
Location: Company Name:
Date: Time :
ITEMS TO BE CHECKED Yes No N/A Comments
1. Hoarding encloses all construction activities.
2. No unauthorised entry to the project
3. Hoarding secure and not damaged.
4. Hoarding not less than 2 meters high.
5. Hoarding inspected both inside and outside.
6. Hoarding support posts securely anchored.
7. Materials/rubble/litter along hoarding.
8. Surveillance of gates maintained while the area open.
9. Warning signs fixed to hoarding
10. Adequate lighting at gates/at boundary
11. Control movement of material in and out of the project
12. Safe access & good visibility for plant & vehicles entering and leaving site.
13. Pedestrians segregated from vehicle access ways
14. Reversing vehicles accompanied by banksmen
15. Condition of vehicle and pedestrian routes maintained
16. Warning signs posted e.g. maximum speed limit, traffic direction, pedestrian routes etc.
17. Bus drop off and pick up areas no risk to pedestrians
18. Housekeeping
19. No sleeping on the site except for rest area
20. Safe Stacking & Storage
21. Night shift: Lighting adequate
22. Security equipment: torches, radios etc. in place
23. Security hand over book completed, no deviations recorded in the Book
24. Others ( Specify)
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
HSE RISK ASSESSMENT Form # HSEQ - HSERA Rev 4 –.docx
Project Name: Ref. No.:
Operation / Tasks: Date:
SN Task/ Activity and Location Potential Hazards Potential Harms/ Damages Risk Rating Existing Control Measures Responsible
Party Additional Control Measure Residual Risk Risk Acceptable (Yes/No) Opportunity
Probability (P) Severity (S) Rating (P X S) (Refer to Hierarchy of Control) (P) (S) (R)
Notes:
(Legal Compliance)
Assessed by: Reviewed by: Approved by: Date of next review:
Name : Name : Name :
Designation: Designation : Designation :
Sign & Date : Sign & Date : Sign & Date :
RA- Pressure Testing Of Pipe Works
This document provides a risk assessment for hydro testing and pressure testing of pipe works conducted by Arabian Bemco Contracting Co. It identifies several hazards associated with the work including high pressure leaks, over pressure, slips trips and falls. For each hazard, it lists the persons at risk, initial risk rating, and proposed control measures to reduce the risk. The control measures include training, use of personal protective equipment, safety signage, permitting, and having emergency response measures in place.
25 Demolition of existing concrete structures Risk Assessment Templates.docx
The document provides a risk assessment for demolition of an existing concrete structure. It identifies hazards associated with the work, assesses the initial risk rating, and lists control measures to reduce the residual risks. Key steps of the work include plant checks, demolition of the structure using an excavator, supervision of demolition, breaking works manually using air hammers, and removal of waste. Hazards include plant/pedestrian interactions, unauthorized plant use, noise, exposed rebar, and contamination. Control measures require certification of plant and operators, designated traffic routes, flagmen, inspections, signage, and personal protective equipment.
Lifting plan template
This document provides a lifting plan, risk assessment, and method statement for lifting operations. It includes details of the load, cranes, lifting accessories, hazards identified, risk assessment, responsibilities of personnel, and acceptance signatures. The key details are the load weight and dimensions, crane models and capacities, identified hazards like overhead power lines, and the sequence of operations. Personnel roles like appointed person, slinger, and crane supervisor are defined. Weather limits and ground conditions are also addressed.
Crane Operation - Lifting
This document outlines safety precautions and procedures for crane operations. It establishes requirements for organizing a crane and rigging group with defined roles and responsibilities. It requires crane operators and signalmen to be qualified and trained. It specifies guidelines for crane set up and operation including following approved lift plans, permit requirements, and stopping work if unsafe conditions arise. It defines critical lifts and provides examples. It lists safety precautions for crane and rigging equipment inspections, defects, capacity markings, and color coding for monthly inspections.
DE-SHUTTERING WORK PERMIT Form # HSEQ - DSWP 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, Grid Line & Floor / Level:
No of persons working :
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement and Risk assessment developed, approved and communicated? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Engage competent Scaffold erector and Carpenters for the de-shuttering task? ☐ ☐ ☐
All nails shall be removed from formwork materials upon dismantling or at least it shall be bent with hammer to avoid pricks? ☐ ☐ ☐
Pre-start briefing shall be done on daily basis before starting the work in each shift? ☐ ☐ ☐
Protruding steels shall be protected by rebar cap or fabricated wood cap. Immediately relocate dismantled materials from the activity area? ☐ ☐ ☐
Ensure de-shuttering area is illuminated with task light? ☐ ☐ ☐
Do not leave any struck formwork materials hanging in concrete (i.e. plywood, wood). Peel off the duct tape used to cover the plywood gaps ☐ ☐ ☐
Do not throw form work materials from top to ground level? ☐ ☐ ☐
Do housekeeping every one hour. Stack the stripped off materials according to its size and type separately away from access routes and pedestrian walk ways ☐ ☐ ☐
Ensure two men handle each form work material to bring down safely and stack them safely? ☐ ☐ ☐
Ensure the availability and use of Safety Helmet, Hand gloves, clear eye protection, Safety Harness and ear plug. ☐ ☐ ☐
Ensure safety harness is hooked to the scaffold ledger above shoulder level while de-shuttering. ☐ ☐ ☐
Ensure Lifting plan implemented if any lifting activity for de-shuttering work. ☐ ☐ ☐
Ensure work platforms without openings and ensure proper access / egress. ☐ ☐ ☐
Restrict other unnecessary movements. Ensure de-shuttering area is barricaded with no entry warning signs? ☐ ☐ ☐
De-shuttering shall be done in same fashion as explained by form work designer and trained by respective section Engineer? ☐ ☐ ☐
Others( Specify) ☐ ☐ ☐
Dismantling of frames and support of formworks shall be from top to bottom provided with safe access & working platform? ☐ ☐ ☐
☐ ☐ ☐
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
27 Hydrostatic Pressure Testing inside buildings Risk Assessment Templates.docx
27 Hydrostatic Pressure Testing inside buildings Risk Assessment Templates.docxDwarika Bhushan Sharma
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Hydrostatic pressure testing of pipework inside buildings Relevant Applicable MAS:
• Additional Training required:
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
L C RR
1 Pressure testing equipment • Use at high pressure; • Rupture/failure of pump during testing;
• Valve/connection failure;
• Instrument failure resulting in system over-pressurization;
3 3 9 MED i. The supervisor in charge of the test shall ensure that all pressure testing gauges etc. are in good sound condition, undamaged, correctly dated with the current valid calibration and that appropriate calibration certificates are available;
ii. All pumps shall be in sound condition and complete with a valid test certificate. Any vulnerable items such as manometers and pressure switches shall be removed or isolated from the system prior to testing if not required;
iii. The test supervisor shall carry out a thorough inspection of the system before requesting the permit detailed above to ensure that all isolations, blanks and other specified safety devices are in place before testing commences; No test documentation available Quarantine equipment until valid documentation provided Low
2 Permit to work system • Interaction of personnel and high pressure system; • Injury due to uncontrolled testing;
• Injury due to failure to ensure adequate pre-checks undertaken; 3 4 12 HIGH i. All pressure testing operations shall require a Permit to Work to ensure that no pressure testing will be allowed to commence until all,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:
3 emergency management risk assessment templates
3 Emergency Management Risk Assessment Templates
Emergency Procedure
Access requirement for Emergency Vehicles
• Police;
• Civil Defense;
• Ambulance;
(Including as per 2017 Fire Life Safety COP Requirements)
Reverse Parking of private vehicles office areas
Project Vehicle Parking
Project Emergency Site Exits
Project Emergency Communication
Project Assembly points
9 lifting operations with tower crane risk assessment templates
This risk assessment document identifies hazards associated with lifting operations using a tower crane on a construction site. It lists 6 specific tasks: 1) access of crane sections, 2) tower crane foundations, 3) siting, setting up and testing, 4) lifting of equipment and material, 5) tower crane supervision, and 6) jumping and dismantling the tower crane. For each task, potential hazards are identified and an initial risk rating is given. Control measures are then provided to reduce the risks, along with any additional measures. Residual risks after controls are also assessed. The goal is to ensure lifting operations are performed safely.
03-hira-for-welding-work-_compress.pdf
This document provides a hazard identification and risk assessment for welding work being conducted at a project site in Versova, Mumbai. It identifies several hazards associated with welding including electric shock, fire, health issues from fumes and sparks, and improper use of equipment. For each hazard, it evaluates the severity and likelihood of risks. It also identifies applicable legal requirements and provides control measures to reduce risks. Controls include inspection of equipment, use of protective gear like face shields, isolating work areas, training workers, and ensuring only authorized personnel conduct welding. The overall risk level is determined to be "acceptable and non-significant" when proper controls are implemented.
EDGE PROTECTION AND FLOOR OPENINGS REMOVAL PERMIT Form # HSEQ - EPRP Rev 2.docx
EDGE PROTECTION AND FLOOR OPENINGS REMOVAL PERMIT Form # HSEQ - EPRP Rev 2.docxDwarika Bhushan Sharma
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:
Area / Location of edge protection or floor openings:
Purpose of removing:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Availability of Fall protection arrangement (i.e. life line, etc.? ☐ ☐ ☐
Any high risk activity associated that requires PTW (i.e. hot work, Shaft Entry, CSE)? ☐ ☐ ☐
Adequate Lighting provided? ☐ ☐ ☐
Are all necessary Permit approved and displayed at work location? ☐ ☐ ☐
Availability of rescue procedure and equipment? ☐ ☐ ☐
Safe access / Working Platform provided? ☐ ☐ ☐
Mean of communication available? (Mobile, radio etc.) ☐ ☐ ☐
Availability of barricades/protection to prevent unauthorized or accidental entry? ☐ ☐ ☐
Helmet, Safety Shoes, Eye Protection, Hearing Protection and Cover All. ☐ ☐ ☐
Warning signs posted? ☐ ☐ ☐
Conduct Task Toolbox Talk prior to start the activity? ( TASK TBT TO BE ATTACHED) ☐ ☐ ☐
Exclusion zone for area below? ☐ ☐ ☐
Others (specify): ☐ ☐ ☐
Availability of Fall protection equipment (i.e. full body harness, etc.)? ☐ ☐ ☐
☐ ☐ ☐
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:
MAST CLIMBER & CRADLE PERMIT Form # HSEQ - 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:
Area / Location of Mast Climber or Cradle:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
Serial No. of Mast Climber or Cradle: No. of persons working on Mast Climber or Cradle:
Safe Working Load of Mast Climber or Cradle:
Other(s):
3. Mast Climber or Cradle Operators Details: (To be filled by initiator/originator)
Operator Contact:
Rigger-1 Contact:
Rigger-2 Contact:
Rigger-3 Contact:
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Area below mast climber or cradle free from personnel and barriers in place when working? ☐ ☐ ☐
Mast climber or cradle have a valid 3rd party certificate and displayed? ☐ ☐ ☐
All mast climber or cradle rigging points secure to building? ☐ ☐ ☐
Operator competent and certified? ☐ ☐ ☐
Are the mast climber or cradles brakes working? ☐ ☐ ☐
Wire ropes in good conditions? ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Counterweights sufficient and properly anchored/secured? ☐ ☐ ☐
Mast climber or cradle SWL displayed?
☐ ☐ ☐
Electrical wires are in good conditions and free from obstructions? ☐ ☐ ☐
Access and egress will be on ground level? ☐ ☐ ☐
Anchor point for safety harness available and in good condition? ☐ ☐ ☐
Rescue plan available and communicated? ☐ ☐ ☐
Personnel working in mast climber cradle wearing safety harness and clipped on? ☐ ☐ ☐
Others (specify): ☐ ☐ ☐
5. 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):
6. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
7. 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:
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CONFINED SPACE ENTRY PERMIT Form # HSEQ - CSE Rev 3.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 is not extendable)
Description of Task:
Detail of Surroundings:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement and Risk assessment developed, approved and communicated? ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Means of communication available? ☐ ☐ ☐
Proper signage are posted? ☐ ☐ ☐
Workplace appropriately illuminated? ☐ ☐ ☐
Electrical equipment & connections safe? ☐ ☐ ☐
Ventilation means are available & used before entry? ☐ ☐ ☐
Gases/ hazardous material Isolation is done (LOTO)? ☐ ☐ ☐
Will ventilation be continued during work? (LEV) ☐ ☐ ☐
Mechanical & electrical equipment isolation done (LOTO)? ☐ ☐ ☐
Harness/lifeline/ mechanical retrieval system (tripod) available? ☐ ☐ ☐
Will any other equipment be used/ running in the space? ☐ ☐ ☐
SCBA is maintained & available? ☐ ☐ ☐
Will any chemical be used in the space? ☐ ☐ ☐
Trained stand-by man available? ☐ ☐ ☐
Was the space been found unacceptable? ☐ ☐ ☐
Others( Specify) ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
☐ ☐ ☐
4. Trained Authorized Individuals: (To be filled by initiator/originator)
Entry Supervisor:
Stand-by Man:
First Aider(s)
Rescuer: 1. 2.
Authorized Entrants: 1. 2.
3. 4.
Equipment/ Materials details to be used
Details of Chemicals to be used (MSDS attached)
5. Atmospheric Conditions: (To be tested by authorized tester)
Authorized Tester(s):
Time O2 LEL H2S CO Heat (C) Other
Pre-entry 1. O2 – 19.5% to 23.5%
2. LEL – less than 10%
3. H2S – below 10 ppm
4. CO – PEL-below 35 ppm
Pre-entry after Vent
During Work
Others
Others
6. 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) :
7. Authorization (PM/CM):
Name: Designation:
Signature: Time:
8. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I
PRESSURE TESTING PERMIT Form # HSEQ - PTP 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 TEST AND IS NOT EXTENDABLE
Description of Task:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
Design Pressure of Pipeline: Operating Pressure:
Testing Pressure: Pressure Time:
3. Pressure Testing Details: (To be filled by initiator/originator)
Type of Work Request ☐ Hydrostatic
☐ Pneumatic
☐ Gravity Testing
☐ Other :
Type of Equipment testing: ☐ Pipeline
☐ GRP ☐ AC ☐ others:
☐ Tanks
☐ Hose
☐ Other(s)
Dimensions: Pipeline/Tank/Hose
☐ Diameter:
☐ Thickness:
☐ Length:
☐ Other(s):
Attachment(s): ☐ Plan
☐ Sketch
☐ Drawing (approved)
☐ Method Statement & Risk Assessment
☐ Authority Approvals (NOCs)
☐ Road Traffic Approval (if applicable)
☐ Other(s)
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Is the segment of pipeline under testing isolated from service by closing nearest valves? ☐ ☐ ☐
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Is the Liquid/Gas vented/removed from the pipeline? ☐ ☐ ☐
Testing & monitoring of the environment prior to entry? ☐ ☐ ☐
Test Head and End plug/end point are properly sealed/secured/tighten. ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Is Air vented completely by pumping and filling the water in the testing segment pipeline without pressurizing? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Pressure testing equipment in good condition with available safe guards ☐ ☐ ☐
Provision of vigilance supervision? ☐ ☐ ☐
Flexible pipe/hose are in good condition and connections are safely clamped ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Pressure testing gauge have valid calibration. ☐ ☐ ☐
Safe means of access/egress provided? ☐ ☐ ☐
Pressure testing gauge/ valve are in safe & accessible place outside restricted/isolated area ☐ ☐ ☐
Means of communication available? ☐ ☐ ☐
Is the testing pipeline/vessel/tank are properly isolated ☐ ☐ ☐
Electrical equipment & connections safe? ☐ ☐ ☐
Is confined space PTW required & obtained? ☐ ☐ ☐
Other(s) ☐ ☐ ☐
5. 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):
6. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
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;
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:
8 lifting operations with mobile crane risk assessment templates
8 Lifting Operations with mobile crane Risk Assessment Templates
Crane checks on arrival to site
PRIOR TO USE
Access of crane to work areas
Siting and setting up of crane
Lifting of equipment and material
(Mobile crane Operator)
Crane supervision
Crane Maintenance
(revised 06-06-2018)
RA for Hot works at MOE-Ghim Moh (Ceiling support works).pdf
This document is an activity-based risk assessment form for hot works (ceiling support works) being conducted at the MOE at Ghim Moh project by Create Logic Pte Ltd. It identifies 5 major hazards - improper manual handling, hot works causing fires/explosions, arc welding electrocutions and fires, gas cutting and arc welding fires, and trip and fall hazards from gas hoses and cables. For each hazard, it evaluates the existing and additional risk controls and assigns risk probability numbers. It also provides a risk level matrix to define acceptable risk levels and recommended actions.
23 casting of concrete slabs risk assessment templates
Concrete Pump checks on arrival to site
PRIOR TO SITE ACCESS
Formwork for slab for temporary support
Falsework to provide temporary support to formwork
Rebar to slabs
Access of mobile pump and delivery trucks to work areas
Siting and setting up of concrete pump
Pumping concrete
(Pump Operator)
Pumping operation supervision
Dismantling of form-work
Striking of false-work
20 use of suspended access cradles and platforms (temporary works) risk asses...
20 use of suspended access cradles and platforms (temporary works) risk asses...Dwarika Bhushan Sharma
20 Use of Suspended Access cradles and Platforms (Temporary Works) Risk Assessment Templates
Cradle checks on arrival to site
PRIOR TO USE • Use of Access equipment • Failure due to use of un-certificated plant;
Pre-use checks of suspended access cradle or platform • Work at Height; • Collapse of cradle through damage or failure of equipment;
• Falling materials;
Cradle operation ; • Work at Height; • Fall from height;
• Material fall from height;
• Machine malfunction at height;
• Workers trapped at height;
SECURITY CHECKLIST Form # HSEQ - SC Rev 2 -.docx
Project Information
Project Name:
Location: Company Name:
Date: Time :
ITEMS TO BE CHECKED Yes No N/A Comments
1. Hoarding encloses all construction activities.
2. No unauthorised entry to the project
3. Hoarding secure and not damaged.
4. Hoarding not less than 2 meters high.
5. Hoarding inspected both inside and outside.
6. Hoarding support posts securely anchored.
7. Materials/rubble/litter along hoarding.
8. Surveillance of gates maintained while the area open.
9. Warning signs fixed to hoarding
10. Adequate lighting at gates/at boundary
11. Control movement of material in and out of the project
12. Safe access & good visibility for plant & vehicles entering and leaving site.
13. Pedestrians segregated from vehicle access ways
14. Reversing vehicles accompanied by banksmen
15. Condition of vehicle and pedestrian routes maintained
16. Warning signs posted e.g. maximum speed limit, traffic direction, pedestrian routes etc.
17. Bus drop off and pick up areas no risk to pedestrians
18. Housekeeping
19. No sleeping on the site except for rest area
20. Safe Stacking & Storage
21. Night shift: Lighting adequate
22. Security equipment: torches, radios etc. in place
23. Security hand over book completed, no deviations recorded in the Book
24. Others ( Specify)
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
HSE RISK ASSESSMENT Form # HSEQ - HSERA Rev 4 –.docx
Project Name: Ref. No.:
Operation / Tasks: Date:
SN Task/ Activity and Location Potential Hazards Potential Harms/ Damages Risk Rating Existing Control Measures Responsible
Party Additional Control Measure Residual Risk Risk Acceptable (Yes/No) Opportunity
Probability (P) Severity (S) Rating (P X S) (Refer to Hierarchy of Control) (P) (S) (R)
Notes:
(Legal Compliance)
Assessed by: Reviewed by: Approved by: Date of next review:
Name : Name : Name :
Designation: Designation : Designation :
Sign & Date : Sign & Date : Sign & Date :
RA- Pressure Testing Of Pipe Works
This document provides a risk assessment for hydro testing and pressure testing of pipe works conducted by Arabian Bemco Contracting Co. It identifies several hazards associated with the work including high pressure leaks, over pressure, slips trips and falls. For each hazard, it lists the persons at risk, initial risk rating, and proposed control measures to reduce the risk. The control measures include training, use of personal protective equipment, safety signage, permitting, and having emergency response measures in place.
25 Demolition of existing concrete structures Risk Assessment Templates.docx
The document provides a risk assessment for demolition of an existing concrete structure. It identifies hazards associated with the work, assesses the initial risk rating, and lists control measures to reduce the residual risks. Key steps of the work include plant checks, demolition of the structure using an excavator, supervision of demolition, breaking works manually using air hammers, and removal of waste. Hazards include plant/pedestrian interactions, unauthorized plant use, noise, exposed rebar, and contamination. Control measures require certification of plant and operators, designated traffic routes, flagmen, inspections, signage, and personal protective equipment.
Lifting plan template
This document provides a lifting plan, risk assessment, and method statement for lifting operations. It includes details of the load, cranes, lifting accessories, hazards identified, risk assessment, responsibilities of personnel, and acceptance signatures. The key details are the load weight and dimensions, crane models and capacities, identified hazards like overhead power lines, and the sequence of operations. Personnel roles like appointed person, slinger, and crane supervisor are defined. Weather limits and ground conditions are also addressed.
Crane Operation - Lifting
This document outlines safety precautions and procedures for crane operations. It establishes requirements for organizing a crane and rigging group with defined roles and responsibilities. It requires crane operators and signalmen to be qualified and trained. It specifies guidelines for crane set up and operation including following approved lift plans, permit requirements, and stopping work if unsafe conditions arise. It defines critical lifts and provides examples. It lists safety precautions for crane and rigging equipment inspections, defects, capacity markings, and color coding for monthly inspections.
DE-SHUTTERING WORK PERMIT Form # HSEQ - DSWP 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, Grid Line & Floor / Level:
No of persons working :
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement and Risk assessment developed, approved and communicated? ☐ ☐ ☐
Emergency response procedure and rescue plan are developed & communicated? ☐ ☐ ☐
Engage competent Scaffold erector and Carpenters for the de-shuttering task? ☐ ☐ ☐
All nails shall be removed from formwork materials upon dismantling or at least it shall be bent with hammer to avoid pricks? ☐ ☐ ☐
Pre-start briefing shall be done on daily basis before starting the work in each shift? ☐ ☐ ☐
Protruding steels shall be protected by rebar cap or fabricated wood cap. Immediately relocate dismantled materials from the activity area? ☐ ☐ ☐
Ensure de-shuttering area is illuminated with task light? ☐ ☐ ☐
Do not leave any struck formwork materials hanging in concrete (i.e. plywood, wood). Peel off the duct tape used to cover the plywood gaps ☐ ☐ ☐
Do not throw form work materials from top to ground level? ☐ ☐ ☐
Do housekeeping every one hour. Stack the stripped off materials according to its size and type separately away from access routes and pedestrian walk ways ☐ ☐ ☐
Ensure two men handle each form work material to bring down safely and stack them safely? ☐ ☐ ☐
Ensure the availability and use of Safety Helmet, Hand gloves, clear eye protection, Safety Harness and ear plug. ☐ ☐ ☐
Ensure safety harness is hooked to the scaffold ledger above shoulder level while de-shuttering. ☐ ☐ ☐
Ensure Lifting plan implemented if any lifting activity for de-shuttering work. ☐ ☐ ☐
Ensure work platforms without openings and ensure proper access / egress. ☐ ☐ ☐
Restrict other unnecessary movements. Ensure de-shuttering area is barricaded with no entry warning signs? ☐ ☐ ☐
De-shuttering shall be done in same fashion as explained by form work designer and trained by respective section Engineer? ☐ ☐ ☐
Others( Specify) ☐ ☐ ☐
Dismantling of frames and support of formworks shall be from top to bottom provided with safe access & working platform? ☐ ☐ ☐
☐ ☐ ☐
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
27 Hydrostatic Pressure Testing inside buildings Risk Assessment Templates.docx
27 Hydrostatic Pressure Testing inside buildings Risk Assessment Templates.docxDwarika Bhushan Sharma
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Hydrostatic pressure testing of pipework inside buildings Relevant Applicable MAS:
• Additional Training required:
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
L C RR
1 Pressure testing equipment • Use at high pressure; • Rupture/failure of pump during testing;
• Valve/connection failure;
• Instrument failure resulting in system over-pressurization;
3 3 9 MED i. The supervisor in charge of the test shall ensure that all pressure testing gauges etc. are in good sound condition, undamaged, correctly dated with the current valid calibration and that appropriate calibration certificates are available;
ii. All pumps shall be in sound condition and complete with a valid test certificate. Any vulnerable items such as manometers and pressure switches shall be removed or isolated from the system prior to testing if not required;
iii. The test supervisor shall carry out a thorough inspection of the system before requesting the permit detailed above to ensure that all isolations, blanks and other specified safety devices are in place before testing commences; No test documentation available Quarantine equipment until valid documentation provided Low
2 Permit to work system • Interaction of personnel and high pressure system; • Injury due to uncontrolled testing;
• Injury due to failure to ensure adequate pre-checks undertaken; 3 4 12 HIGH i. All pressure testing operations shall require a Permit to Work to ensure that no pressure testing will be allowed to commence until all,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:
3 emergency management risk assessment templates
3 Emergency Management Risk Assessment Templates
Emergency Procedure
Access requirement for Emergency Vehicles
• Police;
• Civil Defense;
• Ambulance;
(Including as per 2017 Fire Life Safety COP Requirements)
Reverse Parking of private vehicles office areas
Project Vehicle Parking
Project Emergency Site Exits
Project Emergency Communication
Project Assembly points
9 lifting operations with tower crane risk assessment templates
This risk assessment document identifies hazards associated with lifting operations using a tower crane on a construction site. It lists 6 specific tasks: 1) access of crane sections, 2) tower crane foundations, 3) siting, setting up and testing, 4) lifting of equipment and material, 5) tower crane supervision, and 6) jumping and dismantling the tower crane. For each task, potential hazards are identified and an initial risk rating is given. Control measures are then provided to reduce the risks, along with any additional measures. Residual risks after controls are also assessed. The goal is to ensure lifting operations are performed safely.
03-hira-for-welding-work-_compress.pdf
This document provides a hazard identification and risk assessment for welding work being conducted at a project site in Versova, Mumbai. It identifies several hazards associated with welding including electric shock, fire, health issues from fumes and sparks, and improper use of equipment. For each hazard, it evaluates the severity and likelihood of risks. It also identifies applicable legal requirements and provides control measures to reduce risks. Controls include inspection of equipment, use of protective gear like face shields, isolating work areas, training workers, and ensuring only authorized personnel conduct welding. The overall risk level is determined to be "acceptable and non-significant" when proper controls are implemented.
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DE-SHUTTERING WORK PERMIT Form # HSEQ - DSWP Rev 2.docx
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LIFT SHAFT ENTRY PERMIT Form # HSEQ - LSEP Rev 2 -.docx
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9 lifting operations with tower crane risk assessment templates
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Similar to LADDER PERMIT REV 1 MARCH 28 2018 Form # HSEQ - LP Rev 2.docx
EDGE PROTECTION AND FLOOR OPENINGS REMOVAL PERMIT Form # HSEQ - EPRP Rev 2.docx
EDGE PROTECTION AND FLOOR OPENINGS REMOVAL PERMIT Form # HSEQ - EPRP Rev 2.docxDwarika Bhushan Sharma
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:
Area / Location of edge protection or floor openings:
Purpose of removing:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Availability of Fall protection arrangement (i.e. life line, etc.? ☐ ☐ ☐
Any high risk activity associated that requires PTW (i.e. hot work, Shaft Entry, CSE)? ☐ ☐ ☐
Adequate Lighting provided? ☐ ☐ ☐
Are all necessary Permit approved and displayed at work location? ☐ ☐ ☐
Availability of rescue procedure and equipment? ☐ ☐ ☐
Safe access / Working Platform provided? ☐ ☐ ☐
Mean of communication available? (Mobile, radio etc.) ☐ ☐ ☐
Availability of barricades/protection to prevent unauthorized or accidental entry? ☐ ☐ ☐
Helmet, Safety Shoes, Eye Protection, Hearing Protection and Cover All. ☐ ☐ ☐
Warning signs posted? ☐ ☐ ☐
Conduct Task Toolbox Talk prior to start the activity? ( TASK TBT TO BE ATTACHED) ☐ ☐ ☐
Exclusion zone for area below? ☐ ☐ ☐
Others (specify): ☐ ☐ ☐
Availability of Fall protection equipment (i.e. full body harness, etc.)? ☐ ☐ ☐
☐ ☐ ☐
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:
MAST CLIMBER & CRADLE PERMIT Form # HSEQ - 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:
Area / Location of Mast Climber or Cradle:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
Serial No. of Mast Climber or Cradle: No. of persons working on Mast Climber or Cradle:
Safe Working Load of Mast Climber or Cradle:
Other(s):
3. Mast Climber or Cradle Operators Details: (To be filled by initiator/originator)
Operator Contact:
Rigger-1 Contact:
Rigger-2 Contact:
Rigger-3 Contact:
4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Risk assessment/ method statement developed, approved and communicated? ☐ ☐ ☐
Area below mast climber or cradle free from personnel and barriers in place when working? ☐ ☐ ☐
Mast climber or cradle have a valid 3rd party certificate and displayed? ☐ ☐ ☐
All mast climber or cradle rigging points secure to building? ☐ ☐ ☐
Operator competent and certified? ☐ ☐ ☐
Are the mast climber or cradles brakes working? ☐ ☐ ☐
Wire ropes in good conditions? ☐ ☐ ☐
Proper barricade and signage are posted? ☐ ☐ ☐
Counterweights sufficient and properly anchored/secured? ☐ ☐ ☐
Mast climber or cradle SWL displayed?
☐ ☐ ☐
Electrical wires are in good conditions and free from obstructions? ☐ ☐ ☐
Access and egress will be on ground level? ☐ ☐ ☐
Anchor point for safety harness available and in good condition? ☐ ☐ ☐
Rescue plan available and communicated? ☐ ☐ ☐
Personnel working in mast climber cradle wearing safety harness and clipped on? ☐ ☐ ☐
Others (specify): ☐ ☐ ☐
5. 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):
6. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
7. 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:
WAIVER FORM Form # HSEQ - WF Rev 2.docx
To Use: ☐ Ladder/Step Ladder ☐ 120 V Power Tools ☐ Non-Cordless Power Tools
1. Project Information: (To be filled by initiator/originator of this Waiver)
Project Name: Waiver No.:
Requesting Contractor/Company:
Sub-Contractor scope of work:
2. Waiver Issuance Details: (To be filled by initiator/originator)
THIS WAIVER IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Area / Location use:
Period of use:
Justify why Podium Platforms/ 110V cordless power tools cannot be used:
Waiver will only be issued if there is no other alternative possible for the task
Waiver Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
Identification numbers for tools/equipment to be used:
3. Supervision Details: (To be filled by initiator/originator)
Site Engineer responsible for the activity: Contact:
Supervisor responsible for the activity: Contact:
NOTE: This Waiver does NOT exclude the need for Permit to Work or all other pre-requisites.
4. Authorization (PM/CM)
Name: Designation:
Signature: Date/Time:
JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
POINT OF WORK RISK ASSESSMENT:
S/# ACTIVITY IDENTIFIED HAZARDS PROPOSED CONTROL MEASURES RESPONSIBILITY (Eng., Sup., FM, etc.) Residual Risk
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JSEA JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
POINT OF WORK RISK ASSESSMENT:
S/# ACTIVITY IDENTIFIED HAZARDS PROPOSED CONTROL MEASURES RESPONSIBILITY (Eng., Sup., FM, etc.) Residual Risk
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SDV-20253 VALVE MOD 9 lift plan 1
This LOLER lift plan details the steps for installing Mod 9 PA SDV-20253 valves. It involves pre-rigging lifting points and slinging the 3000kg load. The valves will be lifted using 4 air hoists and soft eye wire slings, transferred across structure, and lowered into position. Riggers will follow safety procedures like using harnesses, erecting barriers, and inspecting equipment. The lift requires multiple personnel and will be supervised by a rigging foreman.
Job Safety Analysis For Lifting Activity By Crane | JSA | Gaurav Singh Rajput
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ContractorSafetyProgram-Safety-Plan-Power-Generation-Template.pdf
This document is a contractor project specific safety plan for work being done for PG&E. It includes instructions for completing the form, general project information, leadership and oversight plans, personal protective equipment requirements, a general safety checklist covering various hazards and safety requirements, a risk assessment and hazard identification section, and a section on hazard communication and training requirements. The contractor must submit this completed plan to PG&E for approval before starting work on the project.
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.
10. lifting-plan-checklist-and-method-statement-2
This document is a lifting plan checklist and method statement for mobile crane lifts. It contains sections for pre-planning the lift, checking the crane on site, and authorizing the lifting operation. Section A requires information on the load, crane access, lift details, and hazards. Section B verifies crane qualifications and positioning. Section C outlines the lift task, controls, assigned roles, lift details, and authorizes the operation start and end times. The checklist aims to ensure lifts are properly planned and authorized according to safety standards.
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The document outlines scaffolding procedures for the Gatun CCGT Project. It details responsibilities for scaffolding work, including requiring the site manager to comply with Panamanian regulations. It also requires training for scaffold users and erectors, and mandates that scaffolds be designed and constructed to support at least four times the planned load. Scaffolds over 15 meters must be engineered and inspected by a competent person. The procedures are intended to ensure the safe erection, use, inspection and dismantling of all scaffolding used on the project.
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The document summarizes the observations from a weekly safety inspection of construction sites for the Gujarat Metro Rail Corporation. It identifies 14 issues observed at various locations including Tapovan station, casting yard, and PDPU station. The issues relate to fall protection, traffic safety, housekeeping, lifting equipment, and other non-compliance or hazards. For each issue, it identifies the observed hazard, responsible party, and required corrective actions to ensure safety compliance. Addressing repeated safety issues was highlighted as a critical concern.
Methodstatement welding
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PA PIPE WORK 14 inch spool TH11177-06-PI-10-004-5
This LOLER lift plan details the lifting of a 349.9kg pipe spool from one location to another on an offshore platform. It involves multiple lifting points and the use of chains, beams, and strops. The plan outlines 16 specific tasks for riggers to complete the lift safely. It requires barriers, designated lifting equipment, slinging methods, communication protocols, and checks of the route and lay down area. The workforce must read, understand, and comply with the risk assessment and lifting plan for the complex operation. No deviations are allowed without approval from the lifting focal point.
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- Instructions for students on completing various tasks like preparing a job safety analysis, signing off on plans, preparing the site, and safely demolishing and rebuilding a load bearing wall.
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The document discusses work permits in construction. It defines a work permit as a written authorization for jobs involving serious hazards. Work permits identify the work, hazards, and necessary precautions. Key points made include:
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- Major works requiring permits include inspection, construction, hot work, and confined space entry.
- The permit procedure involves an issuer authorizing the permit after inspection, a receiver overseeing the work, and cancellation upon completion.
- Non-compliance can occur if permits are invalid or workers don't understand the system. Safety watches also monitor hazards and alert workers.
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Occupational health and safety in the workplace, procedure to carry out high risks job and what to do in ensuring safety of the employees.
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JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
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This document provides the name of a company but no other details. It contains only the words "Company Name" with no other context or information provided. In just two words, the document states the name of a company without any other descriptive text.
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Code of Practice
C.O.P # 01
Fire Prevention Requirements
(Management of Combustible Materials & Electrical Inspections)
Rev. 01, Mar 23
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:
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.
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:
FULL BODY HARNESS INSPECTION RECORD Form # HSEQ - FBHIR Rev 2.docx
Harness Checklist
Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Sl. No
………. Remarks
Shoulder Straps
Chest & Back Straps
Waist Straps
Back D-Ring
Shoulder Adjustment
Legible Label
Shoulder Straps
Chest & Back Straps
Waist Straps
Leg Straps
Cuts
Burns
Holes
Deterioration
Corrosive/ worn out
Color code
Others (Specify)
Project Information
Project Name: Location:
Company name : Date:
Remarks:
Inspector Name: Signature:
Reviewed By HSE Manager / Incharge Signature:
GENERAL SITE SAFETY RULES Form # HSEQ - Rev 2.docx
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LADDER PERMIT REV 1 MARCH 28 2018 Form # HSEQ - LP Rev 2.docx
- 1. Page 1 of 2 Form # HSEQ-LP (Rev 2 - Mar 23) LADDER PERMIT DAILY ONE TIME -ONE TASK USE 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: Area / Location of ladder use: Type of ladder requested Ladder: _______ Length: _______ Step Ladder: _______ Height: ______ Please state why the use of ladder is the ONLY means to perform the task and the use of Mobile Elevated Work Platforms, Scaffolds are IMPOSSIBLE to use. ☐ PERMIT REFUSED, USE OTHER MEANS ☐ SPECIAL DISPENSATION GIVEN IN THIS INSTANCE ☐I have discussed the task with the Arabtec engineer/supervisor ☐ or, I have visited the area ☐ or, I have studied the drawings ☐ or, I understand the task to be performed I hereby confirm that in my professional judgement that there is no other possible means to carry out the task and that the risk in the use of a ladder has been assessed, and with the control measures in place the risk level is deemed acceptable 3. HSE’S DETERMINATION Name Sign: Date: Permit Validity: Time (from): _______Hrs. Time (To): ________Hrs. Date: Serial No. of Ladder: 3. Supervision Details: (To be filled by initiator/originator) Site Engineer responsible for the activity: Contact: Supervisor responsible for the activity: Contact: 4. Prerequisites: (To be filled by initiator/originator and verified by Evaluator) Checks Yes-No-NA Checks Yes-No-NA Risk assessment/ method statement developed, approved and communicated ☐ ☐ ☐ Area where ladder is being used is not close to edge and appropriate fall prevention measures are in place ☐ ☐ ☐
- 2. Page 2 of 2 Form # HSEQ-LP (Rev 2 - Mar 23) Ladder inspection has been done and an inspection tag is available with clear identification number of the ladder ☐ ☐ ☐ Emergency evacuation procedures communicated to all workers ☒ ☐ ☐ Ladder is being set on a flat, stable surface and secured ☐ ☐ ☐ Can 3 point of contact b maintained? If not, can a harness be worn and anchored to a secure point above shoulder height? ☐ ☐ ☐ Tool Box Talk conducted ☐ ☐ ☐ Others (specify): ☐ ☐ ☐ A second person is available at all times to hold/secure the ladder ☐ ☐ ☐ ☐ ☐ ☐ Area is barricaded and signage are posted ☐ ☐ ☐ ☐ ☐ ☐ Ladder safety devices like leg levelers, anti-slip gutter guards and stabilizers are in place and in good condition ☐ ☐ ☐ ☐ ☐ ☐ 5. 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 use ladder 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 using ladder Evaluator (HSE Team): Designation: Signature: Date /Time Comments (if any): 6. Authorization (PM/CM): Name: Designation: Signature: Date /Time: 7. Completion/Cancelation of Permit: ☐ Acknowledge that the area has been restored to a safe and orderly condition. And the ladder has been returned to store. Initiator Signature: Time: ☐ Acknowledge that I have checked the area and it has been restored to a safe and orderly condition. Evaluator Signature: Time: