MAST CLIMBER & CRADLE PERMIT Form # HSEQ - Rev 2.docx
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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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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:
HSE ORIENTATION TRAINING (EMPLOYEES-STAFF) Form # HSEQ - HSEOT Rev 2 -.docx
The document outlines an HSE orientation training for employees that covers 13 topics related to health, safety, and environmental policies and procedures. The training covers the company's safety program, use of personal protective equipment, injury reporting procedures, job hazards, safety rules, first aid, emergency response plans, vehicle safety, work habits, and waste management. Upon completion, employees sign to acknowledge their understanding and acceptance of maintaining a safe work environment.
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 :
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:
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.
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:
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
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:
Recommended
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:
HSE ORIENTATION TRAINING (EMPLOYEES-STAFF) Form # HSEQ - HSEOT Rev 2 -.docx
The document outlines an HSE orientation training for employees that covers 13 topics related to health, safety, and environmental policies and procedures. The training covers the company's safety program, use of personal protective equipment, injury reporting procedures, job hazards, safety rules, first aid, emergency response plans, vehicle safety, work habits, and waste management. Upon completion, employees sign to acknowledge their understanding and acceptance of maintaining a safe work environment.
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 :
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:
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.
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:
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
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:
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
HSE Monitoring schedule plan
This document outlines a monitoring schedule plan for a construction project. It details performance metrics that will be monitored monthly, such as man-hours worked, training hours, inspections, incidents, and near misses. Site tours, inspections, and audits will be conducted on a weekly or monthly basis by various roles to assess safety standards. Findings will be recorded online and responsibilities are defined for project leadership to promote and monitor implementation of the plan.
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:
11 piling operations with rebar cage installation risk assessment templates
11 Piling Operations with Rebar Cage installation Risk Assessment Templates
Piling Rig checks on arrival to site
PRIOR TO USE
Access of rig and delivery vehicles to work areas
Siting and setting up of piling rig
Piling operation
(Mobile rig Operator)
Rebar cage fabrication
Pile case and rebar cage lifting operations
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:
30 workplace temporary electrical supply risk assessment templates
Installation of distribution boards to work areas • Electricity • Electrocution;
• Fire;
Temporary electrics - offices • Electrical connections and terminations • Use of untrained electricians for electrical works;
• Use of substandard electrical fixtures and fittings;
• Use of substandard connections;
• Non-adherence to colour coding of wiring;
• Incorrect earthing;
• Tripping hazard; Damage to unprotected cables;
• Use of incorrectly rated fuses;
Site generators – offices and site
• Temporary supply • Generator fires;
• Incident due to incorrect earthing;
• Fuel leakage – environmental risk;
• Fuel storage;
• Noise;
Near miss report
Workers were lifting an LED wall screen using an electric winch when the clamp failed to properly fasten to the LED, causing it to fall from a height of around four meters. No injuries occurred but damage is still being assessed. The incident was caused by a lack of supervision ensuring the hooks were properly tightened before lifting. Corrective actions include ensuring workers check hooks are tight and no one stands under a lifted load.
WORK PERMIT REGISTER Form # HSEQ - WPR Rev 2.docx
Project Information :
Project Name:
Month : Date :
Sl. No Type of Permit Permit No. Initiator/ Originator Contact No. Of Originator Company Name Issue Time Permit Expiry Close out Time
1
2
3
4
5
6
7
8
9
10
Remarks:
Recorded By: Signature:
Reviewed By HSE Manager / Incharge : Signature:
Pembuatan hse plan
Jasa pembuatan HSE plan WA : 0812-9383-299 di bsafe.co.id hubungi kami untuk konsultasi pembuatan hse plan perusahaan anda.
Apa itu HSE plan ? , hse plan dalam bahasa indonesia singkatan dari kesehatan, keselamatan dan dalam ruang lingkup kerja. Singkatan dari Health Safety and Environment merupakan standar yang harus di penuhi bagi perusahaan yang mengerjakan proyek yang membutuhkan sertifikasi standar kesehatan dan keselamatan dan lingkungan dalam pekerjaan. Rencana kerja HSE fokus pada program partisipatif yang diarahkan pada pencegahan kecelakaan kerja dan penyakit akibat kerja atau pencemaran lingkungan. HSE PLAN secara aktif juga melibatkan semua pekerja dalam menjalankan aktivitas operasional keseharian sesuai dengan prinsip dasar dan aturan dari standar HSE plan.
HSE plan adalah merupakan kumpulan dokumen rencana untuk proses kontrak yang berada dalam bagian persetujuan (agreement). HSE Plan dapat juga berupa kumpulan dokumen tersendiri ataupun terintegrasi dengan dokumen lain. HSE plan tergabung dengan dokumentasi dari sistem manajemen kontrak untuk memperlihatkan bagaimana sistem manajemen penerapan K3 dengan ruang lingkup pekerjaan perusahaan.
HSE plan saat ini sangat penting sebagai salah satu syarat awal misalnya bila perusahaan anda bergerak dalam bidang kontraktor untuk agar nantinya dapat siap mengikuti sebuah tender pada berbagai sektor pekerjaan yang ditawarkan.
Pada bidang sektor minyak dan gas dan juga perusahaan konstruksi. HSE Plan ini termasuk sebagai salah satu pertimbangan dalam mengikuti proyek tender. Perusahaan kontraktor misalnya harus membuat HSE Plan yang bagus dan baik agar menjadi pertimbangan mendapatkan proyek pekerjaannya. Bsafe.co.id dengan team siap membatu membuat hse plan untuk perusahaan anda di seluruh Indonesia.
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Health, Safety and Environmental Management Plan
This Slideshare presentation is a partial preview of the full business document. To view and download the full document, please go here:
http://flevy.com/browse/business-document/health-safety-and-environmental-management-plan-330
This document is a 30 page health, safety and environmental management plan that will provides organisations with a very solid framework for managing health, safety and environmental risk.
The key elements include: HSE policy, risk management, management responsibilities, incident investigation, injury reporting, training and competency, emergency management, sub-contractor management, communication and consultation, occupational health, processes for work practices, monitoring and review.
Once downloaded this document can be enhanced by purchasing a number of forms, registers, checklist or templates from this site.
This document present excellent value for money for the perspective client; to draft a document of similar quality would cost several thousands of dollars in man hours. However, you will need to tailor this HSE management plan to your organisation as well to any relevant legislation, standards or codes.
This document will suit medium to large businesses, or the small business owner looking to step up their HSE compliance or improve their chance of winning work with high end clients.
The savvy buyer will recognise value for money in this document.
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
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
HSE Manager CV
I am Mr. Sony, HSE Manager having working experience more than 23 years. M.Tech In Electrical, NEBOSH IGC, NEBOSH Oil & Gas, Train The Trainer, Diploma in Fire & Safety, Diploma in Industrial safety, Basic First Aider, Lead Auditor. Experience in Watar & Waste water projects, High Rise buildings, Metro Rail project, Dubai, Soil wall & Petrochemicals , Large infrastructure projects of Dubai & Qatar governments etc. I have working experience with ASHGHAL, Public work authority, Qatar also. Can join immediately with NOC.
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.
HSE construction waste management plan
CONSTRUCTION WASTE MANAGEMENT PLAN
1. Introduction 4
1.1 Benefits of Construction Waste Management: 4
2. Roles and Responsibilities 5
2.1 Logistics/Waste Management Coordinator 5
2.2 Team Leaders 5
2.3 Waste Champion 5
3. Waste Management Policy. 6
4. Construction Waste Management Goals 7
5. Waste Management Strategies 7
5.1 Planning and Execution 7
5.2 Waste Segregation 7
5.3 Waste Collection & Segregation Areas 8
5.4 Waste Management Signage 8
5.5 Waste Handling 10
5.6 Hazardous Waste Handling 11
5.7 Communication & Education Plan 12
6 Solid Waste Management 12
7 Hazardous Waste Management 15
8 Expected Project Waste, Disposal and Handling 16
9 Inspection and Monitoring 17
10 Contact Details 18
11 CWM ORGANIZATION CHART 19
12 DM Waste Disposal Log Sheet 20
13 Change History 21
5 Trial Trenches (Temporary Works) Risk Assessment Templates.docx
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
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Trial Trenches on site to locate/expose underground services. Use of excavator
Note: Wherever practicable trial trenches shall be hand dug to expose cables
Classed as Temporary Works Relevant Applicable MAS:
• 00246 – Excavations;
• 01413 – Underground services;
• 00940 – Plant Operators. Additional Training required:
Temporary Works Coordinator to be designated NOC’s Required for task:
Dubai Municipality
No Specific Task Step
(In sequence of works) Hazard Details Consequence/Risk Initial Risk Rating Control Measures Residual Risks Additional Control Measures RR
P S RR
1 Planned shallow Excavation (Trial Trench) in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS • Presence of live underground services;
• Services not in area specified on drawings;
• Heavy plant or vehicles accessing work area;
• Presence of unmarked services;
• Risk of explosion due to gas line rupture;
• Risk of flooding of trenches and adjacent areas due to water main damage;
• Risk of electrocution or fire due to cable strike;
• Risk of hazardous waste entering trenches or water systems due to live sewerage damage;
• Risk of damage to low depth underground services from heavy vehicles;
• Risk of vehicles / Plant entering open trenches; 4 3 12
HIGH i. All existing utility service drawings reviewed for known service details and position;
ii. NOC and Utility provider and ATC Excavation permits to be completed, unique number added and recorded in log;
iii. Work Area, including access route for plant, to be CAT scanned to locate exact position of service by competent per
December -15 Daily Observation Report
The document is a site safety observation report prepared by Mohammed Mubasheeruddin on December 15, 2016. It details three safety observations made at a construction site, including workers following without proper protective equipment, improperly stocked ducting material, and improperly stoked fire fighting pipes. For each observation, the report notes an identified unsafe act and the corresponding correction that was taken.
0-GG010-MZ711-00020 Scaffolding Procedure rev.1 .docx
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.
Duties lifting supervisors
This document outlines the duties and responsibilities of lifting supervisors for a private highway project in Malaysia. The lifting supervisors are responsible for: (1) monitoring lifting operations to ensure they are carried out safely and in compliance with approved plans; (2) briefing lifting crews on plans and ensuring understanding before lifts; and (3) day-to-day management and coordination of lifting operations, including meetings for lifts using multiple cranes. They must also check contractor competencies and appointments, and monitor safe execution of lifts according to the Crane Lift Plan.
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
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:
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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
HSE Monitoring schedule plan
This document outlines a monitoring schedule plan for a construction project. It details performance metrics that will be monitored monthly, such as man-hours worked, training hours, inspections, incidents, and near misses. Site tours, inspections, and audits will be conducted on a weekly or monthly basis by various roles to assess safety standards. Findings will be recorded online and responsibilities are defined for project leadership to promote and monitor implementation of the plan.
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:
11 piling operations with rebar cage installation risk assessment templates
11 Piling Operations with Rebar Cage installation Risk Assessment Templates
Piling Rig checks on arrival to site
PRIOR TO USE
Access of rig and delivery vehicles to work areas
Siting and setting up of piling rig
Piling operation
(Mobile rig Operator)
Rebar cage fabrication
Pile case and rebar cage lifting operations
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:
30 workplace temporary electrical supply risk assessment templates
Installation of distribution boards to work areas • Electricity • Electrocution;
• Fire;
Temporary electrics - offices • Electrical connections and terminations • Use of untrained electricians for electrical works;
• Use of substandard electrical fixtures and fittings;
• Use of substandard connections;
• Non-adherence to colour coding of wiring;
• Incorrect earthing;
• Tripping hazard; Damage to unprotected cables;
• Use of incorrectly rated fuses;
Site generators – offices and site
• Temporary supply • Generator fires;
• Incident due to incorrect earthing;
• Fuel leakage – environmental risk;
• Fuel storage;
• Noise;
Near miss report
Workers were lifting an LED wall screen using an electric winch when the clamp failed to properly fasten to the LED, causing it to fall from a height of around four meters. No injuries occurred but damage is still being assessed. The incident was caused by a lack of supervision ensuring the hooks were properly tightened before lifting. Corrective actions include ensuring workers check hooks are tight and no one stands under a lifted load.
WORK PERMIT REGISTER Form # HSEQ - WPR Rev 2.docx
Project Information :
Project Name:
Month : Date :
Sl. No Type of Permit Permit No. Initiator/ Originator Contact No. Of Originator Company Name Issue Time Permit Expiry Close out Time
1
2
3
4
5
6
7
8
9
10
Remarks:
Recorded By: Signature:
Reviewed By HSE Manager / Incharge : Signature:
Pembuatan hse plan
Jasa pembuatan HSE plan WA : 0812-9383-299 di bsafe.co.id hubungi kami untuk konsultasi pembuatan hse plan perusahaan anda.
Apa itu HSE plan ? , hse plan dalam bahasa indonesia singkatan dari kesehatan, keselamatan dan dalam ruang lingkup kerja. Singkatan dari Health Safety and Environment merupakan standar yang harus di penuhi bagi perusahaan yang mengerjakan proyek yang membutuhkan sertifikasi standar kesehatan dan keselamatan dan lingkungan dalam pekerjaan. Rencana kerja HSE fokus pada program partisipatif yang diarahkan pada pencegahan kecelakaan kerja dan penyakit akibat kerja atau pencemaran lingkungan. HSE PLAN secara aktif juga melibatkan semua pekerja dalam menjalankan aktivitas operasional keseharian sesuai dengan prinsip dasar dan aturan dari standar HSE plan.
HSE plan adalah merupakan kumpulan dokumen rencana untuk proses kontrak yang berada dalam bagian persetujuan (agreement). HSE Plan dapat juga berupa kumpulan dokumen tersendiri ataupun terintegrasi dengan dokumen lain. HSE plan tergabung dengan dokumentasi dari sistem manajemen kontrak untuk memperlihatkan bagaimana sistem manajemen penerapan K3 dengan ruang lingkup pekerjaan perusahaan.
HSE plan saat ini sangat penting sebagai salah satu syarat awal misalnya bila perusahaan anda bergerak dalam bidang kontraktor untuk agar nantinya dapat siap mengikuti sebuah tender pada berbagai sektor pekerjaan yang ditawarkan.
Pada bidang sektor minyak dan gas dan juga perusahaan konstruksi. HSE Plan ini termasuk sebagai salah satu pertimbangan dalam mengikuti proyek tender. Perusahaan kontraktor misalnya harus membuat HSE Plan yang bagus dan baik agar menjadi pertimbangan mendapatkan proyek pekerjaannya. Bsafe.co.id dengan team siap membatu membuat hse plan untuk perusahaan anda di seluruh Indonesia.
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Health, Safety and Environmental Management Plan
This Slideshare presentation is a partial preview of the full business document. To view and download the full document, please go here:
http://flevy.com/browse/business-document/health-safety-and-environmental-management-plan-330
This document is a 30 page health, safety and environmental management plan that will provides organisations with a very solid framework for managing health, safety and environmental risk.
The key elements include: HSE policy, risk management, management responsibilities, incident investigation, injury reporting, training and competency, emergency management, sub-contractor management, communication and consultation, occupational health, processes for work practices, monitoring and review.
Once downloaded this document can be enhanced by purchasing a number of forms, registers, checklist or templates from this site.
This document present excellent value for money for the perspective client; to draft a document of similar quality would cost several thousands of dollars in man hours. However, you will need to tailor this HSE management plan to your organisation as well to any relevant legislation, standards or codes.
This document will suit medium to large businesses, or the small business owner looking to step up their HSE compliance or improve their chance of winning work with high end clients.
The savvy buyer will recognise value for money in this document.
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
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
HSE Manager CV
I am Mr. Sony, HSE Manager having working experience more than 23 years. M.Tech In Electrical, NEBOSH IGC, NEBOSH Oil & Gas, Train The Trainer, Diploma in Fire & Safety, Diploma in Industrial safety, Basic First Aider, Lead Auditor. Experience in Watar & Waste water projects, High Rise buildings, Metro Rail project, Dubai, Soil wall & Petrochemicals , Large infrastructure projects of Dubai & Qatar governments etc. I have working experience with ASHGHAL, Public work authority, Qatar also. Can join immediately with NOC.
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.
HSE construction waste management plan
CONSTRUCTION WASTE MANAGEMENT PLAN
1. Introduction 4
1.1 Benefits of Construction Waste Management: 4
2. Roles and Responsibilities 5
2.1 Logistics/Waste Management Coordinator 5
2.2 Team Leaders 5
2.3 Waste Champion 5
3. Waste Management Policy. 6
4. Construction Waste Management Goals 7
5. Waste Management Strategies 7
5.1 Planning and Execution 7
5.2 Waste Segregation 7
5.3 Waste Collection & Segregation Areas 8
5.4 Waste Management Signage 8
5.5 Waste Handling 10
5.6 Hazardous Waste Handling 11
5.7 Communication & Education Plan 12
6 Solid Waste Management 12
7 Hazardous Waste Management 15
8 Expected Project Waste, Disposal and Handling 16
9 Inspection and Monitoring 17
10 Contact Details 18
11 CWM ORGANIZATION CHART 19
12 DM Waste Disposal Log Sheet 20
13 Change History 21
5 Trial Trenches (Temporary Works) Risk Assessment Templates.docx
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
Project Name: xxx
RA Ref No.: xxx
RA compilation Date: Review date:
Date:
Compiled by:
Reviewed by:
Approved by:
Overall Task Details
Trial Trenches on site to locate/expose underground services. Use of excavator
Note: Wherever practicable trial trenches shall be hand dug to expose cables
Classed as Temporary Works Relevant Applicable MAS:
• 00246 – Excavations;
• 01413 – Underground services;
• 00940 – Plant Operators. Additional Training required:
Temporary Works Coordinator to be designated NOC’s Required for task:
Dubai Municipality
No Specific Task Step
(In sequence of works) Hazard Details Consequence/Risk Initial Risk Rating Control Measures Residual Risks Additional Control Measures RR
P S RR
1 Planned shallow Excavation (Trial Trench) in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS • Presence of live underground services;
• Services not in area specified on drawings;
• Heavy plant or vehicles accessing work area;
• Presence of unmarked services;
• Risk of explosion due to gas line rupture;
• Risk of flooding of trenches and adjacent areas due to water main damage;
• Risk of electrocution or fire due to cable strike;
• Risk of hazardous waste entering trenches or water systems due to live sewerage damage;
• Risk of damage to low depth underground services from heavy vehicles;
• Risk of vehicles / Plant entering open trenches; 4 3 12
HIGH i. All existing utility service drawings reviewed for known service details and position;
ii. NOC and Utility provider and ATC Excavation permits to be completed, unique number added and recorded in log;
iii. Work Area, including access route for plant, to be CAT scanned to locate exact position of service by competent per
December -15 Daily Observation Report
The document is a site safety observation report prepared by Mohammed Mubasheeruddin on December 15, 2016. It details three safety observations made at a construction site, including workers following without proper protective equipment, improperly stocked ducting material, and improperly stoked fire fighting pipes. For each observation, the report notes an identified unsafe act and the corresponding correction that was taken.
0-GG010-MZ711-00020 Scaffolding Procedure rev.1 .docx
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.
Duties lifting supervisors
This document outlines the duties and responsibilities of lifting supervisors for a private highway project in Malaysia. The lifting supervisors are responsible for: (1) monitoring lifting operations to ensure they are carried out safely and in compliance with approved plans; (2) briefing lifting crews on plans and ensuring understanding before lifts; and (3) day-to-day management and coordination of lifting operations, including meetings for lifts using multiple cranes. They must also check contractor competencies and appointments, and monitor safe execution of lifts according to the Crane Lift Plan.
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23 casting of concrete slabs risk assessment templates
23 casting of concrete slabs risk assessment templates
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
11 piling operations with rebar cage installation risk assessment templates
11 piling operations with rebar cage installation risk assessment templates
30 workplace temporary electrical supply risk assessment templates
30 workplace temporary electrical supply risk assessment templates
25 Demolition of existing concrete structures Risk Assessment Templates.docx
25 Demolition of existing concrete structures Risk Assessment Templates.docx
5 Trial Trenches (Temporary Works) Risk Assessment Templates.docx
5 Trial Trenches (Temporary Works) Risk Assessment Templates.docx
0-GG010-MZ711-00020 Scaffolding Procedure rev.1 .docx
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Similar to MAST CLIMBER & CRADLE PERMIT Form # HSEQ - Rev 2.docx
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
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:
LADDER PERMIT REV 1 MARCH 28 2018 Form # HSEQ - LP Rev 2.docx
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
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
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
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.
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:
Plant & Machinery Training
This document outlines safety training requirements for plant and machinery operators on construction sites. It states that in 2019, 19 people were fatally injured by plant and machinery. It requires that all operators have relevant training and certification. Machinery must have inspection certificates and identification stickers upon arrival. Regular weekly inspections are mandated for equipment like excavators, cranes, scaffolding and fall protection. Permits and inspection forms must be completed for equipment use and hazardous activities. The document aims to ensure machinery is properly maintained and operated only by trained personnel.
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
L S RR
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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
L S RR
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Specific method of statmeents risk assessment -job hazard analysis for land ...
The document provides a methodology for removing a landslide near tower 9u to allow construction of access tracks and towers for a transmission line project. The work will be done in 3 zones and involve clearing and excavating the landslide area over 15 working days. Safety and environmental precautions include training crews, using proper PPE, conducting risk assessments, and having a geologist on site to monitor stability. Excavators will work sequentially in each zone while being monitored for signs of further sliding. The contractor's organization assigns roles of project manager, construction manager, site engineer, HSE lead, and geologist to oversee the safe removal of the landslide.
Specific method of statmeents risk assessment -job hazard analysis for land ...
This document provides a method statement for removing a landslide near Tower 9u to allow construction of an access track and transmission line towers. The work will be done in 3 zones using 2 excavators over 15 working days. Health and safety precautions include training staff, using proper equipment and PPE, conducting risk assessments, and having emergency response plans. The contractor's organization assigns roles to a project manager, construction manager, site engineer, and HSE lead to oversee the excavation team and contractor geologist. Attachments include location maps, photos of the site, and risk assessments.
SDV-20253 VALVE MOD 9 lift plan 1
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AUXILIARY CRANE INSPECTION CHECKLIST Form # HSEQ - AC Rev 2.docx
1. This document is an auxiliary crane inspection checklist for the Tiara Hotel Auxiliary Crane No. 4/3.06/1 located on Level 3.
2. It contains 28 items to check including the availability of manuals, maintenance records, operator and rigger competency, structural welds, foundation, hoist limits, drum and wire rope, hook, boom, counterweight, pins and bolts, sheaves, load indicators, limit switches, foundation bolts, means of communication, fire extinguisher, and anti-collision system.
3. The checklist notes that third party inspections of the crane and operator certificates are valid until August 26, 2018 and is to be completed for
2017 cranes_hoists_and_elevators_ codes_regulations.pdf
This document provides information about a continuing education course on cranes, hoists, and elevators codes and regulations. The course will cover various types of cranes, their design, safety requirements, and new rules including energy code compliance for elevators. It lists the learning objectives, describes the different sections that will be covered, and provides background information on codes and regulations regarding cranes.
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.
Lifting plan
This document provides a crane lifting plan and risk assessment for a lifting operation. It details the crane and lift information, including load details, lifting tackle, and crane setup procedures. Safety procedures are outlined, such as conducting a site inspection, briefing personnel, establishing communication methods, and following weather restrictions. Personnel qualifications and roles are defined. The plan is intended to ensure the lifting operation is carried out safely in compliance with relevant standards and regulations.
Lifting steam drum 72 ton by winch
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TOWER CRANE INSPECTION CHECKLIST Form # HSEQ - TCI Rev 2 -.docx
This document is a daily inspection checklist for tower cranes. It contains 21 items to check including the crane foundation, power system, ropes, lifts, lights, safety equipment, and operational controls. Any issues identified during inspection are noted in the comments section. The checklist is signed by both the crane operator and an HSE manager to confirm all inspections were completed for each shift. The purpose is to ensure the crane's safety through regular documented inspections.
Campion_Crane-Safety.pdf
This document discusses crane safety and outlines requirements for crane inspections, operator qualifications, and hazard prevention. It notes that cranes must be inspected by qualified personnel according to OSHA regulations to identify any deficiencies. Inspections include examining components like wires, hooks, controls and pressure systems. Operators must be certified or trained, and medical certification is required. Hazards addressed include overloading, poor setup, electrical lines, weather conditions, and maintenance issues. Thorough planning, inspections, training and following regulations are emphasized to ensure crane safety.
Similar to MAST CLIMBER & CRADLE PERMIT Form # HSEQ - Rev 2.docx (20)
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EDGE PROTECTION AND FLOOR OPENINGS REMOVAL PERMIT Form # HSEQ - EPRP Rev 2.docx
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LADDER PERMIT REV 1 MARCH 28 2018 Form # HSEQ - LP Rev 2.docx
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JOB SAFETY ENVIRONMENTAL ANALYSIS Form # HSEQ - JSEA Rev 2 -.docx
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2017 cranes_hoists_and_elevators_ codes_regulations.pdf
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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.
PRE-START BRIEFING Form # HSEQ - PSB Rev 2 -.docx
Project Information:
Project Name:
Location: Supervisor :
Company name : Date:
Task Description:
Before work starts, the following must be in place
Induction Supervision Test Certificates Communication in same language Method Statement Risk Assessment Permit To Work Area Lighting
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Fall from height Training Access Ladder Access Handrail Edge Protection Secure Ladder Adequate Work Platform Guards for Openings Safety Harness Life Lines
Others( Specify)
Manual Handling Training Check Weight Mechanical Aids Access Route Team Lifting Wrong method Right Method
Power tools Training Color code inspection tag Check Cable Wheel guards Safe plug & sockets Cable Protection Proper Scaffold Cable Overhead Rotatory part guards
Scaffold Scaffold Tag Edge Protection Check Overhead works Access Ladder Adequate Work Platform Weather condition Out riggers Ladder 3 feet above platform Safety Harness
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Risk Assessment
Lifting Plan Tag Lines Lifting points / hooks Banks man Load stability Check Lifting gear Examination /Inspection Sharp edges protected
Lifting operations Weather/ Wind Speed Ground conditions Exclusion zone Communication Loading/ unloading vehicles Spreader Beams Check Ground conditions Check outriggers Others
Fire Fire Extinguisher Fire Hose Fire Exit Assembly point others
Slip/Trip Clean before you go Barricade the waste Waste Management Clean Access Housekeeping Clean liquid spillage Access signs Maintain access/ Egress
PPE
Safety Harness
Safety Helmet Coveralls Hi vis Jacket Safety Shoe Face Shield Ear Protection
Dust mask Respiratory Equipment Life line/ harness anchorage Hand Gloves Goggles/ Glass
Pre start Briefing done by: Signature:
Reviewed By HSE Manager/ In charge: Signature:
FIRE PREVENTION REQUIREMENTS Form # HSEQ - Rev 2.docx
Code of Practice
C.O.P # 01
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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.
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:
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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: ………………………………..…..
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:
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- 1. MAST CLIMBER & CRADDLE PERMIT Page 1 of 2 Form # HSEQ-MCP (Rev 2 - 2023) 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? ☐ ☐ ☐
- 2. MAST CLIMBER & CRADDLE PERMIT Page 2 of 2 Form # HSEQ-MCP (Rev 2 - 2023) 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: