Paint Work Checklist (English)

Document No.UD-F-SHE-103 Revision No.: 02

Effective Date: 17.01.2015

Page No. 1 of 1

Date: ____________

Name of worker: _____________ Dept./Area_____________

Description of work__________________________________

(PTW authorizers can fill this checklist).

Sr.N Description Y N N/A

o
1 Is MSDS of paint available and training of workers have
been done on MSDS?
2 Have workers worn uniform/clothing before paint work?
3 Have workers worn face mask, safety shoes, gloves &
goggles to avoid skin contact with paint ?
4 Has the area well ventilated to avoid any breathing
problem?
5 Has the area cordoned off?

6 Is there any ignition source at work place (match, lighter,

etc)
7 Is the scaffolding, ladder or platform to be used for work,
is according to the standards (if the work is at height)?

Has the area in-charge informed about the work?

8
9 Is the painter experienced? (if yes, how much years =
)
10 Have the chemicals to be used are placed under lock
and key (paint, kerosene oil, thinner, petrol, solvent,
etc.)

Painters Signature ______________________

Work Authorizing Managers Sig. ______________________

Area In-charge Signature ______________________