WORK PERMIT REGISTER Form # HSEQ - WPR Rev 2.docx
•Download as DOCX, PDF•
0 likes•951 views
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:
Report
Share
Report
Share
Recommended
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
16 scaffolding (temporary works) risk assessment templates
16 Scaffolding (Temporary Works) Risk Assessment Templates
Access to work areas by personnel and plant.
Scaffold Material delivery to work area;
Scaffold design and erection standards
(Classified as Temporary Structure)
Scaffold erection
(Classified as Temporary Structure)
Dismantling of scaffold
Maintenance of Scaffold
Worker exposure to direct sun whist working on scaffold
(as applicable)
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:
COLD WORK PERMIT Form # HSEQ - CWP Rev 2.docx
Issue Date: _______________ Permit No: ____________
Permit Requested By: __________________ Company Name: ________________ Permit Accepted By: __________________ Company Name: ________________
Validity From: __________ To: __________
1. Job Location: _____________________________________________________________
2. Job Description: __________________________________________________________
________________________________________________________________________________________________________________________________________________
3 Tools & Materials to be used:
❑Explosive Device ❑Sandblaster ❑Jack hammers
❑Hand Tools ❑Drill ❑Jack hammers
❑Powered Excavation Equipment ❑Powered cutting Saw ❑Ladder/Scaffolding
❑Air Heater ❑LPG Gas ❑Others
4- Details of potential hazards:
❑Falling from height ❑ Material Fall down ❑Skin Exposures
❑Electrocuted ❑ Slip and trip ❑Burn out due to fire/acid etc.
❑Exposure to Eye ❑ Inhalation of any Gas ❑Breathing Problem ❑Others
5- Details of precaution need to be taken:
❑Caution Signage to be placed ❑Proper fixture an erection of Scaffolding/Ladder
❑Excavated Area fencing ❑Electrical Isolation
❑Fire water supply isolation ❑Fire water tanker to be provided
❑Fire Extinguishers to be provided ❑Exhaust fan to be provided
❑Informed security Et Help Desk ❑Other
6- Details of protective equipment to be used or worn:
❑Safety Shoes
❑Safety Helmet
❑Face Shield/Goggle/Glasses
❑Gloves (As per work)
❑Safety harness/Belt/Lifeline
❑Uniform ❑Respiratory Equipment/Dust Mask
❑Chemical Suite/Apron
❑Ear protection
❑Fire Blanket/Protection Sheet
❑Rubber Mat/Ground Fault Interrupter
❑Other
7- Signature of Permit Requestor:
Contact No:-
8- Signature of PTW Acceptor:
Contact No:-
9- Signature of Permit Issuer/HSE Representative:
10- Signature of handover of responsibility between shifts, if needed.
11- Declaration by competent person in -charge of work that work is completed.
12- Signature of Maintenance / works representative ensuring that the work is
completed, site has been checked and that equipment and place may be reinstated / left
Safely isolated.
13- Signature of person issuing the permit / HSE representative which confirms that the
Site has been left in safe condition and the permit is cancelled.
14- Signature of the management representative signing off the permit to work.
REMARKS:-
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
Recommended
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
16 scaffolding (temporary works) risk assessment templates
16 Scaffolding (Temporary Works) Risk Assessment Templates
Access to work areas by personnel and plant.
Scaffold Material delivery to work area;
Scaffold design and erection standards
(Classified as Temporary Structure)
Scaffold erection
(Classified as Temporary Structure)
Dismantling of scaffold
Maintenance of Scaffold
Worker exposure to direct sun whist working on scaffold
(as applicable)
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:
COLD WORK PERMIT Form # HSEQ - CWP Rev 2.docx
Issue Date: _______________ Permit No: ____________
Permit Requested By: __________________ Company Name: ________________ Permit Accepted By: __________________ Company Name: ________________
Validity From: __________ To: __________
1. Job Location: _____________________________________________________________
2. Job Description: __________________________________________________________
________________________________________________________________________________________________________________________________________________
3 Tools & Materials to be used:
❑Explosive Device ❑Sandblaster ❑Jack hammers
❑Hand Tools ❑Drill ❑Jack hammers
❑Powered Excavation Equipment ❑Powered cutting Saw ❑Ladder/Scaffolding
❑Air Heater ❑LPG Gas ❑Others
4- Details of potential hazards:
❑Falling from height ❑ Material Fall down ❑Skin Exposures
❑Electrocuted ❑ Slip and trip ❑Burn out due to fire/acid etc.
❑Exposure to Eye ❑ Inhalation of any Gas ❑Breathing Problem ❑Others
5- Details of precaution need to be taken:
❑Caution Signage to be placed ❑Proper fixture an erection of Scaffolding/Ladder
❑Excavated Area fencing ❑Electrical Isolation
❑Fire water supply isolation ❑Fire water tanker to be provided
❑Fire Extinguishers to be provided ❑Exhaust fan to be provided
❑Informed security Et Help Desk ❑Other
6- Details of protective equipment to be used or worn:
❑Safety Shoes
❑Safety Helmet
❑Face Shield/Goggle/Glasses
❑Gloves (As per work)
❑Safety harness/Belt/Lifeline
❑Uniform ❑Respiratory Equipment/Dust Mask
❑Chemical Suite/Apron
❑Ear protection
❑Fire Blanket/Protection Sheet
❑Rubber Mat/Ground Fault Interrupter
❑Other
7- Signature of Permit Requestor:
Contact No:-
8- Signature of PTW Acceptor:
Contact No:-
9- Signature of Permit Issuer/HSE Representative:
10- Signature of handover of responsibility between shifts, if needed.
11- Declaration by competent person in -charge of work that work is completed.
12- Signature of Maintenance / works representative ensuring that the work is
completed, site has been checked and that equipment and place may be reinstated / left
Safely isolated.
13- Signature of person issuing the permit / HSE representative which confirms that the
Site has been left in safe condition and the permit is cancelled.
14- Signature of the management representative signing off the permit to work.
REMARKS:-
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
21 confined space working risk assessment templates
21 Confined Space Working Risk Assessment Templates
Planned confined space work in areas where live services may be present including:
• Water;
• Sewerage;
• Gas;
PRIOR TO ENTRY
Confined space working –
• Deep excavations;
• Tanks;
• Vessels;
• Manholes;
• NDRC pits;
• Bridge decks;
• Pipework;
• Sewerage;
• Lift shafts;
• Ducting;
• Etc.
