First Aid Box Fill List

Galfar Engineering & Contracting SAOG
Form # HSESP-007-F/01
MANAGEMENT SITE INSPECTION / VISIT REPORT

Job # & Name: Name of Project / Line Manager: Sl # 1 2 3 4 5 6 7 8 9 10 11 DESCRIPTION
HSE Policies are displayed at prominent locations and contents being disseminated through HSE meetings. Hazards involved in project activities are being identified & managed and HEMP Register maintained at site for reference. Company, Customer, Legal & other requirements applicable to the project activities are being monitored regularly for compliance. Project HSE Management Plan and the documents referred therein are available in the project for reference to all concerned. Availablity of resources (human, financial, physical, technology, etc.) to achieve HSE objectives were verified and found adequate. Toolbox Talks being conducted regularly; discussed with employees to confirm its effectiveness. Staff / employees have undergone HSE training identified in HSE Management Plan. Staff / Employees checked at random, are aware of the hazards involved in their jobs and the controls required. HSE Meetings are conducted regularly as planned and the attendence includes sub-contractor (s) / hired employees. Learning points from incidents across the Company are disseminated through HSE meetings. Sub-contractor(s) / hired employees have undergone site HSE induction and comply with site HSE requirements.
Date: Location: YES NO NA REMARKS
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12 Any incident, NCR, CAR - pending action in the project and not closed out? 13
Structured inspections are conducted by site personnel to identify / rectify unsafe acts / conditions.
14 Appropriate warning signs / barricades are provided at sites. 15 Visited the camp / mess and found maintained in good order. 16 Housekeeping at site & camp found satisfactory. 17 18
Employees checked at random, are aware of their 'Empowerment To Work Safely & To Stop When It Is Not Safe'. Employees checked at random are aware of the action to be taken in case of any emergency.
Comments, if any:
Inspection carried out by: _____________________________________Signature: _______________________ Designation : _________________________________________ Date : ____________________ Note: Project / Line Manager concerned shall ensure that the actions needed are captured in Action Tracking Register for necessary follow-up & close-out and timely completion of actions. Copies to be retained by: Project / Line Manager concerned and Unit HSE Manager 1 of 34
Galfar Engineering & Contracting SAOG.
CAMP INSPECTION CHECKLIST

Location: Job # & Name: Inspected By: Sl # 1.0 1.1 1.2 1.3 1.4 1.5 1.6 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Description LIVING ACCOMODATION Sound construction that provides protection against pests & adverse weather conditions. Air-conditioners are provided and are in good working condition. Sufficient lighting provided in the rooms. Furnished with cot, mattresses, pillow, bedsheet, blanket, cupboards, etc. Electrical leads / connections are appropriate and are in good condition. Good housekeeping is maintained in the rooms. KITCHEN & GAS CYLINDER STORAGE Spacious and maintained in clean & tidy condition. Well ventilated and properly illuminated. Air-conditioned and hoods are fixed over cooking ranges / exhaust fans provided and in good order. Floor is durable, non-absorbent, non-slippery and without any crevices. Doors are tight-fitting and self-closing. Windows are provided with fly screens. Insect-o-cutors are provided and maintained in good condition. Fire extinguishers & blankets are properly maintained. First Aid box is available with appropriate contents. Trained personnel available for operation of fire extinguishers and basic first aid. Kitchen crew wear uniforms, aprons, caps and non-slip footwear. Kitchen crew is aware of the actions to be taken in case of any emergency. Medical examination for cooks / helpers are up-to date. Kitchen crew is trained in personal & food hygiene. Gas stoves / burners are firmly positioned, connections / hoses are properly maintained. Full & empty cylinders are stored separately, secured in upright position. Emergency shut down valve for gas cylinders is properly marked and easily accessible. Cylinder manufacturing / test details marked and valid. Cylinders stored in designated area, protected from direct sunlight away from sources of flame. Smoking prohibited; warning signs provided, suitable fire extinguishers available in the vicinity. Adequate dish washing facility, cleaning solution are available with proper drainage system. Yes Accompanied By: No NA Remarks Date & Time:
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Camp Inspection Checklist
Sl #
Description
Yes
No
NA
Remarks
Separate chopping boards are available for 2.21 LIVING ACCOMODATION vegetables, mutton / chicken, fish, etc. Cooked food is stored separately from raw food 2.22 stuff, in utensils with proper lids. 3.0 3.1 FOOD STORAGE (DRY & COLD)
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Air-conditioned and provided with sufficient lighting. Spacious to store sufficient food stuff with safe 3.2 access. Store is maintained clean & dry, free from any 3.3 spillage and pests. Raw food stuff are stored on racks / shelves / 3.4 benches and not kept on the floor. Loose grains / flour, etc are stored in proper 3.5 containers with lids and not left open. Expiry date is clearly marked and stock rotation is 3.6 maintained through 'First In; First Out' basis. Adequate cold storage / refrigeration equipment 3.7 are provided and maintained in good condition. Fish, chicken and meat are properly wrapped and 3.8 stored in separate deep freezers. Refrigerators are kept clean and side walls free 3.9 from frozen ice. Thermometers are in place in the cold storages 3.10 and temperatures are recorded twice daily. Food samples of each prepared item is marked 3.11 and kept in the fridge in proper containers. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 5.0 5.1 5.2 5.3 5.4 6.0 6.1 6.2 6.3 DINING HALL Air-conditioned with sufficient lighting. Spacious and sufficient seating arrangements are provided. Doors are tight-fitting and self-closing. Windows are provided with fly screens. Adequate wash basins with liquid soaps and towel are provided. Insect-o-cutors are provided and maintained in good condition. Fire exits / escape routes are properly marked. Fire extinguishers are provided and properly maintained. Dining tables, floor, sidewalls, etc. are well maintained, hygienically. WATER Water used in the camp is brought from company approved sources. Water storage tanks are provided with safe access, platform with handrails for safe cleaning. Water storage tanks are cleaned every month and next due date for cleaning is marked clearly. Records available for proper purification / chlorination of water used for domestic use. SANITARY FACILITIES Adequate sanitary facilities are provided that includes, toilets, showers, washbasins, etc. Such facilities are maintained clean, non-slippery, dis-infected and with no foul smell. Proper doors, window opening to outside air or exhaust ventilation are provided.
Sl # 6.4 6.5 6.6 6.7 7.0 7.1 7.2 7.3 8.0 8.1 8.2 8.3 8.4 8.5 9.0 9.1 9.2 9.3 9.4
Description Sufficient lighting provided in and around such LIVING ACCOMODATION facilities. Both cold & hot water facilities are available in all showers and washbasins Bucket, mug, etc are provided in the facilites. Drainage system is proper without any choking / no accumulation of water in the floor. WASTE DISPOSAL Wastes from mess, accommodation are collected in closed plastic drums at fixed point. Waste collection point is emptied periodically to the disposal yard without getting accumulated. The waste collection point is maintained neat & clean. EMERGENCY PREPAREDNESS Inmates are aware of the procedure to be followed in case of any emergency. Fire bell / alarm for evacuation, assembly point, escape routes are provided and clearly marked. Fire extinguishers are provided in easily accessible locations and properly maintained. Designated fire fighters are available to tackle any fire at its initial stages. Trained first aider and an emergency vehicle are available for medical emergencies. GENERAL All electrical installations are properly guarded and earthed. Laundry facility / sufficient space for washing & drying is provided and maintained clean. Sufficient lighting is provided in the camp premises. Insecticides are sprayed periodically and records are available.
Yes
No
NA
Remarks
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INSPECTION RESULT- Possible Score: ______, Actual Score: ______, % Achieved: _______
Guidelines: (a.) Each 'Yes' will score one point (b.) Possible score = Total No. of applicable points x 1 (c.) Actual Score against the applicable points and the % achieved, to be established for each inspection event. Comments, if any:
Inspection carried out by: ______________________________________ Signature with date: _________________ Agreed date for action completion : ______________________ Forward report to Camp Boss & Line Manager responsible for actions to be taken considering level of intervention required. Report Forwarded To: 1.) ____________________________________ 2.) __________________________________ (To be signed by the Camp Boss / Line Manager concerned on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed Name: ______________________________________ Signature: ___________________________ Date: __________
Copies to be retained by: Camp Boss, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.
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OFFICE INSPECTION CHECKLIST

Location: Job # & Name: Inspected By: Sl # Description Yes Accompanied By: No NA Remarks Date & Time:
1.0 OFFICE CONSTRUCTION, LAYOUT & MAINTENANCE 1.1 1.2 1.3 1.4 1.5 Sound construction that provides protection against pests & adverse weather conditions. Floor is durable, non-absorbent, non-slippery and without any crevices. Doors are tight-fitting and self-closing (right tension); Windows are provided with curtains / blinds. Doors are provided with transparent sections to enable vision when the door is handled from other side. Air-conditioners provided and are in good working condition.
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1.6 Sufficient lighting provided in cabins & corridors. 1.7 Corridors are free from spills, litter & obstacles. 1.8 Spacious and maintained in clean & tidy condition. 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 2.0 Good housekeeping is maintained in all cabins / workstations. Workstations (Chairs, VDUs, etc.) are ergonomically designed & appropriately positioned. Sufficient & stable shelves & cabinats are provided for storage of files / documents & other materials. Heavy items are stored in the bottom of shelves & cabinats and are kept closed when unattended. Safe access available for materials stored, within easy reach without the need for stretching. Stairs are slip free, well lit, provided with handrails and maintained clear of spills and litter. Photocopiers are kept away from workstations in well ventilated areas for to clear-off harmful fumes. Combustible material not stored near electrical appliances / heat sources. Electrical leads / connections are appropriate and are in good condition. Three pronged plugs are used for electrical appliances; power sockets are not overloaded. Extension cords are used safely; cables are not kinked and clear of walkways. PANTRY / DINING
2.1 Air-conditioned and provided with sufficient lighting. Doors are tight-fitting and self-closing. Windows are provided with curtains / blinds. Electrical leads / connections / kettles are appropriate 2.3 and are in good condition. 2.2 2.4 Spacious to store sufficient food stuff with safe access. Spacious and sufficient seating arrangements are provided. Dining tables, floor, sidewalls, etc. are well maintained, 2.6 hygienically. 2.5 Office Inspection Checklist
Galfar Engineering & Contracting SAOG Sl # Description Yes No NA
Form # HSESP-007-F/03 Remarks
Maintained clean & dry, free from any spillage and 2.7 OFFICE CONSTRUCTION, LAYOUT & MAINTENANCE pests. Refrigerators are kept clean and side walls free from 2.8 frozen ice. Adequate dish washing facility, cleaning solution are 2.9 available with proper drainage system. Adequate wash basins with liquid soaps, tissue rolls 2.10 are provided. 2.11 Insect-o-cutors are provided and in good condition. 2.12 Office Assistanct / Person responsible for Pantry / Dining area is trained in hygiene aspects. 3.0 WATER 3.1 3.2 3.3 3.4 3.5 4.0 4.1 Drinking Water used in the office is brought from Company approved source. Suffficient glasses (hygienically maintained or disposable) are provided for drinking water. Water used for other domestic purposes is brought from company approved sources. Water storage tanks are provided with safe access, platform with handrails for safe cleaning. Water storage tanks are cleaned regularly and next due date for cleaning is marked clearly. SANITARY FACILITIES
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Adequate sanitary facilities are provided that includes urinals, toilets & washbasins, etc. Such facilities are maintained clean, non-slippery, dis4.2 infected and with no foul smell. Proper doors, window opening to outside air or exhaust 4.3 ventilation are provided. 4.4 Sufficient lighting provided in and around such facilities. Both cold & hot water facilities are available in the washbasins Tissue rolls / bucket, mug, etc are provided in the 4.6 facilites. Drainage system is proper without any choking / no 4.7 accumulation of water in the floor. 5.0 WASTE DISPOSAL 4.5 Waste / litter collection bins provided at several locations in the office. Waste collection point is emptied periodically to the 5.2 disposal yard without getting accumulated. 5.1 5.3 The waste collection point is maintained neat & clean. 6.0 EMERGENCY PREPAREDNESS 6.1 6.2 6.3 6.4 6.5 6.6 Fire detectors / bell / alarm are provided for early warning in event of fire. Fire extinguishers / hose reels and other fire fighting equipment are provided & properly maintained. Fire extinguishers provided are suitable to the fire hazard involved / type of fire possible. Escape routes, fire exits, assembly points are designated, signposted and kept clear of obstacles. Fire fighting equipment are at easily accessible locations and clear of obstacles. First aid box is available at easily accessiible locations with appropriate contents.
Office Inspection Checklist
Sl #
Description
Yes
No
NA
Remarks
CONSTRUCTION, & MAINTENANCE 6.7 OFFICE Emergency Response TeamLAYOUT established & maintained. 6.8 6.9 6.10 6.11 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Designated fire fighters & first aiders are available for basic fire fighting / first aid. Identity of fire fighters / first aiders and their contact details are displayed at prominent locations. Emergency numbers to be contacted (ROP / Civil Defence / Hospitals) are displayed prominently. Staff aware of the actions to be taken in case of any emergency. GENERAL Electrical installations are properly guarded and earthed. Sufficient parking area provided, clearly marked & illuminated. Access control systems implemented to prevent unauthorised access into the premises. Office premises properly signposted to guide the staff & other visitors. Visitors are provided with relevant briefing and / or accompanied during their presence in office premises. Insecticides spray carried our periodically around the office premises.
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INSPECTION RESULT- Possible Score: ______, Actual Score: ______, % Achieved: _______
Inspection carried out by: ______________________________________Signature with date:______________ Agreed date for action completion : ______________________ Forward report to Line Manager responsible for actions to be taken considering level of intervention required.
Report Forwarded To: 1.) ____________________________________ 2.) _______________________________ (To be signed by the Line Manager concerned on completion of action and returned to the function who carried out the inspection, for close-out)
Actions identifed above have been completed Name: ______________________________________ Signature: ______________________ Date: __________ Copies to be retained by: Line Manager, Function who carried out the inspection / HSE Advisor concerned. Office Inspection Checklist Page 7 of 34
WORKSITE INSPECTION REPORT

Location: Job # & Name: Inspected By: Sl # 1.0 TOOL BOX MEETING 1.1 Tool box meeting conducted and is based on Hazards involved in the job. Description Accompanied By: Yes No NA Remarks Date & Time:
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1.2 Crew aware of the job being carried out and related hazards 2.0 PERSONNEL 2.1 Have personnel undergone necessary HSE Training? 2.2 Are personnel employed fit for the job being performed? Are the drivers / operators in possession of valid ROP 2.3 license, Customer / Galfar driving / operating permit? 3.0 PERSONAL PROTECTIVE EQUIPMENT Are personnel trained in the use of, provided with and wearing PPE required for the activity being carried out? 4.0 FIRST AID 3.1 4.1 Trained First Aiders and First Aid Box are available at site. 5.0 FIRE FIGHTING 5.1 Suitable fire extinguisher having valid inspection stickers are available at the site.
5.2 Are the personnel trained in use of fire extinguishers? 6.0 WARNING SIGN DISPLAY 6.1 Appropriate Notices / Warning Signs are provided? 6.2 Are necessary barricading provided? 7.0 PERMIT TO WORK 7.1 PTW, applicable for the task is available at site. 7.2 Permit Holder, approved by the customer is available at site Work Crew, is aware of the PTW and adhere to its requirements. 8.0 HAND / POWER TOOLS 7.3 8.1 Tools are maintained in good condition. The hand / power tools are used / operated by trained and 8.2 authorised personnel. 8.3 Are the tools stored in designated storage areas, after use? 9.0 FIXED EQUIPMENT 9.1 All moving parts of the equipment are provided with adequate guards.
Worksite Inspection Checklist
Sl #
Description
Yes
No
NA
Remarks
All electric connections are as per applicable / acceptable 9.2 TOOL BOX MEETING standards. 10.0 VEHICLE / EQUIPMENT 10.1 The vehicles / equipment have necessary valid certification. Necessary warning devices are fitted in the vehicle / 10.2 equipment and are in working condition. 10.3 Daily checks are carried out by the drivers / operators. Periodic maintenance and servicing for the vehicle / 10.4 equipment are carried out. Seat belts are in working condition and are worn by the driver 10.5 / operator / passengers. 10.6 Banksman is provided for the operation of plant / equipment. Work area is kept clear of obstruction, for the safe movement / operation of vehicle / equipment. Lifting accessories have valid certification and are in good 10.8 physical condition, without any visible damages. 10.7 10.9 The lifting accessories are colour coded and SWL identifiable. 11.0 WORKING AT HEIGHT 11.1 11.2 11.3 11.4 11.5 12.0 12.1 Adequate scaffolding / ladder are provided for safe access to all part of work situated 1.5 M or more above ground level. The scaffolding used, is inspected and certified by a competent person. Safety Harness is used while working at height greater than 2 M. Only authorised / trained personnel are engaged for working at height. Tools / equipment are kept in such a way that they do not pose any tripping hazard, on the work platforms. OVERHEAD LINE
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All necessary precautions considered and are the personnel are aware of hazards involved in it? Is necessary approval / clearance, obtained from the 12.2 authorities concerned? 13.0 TRENCHING & EXCAVATION 13.1 13.2 13.3 13.4 13.5 13.6 13.7 14.0 14.1 Excavation areas are barricaded and adequate warning signs displayed. Presence of any underground utilities / services is ascertained before commencing the activity. Suitable means of access and egress are provided for personnel working in deep excavations. Excavated material is stored atleast 1 mtr., from the edge of the excavation to prevent falling back into the trench. Is adequate shoring / sloping to a safe angle of repose provided, to prevent collapse of the side walls? Personnel / vehicle / equipment, are protected from moving close to the edge of the trench / excavation. Adequate temporary crossings are provided for persons to cross over safely. WELDING & CUTTING Welders are provided with face shields and aprons in addition to the other PPE required.
Sl #
Description
Yes
No
NA
Remarks
Fire resistant screens are provided to shield the persons 14.2 TOOL BOX MEETING working nearby, from the welding arc. Welding / cutting sets, gas cylinders & accessories are 14.3 maintained in safe working condition. 14.4 No flammable material or any wastes are found in the vicinity. 14.5 Fire watch available at site. 15.0 HOUSEKEEPING 15.1 Is good housekeeping maintained at work site? Suitable arrangement for waste collection / disposal are provided. Suitable space is maintained for storing materials, without 15.3 posing any hazard? 16.0 EMERGENCY RESPONSE 15.2 Are personal aware of emergency telephone number and action to be taken in case of emergency? Is safe access and exit available at the work site, for use in 16.2 case of any emergency? 17.0 GENERAL 16.1 17.1 17.2 17.3 17.4 17.5 17.6 17.7 Supervisors / Crew Leaders are aware of and can access the Project HSE Plan and documents referenced therein. Are personnel aware of their Empowerment To Stop Unsafe Work? Necessary precautions are taken for working in hazardous areas / handling hazardous substances. Noise level at work site is within acceptable limits and protective devices are provided. Are the personnel aware of the Health hazards in their activities and take necessary precautions for the same? Working hours of the personnel engaged are as per the laid down standards. Are adequate toilet / rest, water facility, provided at the work area?
INSPECTION RESULT - Possible Score: ____, Actual Score: ____, % Achieved: _____
Inspection carried out by: _____________________________________ Signature with date: _____________ Agreed date for action completion : ______________________ Forward report to Line Manager / Engineer / Supervisor concerned, considering level of intervention required. Report Forwarded To: 1.) ____________________________________ 2.) _____________________________ (To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed Name: _____________________________________Signature: ________________________ Date: __________
Copies to be retained by: Line Mgr. / Engineer / Supervisor, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.
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WORKSHOP / INDUSTRIAL / STORAGE YARD INSPECTION CHECKLIST

Location: Job # & Name: Inspected By: Sl # Description Yes Accompanied By: No NA Date & Time:
1.0 FACILITY LAYOUT & MAINTENANCE 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Adequate space is provided for easy entry & exit of vehicles / equipment and for its movement inside. Each activity is performed in a designated area such that the activity doesn't interfere with the other. Segregated & adequate storage areas for different kind of materials. Walkways are clearly defined, marked and are unobstructed. Requirement to wear PPE and other necessary HSE related information are displayed prominently. Employees are provided with / aware of the proper usage of PPE required for the job being carried out. Adequate lighting and ventilation are provided in all work places. All work benches / surfaces are fit for the purpose with sound construction and adequate safety.
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1.9 Provision for drinking water is available in the work area. Adequate toilet facilities are provided for the employees in the premises. Provision is made for collection, segregated storage and 1.11 disposal of wastes generated from the workplace. Good housekeeping is maintained in the yard / workshop 1.12 premises. 1.10 2.0 EMERGENCY PREPAREDNESS 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Eye wash facility is provided wherever required and are maintained in good condition. Adequate number of fire extinguishers & first aid boxes provided at strategic locations. Emergency escape routes, assembly point, first aid / fire fighting arrangement are clearly displayed. Escape routes, alarm points, first aid kits, fire extinguishers, etc are kept clear and in good order. Designated fire fighters are available to tackle any fire at its initial stages. Trained first aider and an emergency vehicle are available for medical emergencies. Personnel are aware of the action to be taken in case of any emergency.
3.0 HAND / PORTABLE POWER TOOLS Tools are subjected to periodical inspections and maintenance as per manufacturer's guidelines. Use of tools are strictly controlled and access allowed only 3.2 to authorised persons. Tools are carried in suitable containers and are stored in 3.3 designated places when not in use. 3.1 WS / Industrial / Storage Yard Inspection Checklist
Sl # 3.4
Description
Yes
No
NA
Personnel are aware the safe operating methods of the FACILITY LAYOUT & of MAINTENANCE tools and its maintenance. Cables, hoses, joints, etc are free from any visible damage 3.5 or defects. Plug adaptors are not in use. Tools are provided with 3.6 appropriate plugs to fit in the socket. 4.0 FIXED POWER TOOLS / EQUIPMENT 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Fixed equipment are subjected to periodical inspections and maintenance as per manufacturer's guidelines. Electrically powered equipment are properly earthed and are provided with circuit breakers for isolation. Moving parts of the equipment are provided with appropriate guards to prevent personal injury. Signboard indicating the PPE required for the safe operation of that equipment is displayed prominently. Temporary / permanent screens are provided around the equipment to protect personnel working nearby. Job pieces are adequately secured to prevent any injury due to kickback while drilling, grinding, etc. Small tongs / fixtures are used to hold jobs while grinding or drilling, instead of holding it in hand. Circular saws are provided with both fixed guard over the upper half and a movable guard on lower half. Long handled brushes are used to clean the equipment and not by hands or air nozzles.
5.0 WELDING & CUTTING Welding & Cutting activities are carried out only by authorised persons and in dedicated areas. Welders are provided with face shields and aprons in 5.2 addition to the other PPE required. No flammable material or any wastes are found in the 5.3 vicinity. Fire resistant screens are provided to shield the persons 5.4 working nearby, from the welding arc. 5.1 5.5 Power cables are properly protected and earthed. 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 Earth connections are bolted / clamped directly to the job to ensure good electrical contact. Welding electrodes are kept properly in appropriate containers. Welding / cutting sets are equipped with flash back arrestors & check valves and are in good condition. Gas cylinders are colour coded and are with punch marks showing cylinder identification & validity details. Hoses and couplings are free from damage, securely fastened and are laid properly without posing any risk Cylinders are fitted with pressure regulators along with high and low pressure manometers. Fling guns or piezo-electric igniters are used to ignite the torch and not matches or smouldering ropes. Cylinders are stored in upright position and secured with chain and hook.
6.0 ABRASIVE BLASTING
WS / Industrial / Storage Yard Inspection Checklist
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Sl # 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8
Description Designated blasting& area away from other activities is FACILITY LAYOUT MAINTENANCE maintained where only authorised persons can enter. Adequate warning signs are displayed to keep personnel informed about the blasting operation. Blasting tool is fitted with self-releasing valve to cut-off air & grit supply when the operator loses his grip. Lid of the blasting pot is in position and not opened during blasting operation. Couplings on the air hose are secured properly to prevent accidental dis-connection under pressure. Personnel engaged in blasting are provided with adequate PPE like, blasting hood, protective suit, etc. Blasters are effectively monitored / supervised to ensure their safety and that of the operation. Waste grit is removed frequently to avoid the hazard of exposure of personnel to the waste grit.
Yes
No
NA
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7.0 SPRAY PAINTING Spray painting is carried out in detached area, away from other activities. Adequate space & ventilation are provided to prevent 7.2 formation of explosive mixtures of vapour and air. Regular cleaning schedule is maintained to eliminate the 7.3 possibility of fire due to spray deposits. Spray gun, pot and the hose connections are free from any 7.4 defects / damages. 7.1 7.5 Spray pot is earthed against generation of static electricity. Painting area is free from any naked flame or ignition sources. Painters are provided with adequate PPE like, face shield, 7.7 respiratory masks, etc and are well maintained Adequate precautions are taken to avoid entry of harmful 7.8 aerosols into the body. 7.6 8.0 BATTERY CHARGING & STORAGE 8.1 8.2 8.3 8.4 8.5 Adequate ventilation is provided in the charging area for rapid dispersion of any flammable hydrogen gas. Separate racks are provided for keeping charged and uncharged batteries, 1 mtr away from charging bench. Electrically connections are properly maintained and the supply to battery is securely clamped. Adequate provisions for draining, collection & proper disposal of battery acid. SHOC card of electrolyte is displayed and adequate PPE are worn by personnel concerned.
9.0 HANDLING & STORAGE OF GAS CYLINDERS Date of manufacture / last date of pressure test marked and valid. Details of the gas stored are legibly marked in the cylinder 9.2 and appropriately coloured. Cylinder valve assemblies in good condition, protective cap 9.3 in place. Cylinders lifted using flat band slings; 9.4 (chains or metal slings not used). 9.1 WS / Industrial / Storage Yard Inspection Checklist
Sl # 9.5
Description
Yes
No
NA
Cylinders transported in designated vehicles, in upright FACILITYare LAYOUT & MAINTENANCE position. Cylinders are stored in designated areas protected from 9.6 direct sunlight with name of gas displayed prominently. Flammable gases are segregated from oxidising gases (6m 9.7 away or by fire resistant wall). 9.8 Empty and full cylinders are stored separately. Cylinders are stored in upright position and secured with chain and hook. Location free from flammable substances; naked flames / 9.10 smoking prohibited in the vicinity. Gas cylinders handled only by authorised personnel aware 9.11 of its properties. 9.9 9.12 Gas cylinder trolleys used for movement of cylinders 9.13 Warning signs, suitable fire extinguishers provided in the vicinity.
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10.0 HANDLING & STORAGE OF FUEL, OIL AND OTHER CHEMICALS Fuel, oil & other chemicals are stored in designated areas, segregated from each other when not compatible. Secondary containment facility provided for storage and is 10.2 adequate for the quantity stored. 10.1 10.3 Chemicals stored are protected from direct sunlight. 10.4 Containers with volatile compounds are kept closed. Arrangements in place for immediate clean-up in case of any spillage. MSDS of the material stored are available in the vicinity and 10.6 the personnel handling are aware of its contents. 10.5
INSPECTION RESULT - Possible Score: ____, Actual Score: ____, % Achieved: ______
Guidelines: (a.) Each 'Yes' will score one point (b.) Possible score = Total No. of applicable points x 1 (c.) Actual Score ag the applicable points and the % achieved, to be established for each inspection event. Comments, if any:
Inspection carried out by: __________________________________
Signature with date: ____________
Agreed date for action completion : ______________________ Forward report to Line Manager / Engineer / Supervisor concerned, considering level of intervention requ
Report Forwarded To: 1.) ________________________________ 2.) ______________________________ (To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned function who carried out the inspection, for close-out) Actions identifed above have been completed
Name: ___________________________________ Signature: __________________________ Date: ____

Page 14 of 34
RKSHOP / INDUSTRIAL / STORAGE YARD INSPECTION CHECKLIST
Accompanied By: Remarks
YOUT & MAINTENANCE
PREPAREDNESS
ABLE POWER TOOLS
Page 15 of 34
Remarks
YOUT & MAINTENANCE
R TOOLS / EQUIPMENT
CUTTING
LASTING
Page 16 of 34
Remarks
YOUT & MAINTENANCE
ING
ARGING & STORAGE
STORAGE OF GAS CYLINDERS
Page 17 of 34
Remarks
YOUT & MAINTENANCE
STORAGE OF FUEL, OIL AND OTHER CHEMICALS
ESULT - Possible Score: ____, Actual Score: ____, % Achieved: ______
core one point (b.) Possible score = Total No. of applicable points x 1 (c.) Actual Score against s and the % achieved, to be established for each inspection event.
out by: __________________________________
Signature with date: ________________
tion completion : ______________________ to Line Manager / Engineer / Supervisor concerned, considering level of intervention required.
To: 1.) ________________________________ 2.) ___________________________________ the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed
_________________________ Signature: __________________________ Date: __________
y: Line Mgr. / Engineer / Supervisor, Function who carried out the inspection / HSE Advisory Staff in the Project / Unit.
Page 18 of 34
VEHICLE INSPECTION / ROAD SAFETY CHECKLIST

Vehicle Make, Regn # / CC #: Job # & Name: Inspected By: Sl # Description Date & Time: Location: Accompanied By: Yes No NA
1.0 Vehicle Condition - A (visual / practical checks) 1.1 Seat Belts - fitted / in good condition / locking mechanism functioning properly.
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Page 19 of 34
1.2 Rollover Bar fitted (for LVs only) Tyre condition - not worn, tread not less than 1/16 inch, no 1.3 deep cracks / visible damages / embedded objects in between treads, right pressure (as marked on wheel arch) Speed limiter - fitted & functioning properly (80 - 100 / 120 1.4 Kmph). Head lamps (both in low & high beam), indicators and high 1.5 intensity rear lights are in proper working condition. 1.6 Brake lights / rotating amber lights functioning properly. 1.7 Windscreen / mirrors are clean, in good condition, no cracks and are positioned properly / wiper in working condition.
1.8 Seats are in good condition & suitably positioned. 1.9 Fire Extinguishers / First Aid Box secured & maintained in proper order.
1.10 Air Conditioner fitted and in good working condition. 1.11 Reverse Alarm / Horn fitted and in working condition. Spare wheels available as required (2 in interior LVs and 1 in others). Wheel chocks, Jack, necessary tools, hazard warning triangle, 1.13 etc., are available in the vehicle. Odometer, fuel / oil gauges & other instruments working 1.14 properly. 1.12 1.15 Fuel / oil / other fluids from the vehicle not found leaking. 1.16 Noise and exhaust emissions are within normal levels. 1.17 General cleanliness of the vehicle found satisfactory. 1.18 Others (specify):
2.0 Vehicle Condition - B (check with the Driver; complaints shall be communicated to Supervisor conc 2.1 Steering 2.2 Engine 2.3 Transmission 2.4 Suspension 2.5 Braking 2.6 Others (specify):
Vehicle Inspection Checklist
Galfar Engineering & Contracting SAOG Sl # Description
Form # HSESP-007-F/06 Yes No NA
Vehicle Condition - A (visual / practical checks) Compliance 3.0 Procedural 3.1 Safe Journey Management Plan 3.2 Valid Driving Permit available with the Driver 3.3 Vehicle Registration Copy, Minor RTA Form available in the vehicle.
3.4 Health Certificate for the Driver available (for water tankers) MSDS / TREM Card (transporting harzardous substance) available and the Driver aware of the contents. Vehicle maintenance / inspection stickers are available and 3.6 valid. Lifting equipment / mobile cranes - inspection / load test 3.7 particulars available and valid. Cabin / passenger compartment are free from loose materials 3.8 that can pose a risk. 3.5 3.9 Load within limits and well secured. 3.10 Others (specify): 4.0 Driver Behaviour 4.1 Wearing seat belts (including passengers) 4.2 Tailgating / Unsafe overtaking 4.3 Unsafe speed (High / Low) 4.4 Dangerous manoeuvres 4.5 Passengers beyond authorised capacity 4.6 Driving without due care & attention 4.7 Wearing coverall / safety shoes (professional drivers) 4.8 Others (specify):
Important Note: 1.) Vehicles found with defects that have high potential to cause an incident such as in Sl # 1.1 1.3, 1.4, 2.0 and 3.8, shall either be stopped for repair / rectification on the spot or instructed to be escorted to ne workshop in consultation with the Responsible Supervisor / Workshop In-charge. 2.) Vehicle shall be stopped fr further use and sent to workshop for repair / rectification in case of other defects. Comments, if any:
Inspection carried out by: __________________________________ Agreed date for action completion : ______________________
Signature with date: _____________
Forward report to Line Manager / Responsible Supervisor / Workshop In-charge, considering level of intervention requir
Report Forwarded To: 1.) ______________________________________ 2.) _________________________ (To be signed by the Line Manager / Responsible Supervisor / Workshop In-charge on completion of action returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed
Name: ______________________________________ Signature: ________________________Date: ______

Copies to be retained by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function who carried out the inspection Advisory Staff in the Project / Unit.
Page 20 of 34
HICLE INSPECTION / ROAD SAFETY CHECKLIST

Date & Time: Location: Accompanied By: Remarks
on - A (visual / practical checks)
on - B (check with the Driver; complaints shall be communicated to Supervisor concerned)
Page 21 of 34
Galfar Engineering & Contracting SAOG Remarks
on - A (visual / practical checks) mpliance
ur
Vehicles found with defects that have high potential to cause an incident such as in Sl # 1.1, 1.2, shall either be stopped for repair / rectification on the spot or instructed to be escorted to nearest ion with the Responsible Supervisor / Workshop In-charge. 2.) Vehicle shall be stopped from o workshop for repair / rectification in case of other defects.
ut by: __________________________________
on completion : ______________________
Line Manager / Responsible Supervisor / Workshop In-charge, considering level of intervention required.
o: 1.) ______________________________________ 2.) _____________________________ the Line Manager / Responsible Supervisor / Workshop In-charge on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed
___________________________ Signature: ________________________Date: _________
by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function who carried out the inspection / HSE ect / Unit.
Page 22 of 34
EQUIPMENT INSPECTION CHECKLIST

Equipment Make, Regn # / CC #: Job # & Name: Inspected By: Sl # Description Date & Time: Location: Accompanied By: Yes No NA
1.0 Equipment Condition (visual & practical checks) 1.1 Rollover Protection Structure fitted. Seat Belts - fitted / in good condition / locking mechanism functioning properly. Cabin protected to shield operator from falling / flying objects 1.3 (grills, canopies, screens, etc.) Tyre condition - not worn, no deep cracks of damages / right 1.4 pressure (as marked on wheel arch) / wheel chocks provided. 1.2 1.5 Track chain / links are in proper condition Work attachments such as bucket, blade, ripper, chisel, etc., 1.6 are in good condition. 1.7 Gauges & other instruments are functioning properly. 1.8 Lamps, Rotating Amber light functioning properly. Safe means of access / egress provided (non-slippery footsteps, handholds, etc.). Windscreen / mirrors are clean, in good condition, no cracks 1.10 and are positioned properly / wiper in working condition. Rotating parts (gears, drums, shafts, belts, etc) and hot 1.11 surfaces (such as exhaust pipes) are guarded. 1.9 1.12 Seats are in good condition & suitably positioned. 1.13 Fire Extinguishers / First Aid Box secured & maintained in proper order.
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Page 23 of 34
1.14 Air Conditioner fitted and in good working condition. 1.15 Reverse Alarm & Horn fitted and in proper working condition. 1.16 Fuel / Oil / other Fluids from the equipment not found leaking Equipment kept clear of spilt fuel, oil & other fluid, in particular 1.17 near exhaust & electical parts. 1.18 Noise & exhaust emissions are within normal levels. 1.19 General cleanliess found satisfactory. 1.20 Others (specify): 2.0 Checks Specific to Lifting Equipment Lifting equipment inspection (every 12 months) / load test (every 48 months) certificates available and valid. Safe Working Load (SWL), due date for inspection & due date 2.2 for load test marked on the boom. Load chart indicating various operational configurations / limits 2.3 available and visible prominently from the operator position. Lifting equipment equipped with Boom Angle Indicator. Level 2.4 Indicator, Safe Load Indicator and are in working properly. 2.1 Equipment Inspection Checklist
Galfar Engineering & Contracting SAOG Sl # Description Yes No
Form # HSESP-007-F/07 NA
Overrun prevention devices, over hoist & over load cut out 2.5 Equipment Condition (visual & practical checks) alarm, swing alarm available & working properly. Ropes, pulleys & drum are properly lubricated are free from 2.6 signs of wear & tear / any damages. 2.7 Hook block provided with safety catch. 2.8 Outriggers functioning properly. 2.9 Others (specify): 3.0 Checks Specific to Forklifts 3.1 3.2 3.3 3.4 3.0 3.1 Physical observation of forks satisfactory (no cracks, bend or physical deformity). Lift mechanism operates smoothly (check by raising forks to maximum height then lowering completely) Tilt mechanism operates smoothly (check by tilting mast all the way forward and backward). Date of inspection (every 6 months) / load test (every 48 months) certificates available and valid. Procedural Compliance Operations / User Manual & other relevant manufacturer instructions available for reference.
3.2 Valid Operating Permit available with the Operator Equipment maintenance / inspection stickers are available and 3.3 valid. Equipment logbook that contain the operating hours, 3.4 maintenance / repair history, etc., being updated regularly. 3.7 Operator cabin free from loose materials that can pose a risk. 3.8 Operating / Swing radius is clear off men / material / other machinery, vehicle & equipment.
3.9 Others (specify):
Important Note: 1.) Inspections carried out on lifting equipment using this checklist will only be supplementry to thorough inspection carried out by authorised agencies on an annual basis, and not intended to substitute the sa Equipment found with any defect shall be stopped for repair / rectification in consultation with the Responsible Supervisor / Workshop In-charge. Comments, if any:
Inspection carried out by: __________________________________ Agreed date for action completion : ______________________
Signature with date: _____________
Forward report to Line Manager / Responsible Supervisor / Workshop In-charge, considering level of intervention requir
Report Forwarded To: 1.) ___________________________________ 2.) ____________________________ (To be signed by the Line Manager / Responsible Supervisor / Workshop In-charge on completion of action returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed
Name: ______________________________________ Signature: _________________________Date: _____

Copies to be retained by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function who carried out the inspection Advisory Staff in the Project / Unit.
Equipment Inspection Checklist
Page 24 of 34
EQUIPMENT INSPECTION CHECKLIST

Date & Time: Location: Accompanied By: Remarks
dition (visual & practical checks)
c to Lifting Equipment
Page 25 of 34
Galfar Engineering & Contracting SAOG Remarks
dition (visual & practical checks)
c to Forklifts
mpliance
nspections carried out on lifting equipment using this checklist will only be supplementry to arried out by authorised agencies on an annual basis, and not intended to substitute the same. 2.) any defect shall be stopped for repair / rectification in consultation with the Responsible p In-charge.
ut by: __________________________________
on completion : ______________________
Line Manager / Responsible Supervisor / Workshop In-charge, considering level of intervention required.
o: 1.) ___________________________________ 2.) ________________________________ the Line Manager / Responsible Supervisor / Workshop In-charge on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed
___________________________ Signature: _________________________Date: _________
by: Line Mgr. / Responsible Supervisor, Workshop In-charge, Function who carried out the inspection / HSE ect / Unit.
Page 26 of 34
SCAFFOLDING INSPECTION CHECKLIST

Location: Job # & Name: Inspected By: Sl. No. 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Description Personnel involved in erection and dismantling of scaffolding trained and experienced in that work. Trained and experienced supervisors provided for the control of erection and dismantling of scaffolds. Personnel involved in the erection and dismantling of scaffold wear safety harness, helmet with chinstrap, gloves & shoes. Scoffold erection has taken into consideration the structures, overhead lines and other activities in the vicinity. Scaffolding materials are of proprietary make, free from defects / damages and used in accordance with its designed purpose. Standards placed on hard ground, steel, concrete, etc. or suitable sole plates / base plates provided. Yes Accompanied By: No NA Remarks Date & Time:
o o o o o o o o o o o o o o o o o o o o o
Sole plates where provided support at least two standards; either two adjacent or two opposite standards. Spacing is adequate between the standards with respect to the intended load. Type of work Spacing Maximum Load Access 2.7 M 0.75 KN / M2 1.8 Light Duty 2.4 M 1.50 KN / M2 General Purpose 2.1 M 2.00 KN / M2 Heavy Duty 2.0 M 2.50 KN / M2 Special Duty 1.8 M 3.00 KN / M2 1.9 Ledger joints are staggered and not on the same bay. Transoms spacing suitable to the platform board thickness Board Thickness Transoms Spacing 32 mm 0.9 m 1.10 40 mm 1.5 m 51 mm 2.5 m 63 mm 3.2 m 1.11 1.12 Intermediate transoms are provided where the transoms spacing exceeds the limit (every 1.5m for 40 mm thick plank). Ledger (shorter dimension) / faade (longer dimension) bracing provided from bottom up to top lift.
o o o
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Page 27 of 34
1.13 Platform is fully boarded without any gaps between hand rails. 1.14 1.15 The spacing between platform and the structure being worked on does not exceed 300 mm, without any need for stretching. Work platform is free from projecting nails, bends, cracks, gaps, overlaps, etc.
1.16 Planks are securely fastened. 1.17 Overhanging of wooden planks of working platforms is restricted between 50 150 mm.
1.18 Guard Rails are provided on top of the work platform. Scaffolding Inspection Checklist
Galfar Engineering & Contracting SAOG Sl. No. 1.19 1.20 1.21 1.22 1.23
Description Middle Rails are provided in between guard rail and working platform (at a height of 0.5 M above the platform). Toe boards (secured inside the standards; height not above 150 mm from the platform) are provided around all open sides. The gap between the toe board and the guard rail does not exceed 750mm. Ties provided fixing the scaffolding to fixed structures (one tie for every 40 m sq). Scaffold area barricaded to prevent movement of vehicle / equipment / personnel, in the vicinity.
Yes
No
NA
Remarks
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Fans or catchment platforms of adequate strength and 1.24 dimension are provided to protect passing men / vehicle / equipment, etc., below the scaffold, when permitted. 1.25 Proper ladder of proprietary make is provided for ascending & descending and reaching all part of the scaffold (above 1.5 m).
1.26 Ladder made of timber (timber not painted) or aluminium. Series of ladders with intermediate platforms properly protected 1.27 with guard rails and toe boards, are provided, where more than 9 m height to be climbed. 1.28 1.29 The base to height ratio of ladder maintained as 1 : 4 such that the angle is 75 from horizontal and 15 from vertical. The ladder is adequately secured with a minimum vertical protrusion of 1 m above Platform.
1.30 Scafftag provided in the scaffold indicating its suitability for use.
Comments, if any:
Inspection carried out by: __________________________________
Agreed date for action completion : ______________________ Forward report to Line Manager / Engineer / Supervisor concerned, considering level of intervention required. Report Forwarded To: 1.) ___________________________________ 2.) _______________________________ (To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the function who carried out the inspection, for close-out) Actions identifed above have been completed Name: ______________________________________ Signature: _________________________Date: _________
Scaffolding Inspection Checklist
Page 28 of 34
FIXED POWERTOOLS INSPECTION RECORD

Job # & Name:
Identification # Monthly Inspection Details (Yes / No / NA)
Good housekeeping in the surrounding Tool firmly positioned and provision for job piece to be secured. On / Off / isolation switch, Operating lever in good condition within safe access Moving / rotating parts guarded Bit, Wheel, Blade, Three Cooling etc., in good pronged plug Cable routed Users of system (self the tool condition and used; power safely and in feed) without good identified / suitable to the job source exposing the condition controlled. & rated capacity connected to operator of the machine ELCB
Month:
Sl #
Type / Description of the Tool

(Fixed drill, grinder, lathe, saw, grooving / cutting machine, etc.)
Remarks / Actions, if any
Inspection carried out by: ___________________________________________________________
Signature with Date: ___________________________
Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions / level of intervention required.
Report Forwarded To:___________________________________________________________ Actions identifed above have been completed
Agreed date for action completion: ____________________
(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the inspection for close-out)
Name of the responsible Line Mgr./ Supr.: ________________________________________ Signature: ___________________________ Date: ___________ Signature of the function who carried out the inspection (upon verification of action completion): ______________________________________ Date: ___________
Copies to be sent to / retained by: 1. Line Mgr./ Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advisor.
Fixed Power Tools Inspection Record
Page 29 of 35
HAND / PORTABLE POWERTOOLS INSPECTION RECORD

Job # & Name: Type / Description of the Tool Sl #
(hammer, spanner, screwdriver, plier, chisel, hacksaw, portable buffing machine / power drill / grinder / cutter, wrench, etc.)
Month:
Tool edge free from burrs / damages Handlle with proper grip & in good condition Sharp edges Tool / handle Moving / protected Insulated / rotating parts when not in non-sparking guarded use Three pronged plug used; cables in good condition
Tool suitable Users of the to the rated tool identified capacity / controlled.
Quantity not fit for use
Quantity inspected
Monthly Inspection Details (Yes / No / NA)
Report Forwarded To:_______________________________________________________ Actions identifed above have been completed
Hand Tool Inspection Record
Page 30 of 35
STATIC EQUIPMENT INSPECTION RECORD

Job # & Name:
Identification # Monthly Inspection Details (Yes / No / NA)
On / Off / Equipment isolation firmly switches in positioned in good condition level ground. with safe access Pressure gauge functioning properly within permissible Moving / rotating parts guarded Noise & exhaust emissions are within normal levels Earthing proper / resistance checked Cables / hoses routed properly without obstructing the pathways. Equipment & surroundings maintained clean & free of dust / spilt oil, etc. Suitable fire extinguisher (DCP / CO2) provided with the equipment Equipment Operator / User identified / controlled.
Month:
Sl #
Description of the Equipment

(Static equipment such as Compressors, Diesel Generators, etc.)
Report Forwarded To:____________________________________________________ Actions identifed above have been completed
Static Equipment Inspection Record
Page 31 of 35
LIFTING ACCESSORIES INSPECTION RECORD

Job # & Name: Sl # Lifting Accessories - Type
(Slings, Hooks, Bolts, etc.)
Colour Code for the month: Identification Safe Working Inspection Due Date for Certificate Colour Code # Load (Ton) Marked (Yes/No) Date Next Inspection #
Third Party (1/2 Yearly) Inspection Details
Month:
^ Physical Observation Satisfactory (Yes / No)
In-house Monthly Inspection Details
Note: 1.) No physical damage; wear & tear not more than 5% of the original dimension ^. Inspection carried out by: ___________________________________________________________ Signature with Date: ___________________________ Forward report to Line Manager / Engineer / Supervisor responsible for actions to be taken, considering the criticality of actions / level of intervention required. Report Forwarded To:____________________________________________________ Agreed date for action completion: ____________________ (To be signed by the Line Manager / Engineer / Supervisor concerned on completion of action and returned to the function who carried out the inspection for close-out) Actions identifed above have been completed Name of the responsible Line Mgr./ Engr. / Supr.: ________________________________________ Signature: ___________________________ Date: ___________ Signature of the function who carried out the inspection (upon verification of action completion): ______________________________________ Date: ___________ Copies to be sent to / retained by: 1. Line Mgr./ Engr. / Supr. responsible for that area / activity; 2. Function who carried out the inspection / HSE Manager / Advisor. Lifting Accessories Inspection Record Page 32 of 35
FIRE EXTINGUISHERS INSPECTION RECORD

Job # & Name:
Annual Inspection Details
Month:
In-house Monthly Inspection Details (Yes / No)
(1) Clear Access Maintained (2) Physical (3) Pressure / (4) Inspection / Observation Weight Validity Details satisfactory satisfactory Marked
Sl #
Extinguisher Type
Identification Location # Identification
Inspection Date
Due Date for Next Inspection
Note: 1.) Check location for positioning and confirm easy access; 2.) Check for signs of corrosions, damage to cylinder, delivery hose / nozzle for choking, surface cracks / swelling / bulging / sponging; damage to coupling and condition of safety pins / plastic tie / activating lever / handle 3.) Pressure gauge to indicate green for right pressure and for cartridge type check weight by approximate assessment 4.) Labels mentioning date of inspection & due date for next inspection and punch mark in monthly inspection tags. Inspection carried out by: ___________________________________________________________ Signature with Date: ___________________________
Report Forwarded To:____________________________________________________ Actions identifed above have been completed
Fire Extinguisher Inspection Record
Page 33 of 35
FIRST AID BOX INSPECTION RECORD

Job # & Name: Sl # QLM ODC 07/798 Month: 31-Jan Remarks / Actions, if any
NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL
Identification Location # Identification

SITE 77943 TRAILER
Monthly Inspection Details (Yes / No) Clear Maintained Name of First Aider Identified * Contents clean & access adequate maintained hygienically
JOBY YOHANNAN VINOTH MOSHIN RAJESH SINGH PARAZ BISWAS PRBAKARAN MOHD SALIM RAJAKHAN MOHD MUTHUMANIKANDAN GIREESH M.SURESH AYOOB PRABU DEVARAJ SAJU B JOHN AMRITHSINGH SUBU PERUMAL
1 CAPE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
CANTHER R O PLANT SITE SITE JCP LAUNDARY HIYAB SITE SITE J.OFFICE CCS MESS 61470 HIYAB ccs KITCHEN DRAT AL SAHRA 112327 CANTHER CC -15625 TIPPER 2729 CANTHER
81916 105295 CAPE 6030 15902 CCS ALROMAL 81855 17031 69768
* To be sent for re-fill, if not found adequate. First Aid Box Contents (Typical - may vary w.r.t. the site & clinic location): Sterile Cotton Bandage 5 cm (6 rolls), Crepe Bandage 7.5 cm (6 rolls), Triangular Bandage (6 rolls), Safety Pins (6 nos), Adhesive Plaster - 1.25 cm (1 roll), Eye Pad (5 pads), Assorted Plasters (1 packet), Gauze Swabs (20 pieces), Scissors (1), Protective Gloves (2 pairs), Oropharyngeal Airway (1 item) or Mask or Airway Shield. Inspection carried out by: M.SELVAN/Malenurse Signature with Date:___________31.01.13
Forward report to Line Manager / Supervisor responsible for actions to be taken, considering the criticality of actions required.
Report Forwarded To:___________________________________ Agreed date for action completion:_________

(To be signed by the Line Manager / Supervisor concerned on completion of action and returned to the function who carried out the inspection for closeout)
Actions identifed above have been completed Name of the responsible Line Mgr./ Supr.: ________________________ Signature with Date: ______________
First Aid Box Inspection Record
Page 34 of 34

First Aid Box Fill List

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Galfar Engineering & Contracting SAOG

MANAGEMENT SITE INSPECTION / VISIT REPORT

Date: Location: YES NO NA REMARKS

Galfar Engineering & Contracting SAOG.

CAMP INSPECTION CHECKLIST

Camp Inspection Checklist

Galfar Engineering & Contracting SAOG.

Camp Inspection Checklist

Galfar Engineering & Contracting SAOG.

Camp Inspection Checklist

Galfar Engineering & Contracting SAOG

OFFICE INSPECTION CHECKLIST

Galfar Engineering & Contracting SAOG Sl # Description Yes No NA

Form # HSESP-007-F/03 Remarks

Office Inspection Checklist

Galfar Engineering & Contracting SAOG

Galfar Engineering & Contracting SAOG

WORKSITE INSPECTION REPORT

Worksite Inspection Checklist

Galfar Engineering & Contracting SAOG

Worksite Inspection Checklist

Galfar Engineering & Contracting SAOG

Worksite Inspection Checklist

Galfar Engineering & Contracting SAOG

WORKSHOP / INDUSTRIAL / STORAGE YARD INSPECTION CHECKLIST

Galfar Engineering & Contracting SAOG

6.0 ABRASIVE BLASTING

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

Sl # 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8

Galfar Engineering & Contracting SAOG

Inspection carried out by: __________________________________

Signature with date: ____________

Name: ___________________________________ Signature: __________________________ Date: ____

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

RKSHOP / INDUSTRIAL / STORAGE YARD INSPECTION CHECKLIST

Accompanied By: Remarks

YOUT & MAINTENANCE

ABLE POWER TOOLS

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

YOUT & MAINTENANCE

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

YOUT & MAINTENANCE

ARGING & STORAGE

STORAGE OF GAS CYLINDERS

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

YOUT & MAINTENANCE

STORAGE OF FUEL, OIL AND OTHER CHEMICALS

ESULT - Possible Score: ____, Actual Score: ____, % Achieved: ______

out by: __________________________________

Signature with date: ________________

_________________________ Signature: __________________________ Date: __________

WS / Industrial / Storage Yard Inspection Checklist

Galfar Engineering & Contracting SAOG

VEHICLE INSPECTION / ROAD SAFETY CHECKLIST

Vehicle Inspection Checklist

Galfar Engineering & Contracting SAOG Sl # Description

Form # HSESP-007-F/06 Yes No NA

Signature with date: _____________

Name: _____________ Signature: Date:

ESULT - Possible Score: , Actual Score: , % Achieved: __

_________ Signature: Date:

Name: ____________________ Signature: Date:

___________ Signature: Date: _

Name: __________________ Signature: _Date: _

___________ Signature: _Date: _