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SAFETY INDUCTION FORM

PATCO (M) BHD

EMLPLOYEE NAME TRADE NRIC / PASSPORT NO. DATE


1. 1.1 2. 2.1 3. 3.1 4. 4.1 4.3 4.5 4.7 4.9 5. 5.1 5.3 5.5 6. 6.1 6.3 6.5 7. 7.1 8. 8.1 Language Used: B. Malaysia Others

: :

:
Occupational Safety and Health Act 1994 Section 24 ( Briefed ) OSH Policy and Objective Copy of Policy Statement NIOSH Certificate / CIDB Green Card NIOSH Personal Protective Equipment / To Be Used Safety Helmet Shoes / Safety Safety Belt / Harness Ear Plug / Muff Eye Protection Hazards Identification / Risk Assessment Sling / Lifting Operation Panel Erection / Excavation Scaffolding / Netting 5.2 5.4 5.6 Machineries Guarding Housekeeping Material Arrangement 4.2 4.4 4.6 4.8 4.10 Work Attire Welding Shield Dust Mask Respirator Gloves 3.2 CIDB Green Card 2.2 OSH Objective 1.2 Section 25 (Briefed)

Emergency / Response Procedure Accommodation Personal Hygiene Safety Video Presentation Yes / No

6.2 6.4 6.6

Drugs / Alcohol Health / Welfare Security

8.2

English

8.3

Others

I hereby acknowledge to have received a Safety Induction in the language I understand, I duly acknowledge and confirmed that the abovementioned and topics have been covered in the induction attended by me. Inducted by : Name Date : : Signed by : Name Date : :

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