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
1. Project Information:
Project Name: Checklist No.:
Sub-Contractor/Company:
Date:
2. Task Details:
Description of Task:
Location / Area :
Number of Workers:
Task Duration:
Time (from): _______Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites:
Checks Yes-No-NA Checks Yes-No-NA
Safety induction done. ☐ ☐ ☐
Safety tool box talk done. ☐ ☐ ☐
Method statement/Risk assessment in place. ☐ ☐ ☐
Training on Risk Assessment/ Method Statement done ☐ ☐ ☐
Job Safety Analysis done. ☐ ☐ ☐
3 Month Safety Look Ahead in place ☐ ☐ ☐
Permit to Work obtained ☐ ☐ ☐
Site Supervisor available ☐ ☐ ☐
PPE Available ☐ ☐ ☐
Working area is well lighted ☐ ☐ ☐
Tools and equipment inspected and tagged ☐ ☐ ☐
Unsafe conditions rectified ☐ ☐ ☐
Pre-Start Checks completed ☐ ☐ ☐
Emergency procedures communicated ☐ ☐ ☐
Unauthorized workers are cleared from the area.
☐ ☐ ☐
Other ( Specify): ☐ ☐ ☐
4. Acknowledgement by Sub-Contractor:
☐ Acknowledge that all above precautions/ controls measures 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:
Signature: Date /Time
CONCRETE PUMP & EXTENSION PIPELINE Form # HSEQ - CPC Rev 2.docx
Project Information
Project Name: Concrete Pump Reg. No:
Location: Operators Name:
Company Name: Date :
Sr. Description Yes No N/A Comments
1. Concrete Pump 3rd Party Certificate & Registration
2. Sonographic test of all pipes
3. Calibration of all the pressure gauges
4. Operator’s Competency Certificate & Driver’s License
5. Safe distance from the edge of the excavation
6. Outrigger pads are free from damage
7. Outriggers are level
8. Reverse alarm and beacon light are operational
9. Whip arrester on the pipes and pump
10. Safe access for concrete mixer to the area (In/Out)
11. Area properly barricaded and signage posted
12. Hydraulic Oil / Diesel Leakage
13. Extension Pipeline - Free from damage
14. Extension Pipeline -Locking pin in every connection
15. Extension Pipeline - Adequately supported & secured
16. Spillage control measure in place
17. Other accessories e.g. spider pacing boom 3rd party certificate
18. Static pumps positioned properly
19. Static pumps – concrete pipes fixed on structure as per design
20. Concrete pipes coupler pins provided
21. Concrete pipes on floor – away from scaffolds/ formworks
22. Competent banks man and supervision provided
23. Others (Specify)
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader Signature:
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
AUXILIARY CRANE INSPECTION CHECKLIST Form # HSEQ - AC Rev 2.docx
Project Information
Project Name: Tiara Hotel Auxiliary Crane No: 4/3.06/1
Location: Level 3 Date :
3rd Party Inspection of Auxiliary crane valid till: 26 August 2018 3rd Party certificate of operator valid till:
Shift: (This checklist to be completed for both Shifts)
Sr. Description S
(Satisfactory) D
(Deficiency) N/A Comments
1. Availability of Operators Manual and load chart
2. Maintenance Records
3. Operator Competency
4. Rigger Competency
5. Auxiliary Crane Section Condition
6. Structural Welds Physical Condition
7. Tie Bars and Pins
8. Foundation/Ballast
9. Earthing Condition
10. Hoist limits and breaks functioning
11. Slewing Gear
12. Drum and Wire Rope
13. Hook and Safety Latches
14. Main/luffing boom
15. Counter Jib
16. Counter weight secured
17. Pin and Bolts
18. Rope Sheaves
19. Safe Load Indicator
20. Radius Angle Indicator
21. Overload Cut-off device
22. Limit switches
23. Foundation bolts/ anchors
24. Effective means of communication
25. Fire extinguisher
26. Anti-collision system working
27. Valid Third Party Test and Inspection Certificates
28. Others ( Specify)
Remarks:
This checklist to be completed for both Shifts
Operator Name: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader Signature:
31 ndrc operations within excavations (temporary works) risk assessment templ...
31 ndrc operations within excavations (temporary works) risk assessment templ...Dwarika Bhushan Sharma
Planned excavation for NDRC pit in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS
Use of Excavator for excavating NDRC Pit and backfilling
Excavation open in site area
Confined space working – deep excavation for NDRC
NDRC – Thrust boring operation
Pipe electric welding inside pit
HDPE Welding inside pit
Maintenance of NDRC Excavation
Worker exposure to direct sun
(as applicable)
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:
Safety evaluation Best practices-04.11.10
AMANA Best Practices @ SeAH Pipe Mill Project - RAK UAE
Scope: Civil Work, MEP works, Steel Structure, Roof Works, Cladding work
Client: SeAH Steel UAE LLC
Consultant: IEC (International Engineering Center Eng. Conslt.)
EPC Contractor: SECL (SAMSUNG Engineering Corp LTD, S Korea)
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:
22 casting of concrete columns risk assessment templates
Concrete Pump checks on arrival to site
PRIOR TO SITE ACCESS
Formwork for columns
Scaffolding to formwork
Access of mobile pump and delivery trucks to work areas
Siting and setting up of concrete pump
Pumping concrete
(Pump Operator)
6 excavations (temporary works) risk assessment templates
6 Excavations (Temporary Works) Risk Assessment Templates
Planned Excavation in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS
Use of Excavator for excavating and backfilling
Excavation open in site area
Confined space working – deep excavations
Maintenance of Excavations
Worker exposure to direct sun
(as applicable)
25 demolition of existing concrete structures risk assessment templates
Plant checks on arrival to site
PRIOR TO SITE ACCESS • Use of heavy plant for demolition;
Demolition of concrete structure • Excavator breaker operation
• (Operator)Plant / pedestrian interaction;
• Operator visibility;
Demolition (supervision) • Plant operations around workers;
• Workers in plant operating radius;
Undertaking breaking Works – Manual operation using compressed air jack hammers; • Use of hand held breakers;
Removal of waste concrete and rebar • Truck operations around workers;
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
2 fire risk assessment template risk assessment templates
2 Fire Risk Assessment Template Risk Assessment Templates
1. Site set up of temporary offices and cabins
Incl. Fire risk assessment;
2. Use of Portable gas heating or cutting equipment.
(all areas)
3. Electrical equipment (portable and fixed installation)
4. Smoking prevention, controls and arrangements within the Project
5. Hot Works activity controls
(Grinding, Welding, Cutting etc.)
6. Waste disposal: Combustible materials controlled and disposed of correctly.
(E.g. paper, cardboard plastics or wood.)
7. Storage of Flammable Gas within the project
(Acetylene, propane, butane, LPG etc.)
8. Flammable or highly flammable materials or substances on site and point of use.
(e.g. solvents, paints, adhesives, aerosols etc.)
9. Steps to reduce the potential sources of oxygen to a fire.
10. Any operations (or proposed) that may affect the Fire risk assessment
11. Clear access to electrical components and equipment.
12. Suspended ceilings within temporary buildings
(Offices, cabins etc.)
13. Alterations to structure and installations designed to prevent fire spread
14. Arson Prevention
(including security)
15. Smoke/heat detectors installed in high risk areas
16. Fire call points (break glass) installation.
17. Audible/visual fire alarms.
Job safety analysis
What is JSA?
A Job Safety Analysis is a task-oriented risk assessment used to review the hazards associated with a particular work task, and to verify that adequate safeguards are in place to control those hazards.
JSAs are known by a variety of terms, including Job Hazard Analysis (JHA), Job Risk Assessment (JRA), Task Risk Assessment (TRA), Safe Job Analysis (SJA).
Job Safety Analysis and its Implementation
INVOLVE employees in the development
KEEP written JSA short and simple
ILLUSTRATE safe practices
ASSIGN responsibility of JSA
TRAIN all employees and supervisors
EXPLAIN the use of JSA to employees
IMPLEMENT safe work practices
REVIEW JSA when equipment or process changes or new information becomes available regarding potential hazards associated with the job.
Job Safety Analysis For Lifting Activity By Crane | JSA | Gaurav Singh Rajput
Job Safety Analysis For Lifting Activity By Crane | Gaurav Singh Rajput | TBRA | JSA | Risk Assessment
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB.pdf
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB
More Related Content
What's hot
21 confined space working risk assessment templates
21 Confined Space Working Risk Assessment Templates
Planned confined space work in areas where live services may be present including:
• Water;
• Sewerage;
• Gas;
PRIOR TO ENTRY
Confined space working –
• Deep excavations;
• Tanks;
• Vessels;
• Manholes;
• NDRC pits;
• Bridge decks;
• Pipework;
• Sewerage;
• Lift shafts;
• Ducting;
• Etc.
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
1. Project Information:
Project Name: Checklist No.:
Sub-Contractor/Company:
Date:
2. Task Details:
Description of Task:
Location / Area :
Number of Workers:
Task Duration:
Time (from): _______Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites:
Checks Yes-No-NA Checks Yes-No-NA
Safety induction done. ☐ ☐ ☐
Safety tool box talk done. ☐ ☐ ☐
Method statement/Risk assessment in place. ☐ ☐ ☐
Training on Risk Assessment/ Method Statement done ☐ ☐ ☐
Job Safety Analysis done. ☐ ☐ ☐
3 Month Safety Look Ahead in place ☐ ☐ ☐
Permit to Work obtained ☐ ☐ ☐
Site Supervisor available ☐ ☐ ☐
PPE Available ☐ ☐ ☐
Working area is well lighted ☐ ☐ ☐
Tools and equipment inspected and tagged ☐ ☐ ☐
Unsafe conditions rectified ☐ ☐ ☐
Pre-Start Checks completed ☐ ☐ ☐
Emergency procedures communicated ☐ ☐ ☐
Unauthorized workers are cleared from the area.
☐ ☐ ☐
Other ( Specify): ☐ ☐ ☐
4. Acknowledgement by Sub-Contractor:
☐ Acknowledge that all above precautions/ controls measures 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:
Signature: Date /Time
CONCRETE PUMP & EXTENSION PIPELINE Form # HSEQ - CPC Rev 2.docx
Project Information
Project Name: Concrete Pump Reg. No:
Location: Operators Name:
Company Name: Date :
Sr. Description Yes No N/A Comments
1. Concrete Pump 3rd Party Certificate & Registration
2. Sonographic test of all pipes
3. Calibration of all the pressure gauges
4. Operator’s Competency Certificate & Driver’s License
5. Safe distance from the edge of the excavation
6. Outrigger pads are free from damage
7. Outriggers are level
8. Reverse alarm and beacon light are operational
9. Whip arrester on the pipes and pump
10. Safe access for concrete mixer to the area (In/Out)
11. Area properly barricaded and signage posted
12. Hydraulic Oil / Diesel Leakage
13. Extension Pipeline - Free from damage
14. Extension Pipeline -Locking pin in every connection
15. Extension Pipeline - Adequately supported & secured
16. Spillage control measure in place
17. Other accessories e.g. spider pacing boom 3rd party certificate
18. Static pumps positioned properly
19. Static pumps – concrete pipes fixed on structure as per design
20. Concrete pipes coupler pins provided
21. Concrete pipes on floor – away from scaffolds/ formworks
22. Competent banks man and supervision provided
23. Others (Specify)
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader Signature:
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
AUXILIARY CRANE INSPECTION CHECKLIST Form # HSEQ - AC Rev 2.docx
Project Information
Project Name: Tiara Hotel Auxiliary Crane No: 4/3.06/1
Location: Level 3 Date :
3rd Party Inspection of Auxiliary crane valid till: 26 August 2018 3rd Party certificate of operator valid till:
Shift: (This checklist to be completed for both Shifts)
Sr. Description S
(Satisfactory) D
(Deficiency) N/A Comments
1. Availability of Operators Manual and load chart
2. Maintenance Records
3. Operator Competency
4. Rigger Competency
5. Auxiliary Crane Section Condition
6. Structural Welds Physical Condition
7. Tie Bars and Pins
8. Foundation/Ballast
9. Earthing Condition
10. Hoist limits and breaks functioning
11. Slewing Gear
12. Drum and Wire Rope
13. Hook and Safety Latches
14. Main/luffing boom
15. Counter Jib
16. Counter weight secured
17. Pin and Bolts
18. Rope Sheaves
19. Safe Load Indicator
20. Radius Angle Indicator
21. Overload Cut-off device
22. Limit switches
23. Foundation bolts/ anchors
24. Effective means of communication
25. Fire extinguisher
26. Anti-collision system working
27. Valid Third Party Test and Inspection Certificates
28. Others ( Specify)
Remarks:
This checklist to be completed for both Shifts
Operator Name: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader Signature:
31 ndrc operations within excavations (temporary works) risk assessment templ...
31 ndrc operations within excavations (temporary works) risk assessment templ...Dwarika Bhushan Sharma
Planned excavation for NDRC pit in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS
Use of Excavator for excavating NDRC Pit and backfilling
Excavation open in site area
Confined space working – deep excavation for NDRC
NDRC – Thrust boring operation
Pipe electric welding inside pit
HDPE Welding inside pit
Maintenance of NDRC Excavation
Worker exposure to direct sun
(as applicable)
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:
Safety evaluation Best practices-04.11.10
AMANA Best Practices @ SeAH Pipe Mill Project - RAK UAE
Scope: Civil Work, MEP works, Steel Structure, Roof Works, Cladding work
Client: SeAH Steel UAE LLC
Consultant: IEC (International Engineering Center Eng. Conslt.)
EPC Contractor: SECL (SAMSUNG Engineering Corp LTD, S Korea)
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:
22 casting of concrete columns risk assessment templates
Concrete Pump checks on arrival to site
PRIOR TO SITE ACCESS
Formwork for columns
Scaffolding to formwork
Access of mobile pump and delivery trucks to work areas
Siting and setting up of concrete pump
Pumping concrete
(Pump Operator)
6 excavations (temporary works) risk assessment templates
6 Excavations (Temporary Works) Risk Assessment Templates
Planned Excavation in areas where live services may be present including:
• Electrical;
• Water;
• Sewerage;
• Gas;
• Telecoms;
PRIOR TO WORKS
Use of Excavator for excavating and backfilling
Excavation open in site area
Confined space working – deep excavations
Maintenance of Excavations
Worker exposure to direct sun
(as applicable)
25 demolition of existing concrete structures risk assessment templates
Plant checks on arrival to site
PRIOR TO SITE ACCESS • Use of heavy plant for demolition;
Demolition of concrete structure • Excavator breaker operation
• (Operator)Plant / pedestrian interaction;
• Operator visibility;
Demolition (supervision) • Plant operations around workers;
• Workers in plant operating radius;
Undertaking breaking Works – Manual operation using compressed air jack hammers; • Use of hand held breakers;
Removal of waste concrete and rebar • Truck operations around workers;
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
2 fire risk assessment template risk assessment templates
2 Fire Risk Assessment Template Risk Assessment Templates
1. Site set up of temporary offices and cabins
Incl. Fire risk assessment;
2. Use of Portable gas heating or cutting equipment.
(all areas)
3. Electrical equipment (portable and fixed installation)
4. Smoking prevention, controls and arrangements within the Project
5. Hot Works activity controls
(Grinding, Welding, Cutting etc.)
6. Waste disposal: Combustible materials controlled and disposed of correctly.
(E.g. paper, cardboard plastics or wood.)
7. Storage of Flammable Gas within the project
(Acetylene, propane, butane, LPG etc.)
8. Flammable or highly flammable materials or substances on site and point of use.
(e.g. solvents, paints, adhesives, aerosols etc.)
9. Steps to reduce the potential sources of oxygen to a fire.
10. Any operations (or proposed) that may affect the Fire risk assessment
11. Clear access to electrical components and equipment.
12. Suspended ceilings within temporary buildings
(Offices, cabins etc.)
13. Alterations to structure and installations designed to prevent fire spread
14. Arson Prevention
(including security)
15. Smoke/heat detectors installed in high risk areas
16. Fire call points (break glass) installation.
17. Audible/visual fire alarms.
Job safety analysis
What is JSA?
A Job Safety Analysis is a task-oriented risk assessment used to review the hazards associated with a particular work task, and to verify that adequate safeguards are in place to control those hazards.
JSAs are known by a variety of terms, including Job Hazard Analysis (JHA), Job Risk Assessment (JRA), Task Risk Assessment (TRA), Safe Job Analysis (SJA).
Job Safety Analysis and its Implementation
INVOLVE employees in the development
KEEP written JSA short and simple
ILLUSTRATE safe practices
ASSIGN responsibility of JSA
TRAIN all employees and supervisors
EXPLAIN the use of JSA to employees
IMPLEMENT safe work practices
REVIEW JSA when equipment or process changes or new information becomes available regarding potential hazards associated with the job.
Job Safety Analysis For Lifting Activity By Crane | JSA | Gaurav Singh Rajput
Job Safety Analysis For Lifting Activity By Crane | Gaurav Singh Rajput | TBRA | JSA | Risk Assessment
What's hot (20)
21 confined space working risk assessment templates
21 confined space working risk assessment templates
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
SUB CONTRACTORS HSE CHECKLIST Form # HSEQ - SPSC Rev 2 -.docx
CONCRETE PUMP & EXTENSION PIPELINE Form # HSEQ - CPC Rev 2.docx
CONCRETE PUMP & EXTENSION PIPELINE Form # HSEQ - CPC Rev 2.docx
AUXILIARY CRANE INSPECTION CHECKLIST Form # HSEQ - AC Rev 2.docx
AUXILIARY CRANE INSPECTION CHECKLIST Form # HSEQ - AC Rev 2.docx
31 ndrc operations within excavations (temporary works) risk assessment templ...
31 ndrc operations within excavations (temporary works) risk assessment templ...
FULL BODY HARNESS INSPECTION RECORD Form # HSEQ - FBHIR Rev 2.docx
FULL BODY HARNESS INSPECTION RECORD Form # HSEQ - FBHIR Rev 2.docx
PRESSURE TESTING PERMIT Form # HSEQ - PTP Rev 2 -.docx
PRESSURE TESTING PERMIT Form # HSEQ - PTP Rev 2 -.docx
22 casting of concrete columns risk assessment templates
22 casting of concrete columns risk assessment templates
6 excavations (temporary works) risk assessment templates
6 excavations (temporary works) risk assessment templates
25 demolition of existing concrete structures risk assessment templates
25 demolition of existing concrete structures risk assessment templates
CONFINED SPACE ENTRY PERMIT Form # HSEQ - CSE Rev 3.docx
CONFINED SPACE ENTRY PERMIT Form # HSEQ - CSE Rev 3.docx
2 fire risk assessment template risk assessment templates
2 fire risk assessment template risk assessment templates
Job Safety Analysis For Lifting Activity By Crane | JSA | Gaurav Singh Rajput
Job Safety Analysis For Lifting Activity By Crane | JSA | Gaurav Singh Rajput
More from Dwarika Bhushan Sharma
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB.pdf
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB
3-STOP FALLS, CLEAN UP, PICK UP, WIPE UP.pdf
3-STOP FALLS, CLEAN UP, PICK UP, WIPE UP3-STOP FALLS, CLEAN UP, PICK UP, WIPE UP-STOP FALLS, CLEAN UP, PICK UP, WIPE UP
2-THERE'S A SAFE WAY TO DO EVERY JOB, OF YOU DON'T KNOW ASK.pdf
2-THERE'S A SAFE WAY TO DO EVERY JOB, OF YOU DON'T KNOW ASK 2-THERE'S A SAFE WAY TO DO EVERY JOB, OF YOU DON'T KNOW ASK
PRE-START BRIEFING Form # HSEQ - PSB Rev 2 -.docx
Project Information:
Project Name:
Location: Supervisor :
Company name : Date:
Task Description:
Before work starts, the following must be in place
Induction Supervision Test Certificates Communication in same language Method Statement Risk Assessment Permit To Work Area Lighting
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Fall from height Training Access Ladder Access Handrail Edge Protection Secure Ladder Adequate Work Platform Guards for Openings Safety Harness Life Lines
Others( Specify)
Manual Handling Training Check Weight Mechanical Aids Access Route Team Lifting Wrong method Right Method
Power tools Training Color code inspection tag Check Cable Wheel guards Safe plug & sockets Cable Protection Proper Scaffold Cable Overhead Rotatory part guards
Scaffold Scaffold Tag Edge Protection Check Overhead works Access Ladder Adequate Work Platform Weather condition Out riggers Ladder 3 feet above platform Safety Harness
SELECT HAZARDS SELECT CONTROLS
( Tick to identify the controls in place)
Risk Assessment
Lifting Plan Tag Lines Lifting points / hooks Banks man Load stability Check Lifting gear Examination /Inspection Sharp edges protected
Lifting operations Weather/ Wind Speed Ground conditions Exclusion zone Communication Loading/ unloading vehicles Spreader Beams Check Ground conditions Check outriggers Others
Fire Fire Extinguisher Fire Hose Fire Exit Assembly point others
Slip/Trip Clean before you go Barricade the waste Waste Management Clean Access Housekeeping Clean liquid spillage Access signs Maintain access/ Egress
PPE
Safety Harness
Safety Helmet Coveralls Hi vis Jacket Safety Shoe Face Shield Ear Protection
Dust mask Respiratory Equipment Life line/ harness anchorage Hand Gloves Goggles/ Glass
Pre start Briefing done by: Signature:
Reviewed By HSE Manager/ In charge: Signature:
FIRE PREVENTION REQUIREMENTS Form # HSEQ - Rev 2.docx
Code of Practice
C.O.P # 01
Fire Prevention Requirements
(Management of Combustible Materials & Electrical Inspections)
Rev. 01, Mar 23
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
PROJECT:
LOCATION: DATE:
I (name)_____________________________________would like provide my statement as follows on.
I hereby acknowledge that the above statement are true to the best of my recollection, and that these are my very own written down by m myself s others _________Name and Signature________
Name : ____________________________ Signature: ______________________
Position: _________________________________________Date:_________________
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:
LIFT SHAFT ENTRY PERMIT Form # HSEQ - LSEP Rev 2 -.docx
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location:
Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Detail of Surroundings:
Permit Validity:
Time (from): __________Hrs.
Time (To): __________Hrs.
Date:
3. Control Measures: (To be filled by initiator/originator and verified by Evaluator)
Checks Yes-No-NA Checks Yes-No-NA
Method statement & Risk assessment developed, approved & communicated? ☐ ☐ ☐
Availability of rescue procedure and equipment? ☐ ☐ ☐
Operatives are trained and competent? ☐ ☐ ☐
Workplace appropriately illuminated ☐ ☐ ☐
Any high risk activity associated that requires PTW (i.e. hot work, CSE)? ☐ ☐ ☐
Forced ventilation provided? ☐ ☐ ☐
Are all necessary Permit approved and displayed at work location? ☐ ☐ ☐
Means of communication available? (Mobile, radio etc.) ☐ ☐ ☐
Safe access / Working Platform provided? ☐ ☐ ☐
Mandatory/specific good condition PPEs are available ☐ ☐ ☐
Availability of barricades/protection to prevent unauthorized or accidental entry? ☐ ☐ ☐
Life Line provided? ☐ ☐ ☐
Warning signs posted? ☐ ☐ ☐
Fall Protection equipment (e.g. full body harness) available? ☐ ☐ ☐
Availability of Fall protection arrangement? ☐ ☐ ☐
Other(s): ☐ ☐ ☐
Adequate Lighting provided? ☐ ☐ ☐
☐ ☐ ☐
4. Acknowledgement by Initiator and Evaluator:
☐ Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives, and I consider them competent to do it safely.
Initiator/Originator Name: Designation:
Signature: Time:
☐ Acknowledge that I have checked above control measures and consider the work area safe to carry out the activity
Evaluator (HSE Team): Designation:
Signature: Time
Comments (if any):
5. Authorization (PM/CM):
Name: Designation:
Signature: Time:
6. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I have checked the area and been restored to a safe and orderly condition.
Evaluator Signature: Time:
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
1. Project Information: (To be filled by initiator/originator)
Project Name: Permit No.:
Project Location:
Requesting Contractor/Company
2. Permit Issuance Details: (To be filled by initiator/originator)
THIS PERMIT IS ONLY FOR ONE SHIFT AND NOT EXTENDABLE
Description of Task:
Location / Area :
Panel No : Voltage:
Permit Validity:
Time (from): _______Hrs.
Time (To): __________Hrs.
Date:
3. Prerequisites: (To be filled by initiator/originator and verified by Evaluator)
No: Checks Yes-No-NA Checks Yes-No-NA
ENERGIZATION (“Power On”) ISOLATION (“Power Off”)
1. Safety tool box briefing done. ☐ ☐ ☐
Method statement/Risk assessment in place. ☐ ☐ ☐
2. Authorized personnel / operators available. ☐ ☐ ☐
Authorized personnel / operators available. ☐ ☐ ☐
3. Method statement/Risk assessment in place. ☐ ☐ ☐
Adjacent live areas protected. ☐ ☐ ☐
4. Safety Barriers in place and safety signage Displayed. ☐ ☐ ☐
PPE available, high voltage rubber gloves, Safety goggles and floor mat. ☐ ☐ ☐
5. Working area is well lighted. ☐ ☐ ☐
Isolation/Lock-out in place. ☐ ☐ ☐
6. Electrical instruments are available for any Purpose. ☐ ☐ ☐
Electrical circuits “proved” by calibrated Instrument and found out to be no power. ☐ ☐ ☐
7. Correct PPE available, high voltage rubber Gloves, safety goggles and floor mat. ☐ ☐ ☐
Unauthorized workers are cleared from the Area. ☐ ☐ ☐
8. Approved WIR for installation, testing and Termination are attached to the permit. ☐ ☐ ☐
Standby operatives in the event of contact With live circuits. ☐ ☐ ☐
9. Emergency light (Flashlight) available. ☐ ☐ ☐
Emergency light (Flashlight) available. ☐ ☐ ☐
10. Is live work absolutely necessary? ☐ ☐ ☐
Emergency response plan available ☐ ☐ ☐
11. Unauthorized workers are cleared from the area.
☐ ☐ ☐
Other ( Specify): ☒ ☐ ☐
12. Power cable route from panel board to plant & equipment has been checked ☐ ☐ ☐
13 Emergency response plan available ☐ ☐ ☐
14 Other ( Specify): ☐ ☐ ☐
4. Acknowledgement by Initiator and Evaluator:
☐ Acknowledge that all above precautions have been taken. These have also been fully explained to the operatives, and I consider them competent to do it safely.
Initiator/Originator Name: Designation:
Signature: Date /Time:
☐ Acknowledge that I have checked above control measures and consider the work area safe to carry out the activity
Evaluator (HSE Team): Designation:
Signature: Date /Time
Comments (if any):
5. Authorization (PM/CM):
Name: Designation:
Signature: Date /Time:
6. Completion/Cancelation of Permit:
☐ Acknowledge that the area have been restored to a safe and orderly condition.
Initiator Signature: Time:
☐ Acknowledge that I have checked the area and been restored to a safe and orderly condition.
Evaluator Signature: Time:
MOBILE PLANT REGISTER Form # HSEQ - MPR Rev 3.docx
Project Information
Project Name:
Date: Location:
Sr. Equipment type / Name Registration No & Exp Date Company Name
Operator Name / Mb. No Operator Third party competency certificate expiry date Operator License expiry date Equipment & Plant 3rd Party Inspection Certificate expiry date SWL / Capacity Signalman /Rigger name & TPC Exp Comment
1
2
3
4
5
6
7
8
9
10.
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge: Signature:
LABOR ACCOMMODATION CHECKLIST Form # HSEQ - LAC Rev 2.docx
Accommodation Name: Date :
Accommodation Location: Time :
SN Description Yes NO N/A Observation Control
Measures Due Date
ACCESS AND EGRESS
1 Is there segregation between vehicles/ pedestrians
2 Is entry to inside camp restricted to workforce only? How is this controlled
3 Is the entrance well lit
4 Is the entrance free from water pooling
GENERAL HOUSEKEEPING
1 Are there adequate dustbins available? Are they covered
2 Is garbage disposed of on a regular basis?
3 Are toilets wash areas cleaned regular?
4 Is there adequate water for toilet and bath
5 Are water tanks kept covered at all times
6 Is soap and hand towels available?
7 Is bathroom area cleaned on a regular basis and kept dry and non-slippery
8 Is the water tank cleaned on a regular basis
9 Is the laundry area electrical & connections/ wires are in good condition.
10 Is the laundry area kept clean and dry
11 Is the tumble dryer filters cleaned frequently to prevent overheating
SEPTIC TANKS
1 Is the camp on main drainage?
2 If not are septic tanks provided?
3 Are septic tanks fitted with overflow alarm if not how are they prevented from overflowing
4 If septic tank in ground is it in a membrane?
5 If above ground is it protected from being hit by vehicular traffic?
FOOD PREPARATION AREA
1 Is the area kept clean and tidy
2 Are food preparation areas cleaned and free from cracks
3 Are signs for "No smoking" being posted
4 Food waste storage area is cleaned, odour free. Flies area controlled
5 Floor drains are provided in sink area
6 All refrigerators and freezers are working at correct temperatures Refrigerators 1c0 to 4c0
Freezers -14c0 to -18c0
7 Are there temp gauges fitted?
8 Are these temperatures recorded?
9 The Dining and Kitchen areas have an overall clean, tidy and well maintained appearance
10 LPG cylinders are of good conditions (free of damages)
11 Is storage of LPG satisfactory under shed & outside kitchens with no flammable materials nearby
12 Are Piping not perished
13 Are firefighting equipment provided in kitchen area?
LIVING QUARTERS
1 Are Ventilation working well
2 Is lighting suitable
3 Are Emergency numbers being posted in each room
4 Are emergency procedures posted in each room
5 Are Electrical sockets in good condition not damaged & no bare wires are placed in sockets
6 Are sockets overloaded
7 ELCB is provided checks carried out and recorded by
INCIDENT INVESTIGATION REPORT Form # HSEQ - IIR Rev 9 -.docx
INCIDENT INVESTIGATION REPORT
(To be submitted to the HSEQ Corporate Office within 7 days of incident.)
1. Project Information:
Project Name: Click here to enter text.
Report No.: Click here to enter text.
Project Location: Click here to enter text.
Property No.: Click here to enter text.
☐ Fatality ☐ Major Incident ☐ Minor Incident
2. Describe the Incident in detail:
Answer who, what, why, where, when & how in this section: (Attach additional pages if required)
Click here to enter text.
☐ Photos Attached
3. Incident Root Causes:
Describe direct, indirect & root cause: (Attach additional pages if required)
Click here to enter text.
4. Key Corrective Actions to Prevent Recurrence:
Describe the corrective actions with timeframe: (Attach additional pages if required)
Click here to enter text.
5. Key Corrections Taken Immediately after the Incident:
Attach additional pages if more space is required:
Click here to enter text.
6. Witnesses:
I declare that I witnessed the incident and the information provided above is true, correct and complete.
No. Name Designation Signature Date
1. Click here to enter text.
Click here to enter text.
Click here to enter text.
2. Click here to enter text.
Click here to enter text.
Click here to enter text.
7. Incident Information:
Initial Incident Report No.: Click here to enter text.
Date Reported: Click here to enter text.
Date of Incident: Click here to enter text.
Time of Incident: Click here to enter text.
Type of Incident: ☐ Near Miss
☐ Major Environmental Incident
☐ Serious Dangerous Occurrence
☐ Equipment / Property Damage
☐ Medical Treatment Case (MTC)
☐ Restricted Work Case (RWC)
☐ Lost Workday Case (LWC)
☐ Serious Occupational Illness/Disease
☐ Class 1 Injuries
☐ Permanent Partial Disability (PPD)
☐ Permanent Total Disability (PTD)
☐ Fatality (F)
Recordkeeping: ☐ Reportable ☐ Recordable
Incident Location on Site: Click here to enter text.
Applicable Reports: ☐ Police
☐ Medical
☐ Other (Specify)
Click here to enter text.
Attached: ☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
8. Injured Person’s Personal Details:
In case of an incident with more than one injured person, complete the information for each person using separate forms.
Name: Click here to enter text.
Occupation: Click here to enter text.
Company: Click here to enter text.
MB / Oracle No.: Click here to enter text.
Nationality: Click here to enter text.
Date of Birth: Click here to enter text.
Passport Number: Click here to enter text.
Length of Service: Click here to enter text.
Gender: ☐ Male ☐ Female
Labour Card No.: Click here to enter text.
9. Incident Causes Details: To be supported with factual evidence
Immediate Cause
(Unsafe Acts) ☐ Failure to secure
☐ Failure to warn
☐ Removing / Defeating Safety Devices
☐
HSE INDUCTION Form # HSEQ - HSEI Rev 2 -.doc
HSE INDUCTION
(Workers)
Name: _________________________________ Trade: ____________________________
M.B. No./Company Name : ________________
Date of Joining: __________________________
SL. N SUBJECT ON INDUCTION PREVIOUS SAFETY EXPOSURE FURTHER SAFETY TRAINING NEED ANALYSIS
1. Introduction Safety Requirements
2. Working Safety is of Primary Importance
3. General Safety Rules
4. Basic Safety Requirements
5. House Keeping
6. Health, Hygiene & Welfare Facilities
7. Fire Extinguisher / Fire Fighting
8. Emergency Procedure
9. Safety Violations & Penalty
10. Safety Award
11. Manual Handling
Induction Given By: Name: ___________________________
Designation: ___________________________
HSE WARNING LETTER-DISCIPLINARY NOTICE Form # HSEQ - HSEWL Rev 6.doc
1st Warning 0 Ref. No. ______________
2nd Warning 0
3rd Warning 0
4th Warning 0 Date: ________________
Employee’s Name : ______________________________________ M.B No. : __________
Occupation : _____________________________________________________________________
Location / Project Site: _____________________________________________________________________
You have committed the following HSE violation/s:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….….
The employee is hereby warned that if the violation is repeated further disciplinary action can be
taken as per the company Code of Conduct.
ORIGINATOR APPROVED BY (MANAGER IN CHARGE / ARABTEC HSEQ & ORG. RISK Manager)
Name: _______________________________ Name: _____________________________
Designation: _______________________________ Designation: _____________________________
Signature:
_______________________________ Signature:
_____________________________
Employee Acknowledgement:
I the undersigned have received this Safety warning letter / disciplinary notice and I admit that I have understood the contents.
0 Received on: ………………………….. (Date) Signature: ………………………………..…..
OFFICE PORTA CABIN INSPECTION Form # HSEQ - OPC Rev 2.docx
Project Information
Project Name: Porta Cabin No:
Location: Contact Person:
Company Name: Date :
Sr. Description Yes No N/A Comments
1. Emergency exit signs are available in right locations
2. Fire alarms and fire extinguishers are visible and accessible.
3. Fire doors (e.g. in stairways) are kept closed unless equipped with automatic closing device
4. Fire extinguishers are serviced regularly
5. Corridors and stairways are kept free of obstruction
6. Fire escape/ evacuation plan available and posted
7. First aid box available
8. Floor surfaces are kept dry and free of slip hazards
9. Electrical cords and plugs are in good condition with proper Grounding
10. Kitchen equipment checked
11. Fire blanket available in the pantry
12. Heat detector available in the pantry
13. Toilets floor clean and dry
14. Are staff trained to use Fire Extinguishers
15. Hand wash/ soap solution available in the toilet
16. Civil Defense or Authority approval
17. Others if any:
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
MEDICAL REPORT FORM Form # HSEQ - MRF Rev 3 -.docx
MEDICAL REPORT FORM
Day _____________
Date ____________
Time ____________
To: _________________________________________________________________________________________________________
Dear Sir,
We would kindly request you to give necessary treatment to our following employee who had met with an accident and provide us with your diagnosis.
Name of injured __________________________________________________________ Age ( ) years.
Occupation __________________________________________________________ M.B. No. _______________________________
Date of Accident ____________________________________________ Time of Accident __________________________________
Place of Accident (Project Name) _______________________________ Location _________________________________________
Nature of Accident ____________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
First Aider Name: ________________________________ SE Manager/Incharge: ________________________________
Signature: ________________________________ Signature: ________________________________
(If Medical Certificate is attached, this portion is not required.)
MEDICAL REPORT
Nature and extent of Accident / Injury____________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Fit for duty___________________________________________________________________________________________________
Unfit for duty_________________________________________________________________________________________________
Remarks_____________________________________________________________________________________________________
____________________________________________________________________________________________________________
Signature of Medical Officer Date _______________
More from Dwarika Bhushan Sharma (20)
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB.pdf
5 - CLOWNS BELONG IN THE CIRCUS & NOT ON THE JOB.pdf
2-THERE'S A SAFE WAY TO DO EVERY JOB, OF YOU DON'T KNOW ASK.pdf
2-THERE'S A SAFE WAY TO DO EVERY JOB, OF YOU DON'T KNOW ASK.pdf
FIRE PREVENTION REQUIREMENTS Form # HSEQ - Rev 2.docx
FIRE PREVENTION REQUIREMENTS Form # HSEQ - Rev 2.docx
PROJECT LEADER INCIDENT BRIEFING Form # HSEQ - PLIB Rev 2 -.docx
PROJECT LEADER INCIDENT BRIEFING Form # HSEQ - PLIB Rev 2 -.docx
LIFT SHAFT ENTRY PERMIT Form # HSEQ - LSEP Rev 2 -.docx
LIFT SHAFT ENTRY PERMIT Form # HSEQ - LSEP Rev 2 -.docx
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
LIVE ELECTRICAL WORK PERMIT Form # HSEQ - LEP Rev 2.docx
MOBILE PLANT REGISTER Form # HSEQ - MPR Rev 3.docx
MOBILE PLANT REGISTER Form # HSEQ - MPR Rev 3.docx
LABOR ACCOMMODATION CHECKLIST Form # HSEQ - LAC Rev 2.docx
LABOR ACCOMMODATION CHECKLIST Form # HSEQ - LAC Rev 2.docx
INCIDENT INVESTIGATION REPORT Form # HSEQ - IIR Rev 9 -.docx
INCIDENT INVESTIGATION REPORT Form # HSEQ - IIR Rev 9 -.docx
HSE WARNING LETTER-DISCIPLINARY NOTICE Form # HSEQ - HSEWL Rev 6.doc
HSE WARNING LETTER-DISCIPLINARY NOTICE Form # HSEQ - HSEWL Rev 6.doc
OFFICE PORTA CABIN INSPECTION Form # HSEQ - OPC Rev 2.docx
OFFICE PORTA CABIN INSPECTION Form # HSEQ - OPC Rev 2.docx
MEDICAL REPORT FORM Form # HSEQ - MRF Rev 3 -.docx
MEDICAL REPORT FORM Form # HSEQ - MRF Rev 3 -.docx
Recently uploaded
在线办理(ANU毕业证书)澳洲国立大学毕业证录取通知书一模一样
学校原件一模一样【微信：741003700 】《(ANU毕业证书)澳洲国立大学毕业证》【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
Investor-Presentation-Q1FY2024 investor presentation document.pptx
this is the investor presemtaiton document for qurrter 1 2024
Recycled Concrete Aggregate in Construction Part III
Using recycled concrete aggregates (RCA) for pavements is crucial to achieving sustainability. Implementing RCA for new pavement can minimize carbon footprint, conserve natural resources, reduce harmful emissions, and lower life cycle costs. Compared to natural aggregate (NA), RCA pavement has fewer comprehensive studies and sustainability assessments.
Design and Analysis of Algorithms-DP,Backtracking,Graphs,B&B
Dynamic Programming
Backtracking
Techniques for Graphs
Branch and Bound
CW RADAR, FMCW RADAR, FMCW ALTIMETER, AND THEIR PARAMETERS
It consists of cw radar and fmcw radar ,range measurement,if amplifier and fmcw altimeterThe CW radar operates using continuous wave transmission, while the FMCW radar employs frequency-modulated continuous wave technology. Range measurement is a crucial aspect of radar systems, providing information about the distance to a target. The IF amplifier plays a key role in signal processing, amplifying intermediate frequency signals for further analysis. The FMCW altimeter utilizes frequency-modulated continuous wave technology to accurately measure altitude above a reference point.
Final project report on grocery store management system..pdf
In today’s fast-changing business environment, it’s extremely important to be able to respond to client needs in the most effective and timely manner. If your customers wish to see your business online and have instant access to your products or services.
Online Grocery Store is an e-commerce website, which retails various grocery products. This project allows viewing various products available enables registered users to purchase desired products instantly using Paytm, UPI payment processor (Instant Pay) and also can place order by using Cash on Delivery (Pay Later) option. This project provides an easy access to Administrators and Managers to view orders placed using Pay Later and Instant Pay options.
In order to develop an e-commerce website, a number of Technologies must be studied and understood. These include multi-tiered architecture, server and client-side scripting techniques, implementation technologies, programming language (such as PHP, HTML, CSS, JavaScript) and MySQL relational databases. This is a project with the objective to develop a basic website where a consumer is provided with a shopping cart website and also to know about the technologies used to develop such a website.
This document will discuss each of the underlying technologies to create and implement an e- commerce website.
RAT: Retrieval Augmented Thoughts Elicit Context-Aware Reasoning in Long-Hori...
RAT: Retrieval Augmented Thoughts Elicit Context-Aware Reasoning in Long-Horizon Generation
Forklift Classes Overview by Intella Parts
Discover the different forklift classes and their specific applications. Learn how to choose the right forklift for your needs to ensure safety, efficiency, and compliance in your operations.
For more technical information, visit our website https://intellaparts.com
Building Electrical System Design & Installation
Guide for Building Electrical System Design & Installation
6th International Conference on Machine Learning & Applications (CMLA 2024)
6th International Conference on Machine Learning & Applications (CMLA 2024) will provide an excellent international forum for sharing knowledge and results in theory, methodology and applications of on Machine Learning & Applications.
Heap Sort (SS).ppt FOR ENGINEERING GRADUATES, BCA, MCA, MTECH, BSC STUDENTS
HEAP SORT ILLUSTRATED WITH HEAPIFY, BUILD HEAP FOR DYNAMIC ARRAYS.
Heap sort is a comparison-based sorting technique based on Binary Heap data structure. It is similar to the selection sort where we first find the minimum element and place the minimum element at the beginning. Repeat the same process for the remaining elements.
Nuclear Power Economics and Structuring 2024
Title: Nuclear Power Economics and Structuring - 2024 Edition
Produced by: World Nuclear Association Published: April 2024
Report No. 2024/001
© 2024 World Nuclear Association.
Registered in England and Wales, company number 01215741
This report reflects the views
of industry experts but does not
necessarily represent those
of World Nuclear Association’s
individual member organizations.
一比一原版(SFU毕业证)西蒙菲莎大学毕业证成绩单如何办理
SFU毕业证原版定制【微信：176555708】【西蒙菲莎大学毕业证成绩单-学位证】【微信：176555708】（留信学历认证永久存档查询）采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
◆◆◆◆◆ — — — — — — — — 【留学教育】留学归国服务中心 — — — — — -◆◆◆◆◆
【主营项目】
一.毕业证【微信：176555708】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【微信：176555708】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分→ 【关于价格问题（保证一手价格）
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
选择实体注册公司办理，更放心，更安全！我们的承诺：可来公司面谈，可签订合同，会陪同客户一起到教育部认证窗口递交认证材料，客户在教育部官方认证查询网站查询到认证通过结果后付款，不成功不收费！
学历顾问：微信：176555708
Recently uploaded (20)
Investor-Presentation-Q1FY2024 investor presentation document.pptx
Investor-Presentation-Q1FY2024 investor presentation document.pptx
Recycled Concrete Aggregate in Construction Part III
Recycled Concrete Aggregate in Construction Part III
Design and Analysis of Algorithms-DP,Backtracking,Graphs,B&B
Design and Analysis of Algorithms-DP,Backtracking,Graphs,B&B
block diagram and signal flow graph representation
block diagram and signal flow graph representation
CW RADAR, FMCW RADAR, FMCW ALTIMETER, AND THEIR PARAMETERS
CW RADAR, FMCW RADAR, FMCW ALTIMETER, AND THEIR PARAMETERS
Final project report on grocery store management system..pdf
Final project report on grocery store management system..pdf
RAT: Retrieval Augmented Thoughts Elicit Context-Aware Reasoning in Long-Hori...
RAT: Retrieval Augmented Thoughts Elicit Context-Aware Reasoning in Long-Hori...
Planning Of Procurement o different goods and services
Planning Of Procurement o different goods and services
6th International Conference on Machine Learning & Applications (CMLA 2024)
6th International Conference on Machine Learning & Applications (CMLA 2024)
MCQ Soil mechanics questions (Soil shear strength).pdf
MCQ Soil mechanics questions (Soil shear strength).pdf
Heap Sort (SS).ppt FOR ENGINEERING GRADUATES, BCA, MCA, MTECH, BSC STUDENTS
Heap Sort (SS).ppt FOR ENGINEERING GRADUATES, BCA, MCA, MTECH, BSC STUDENTS
Fundamentals of Electric Drives and its applications.pptx
Fundamentals of Electric Drives and its applications.pptx
WORK PERMIT REGISTER Form # HSEQ - WPR Rev 2.docx
- 1. WORK PERMIT REGISTER Page 1 of 1 Form # HSEQ- WPR (Rev 2 - Mar 23) 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: