Date: PAKAT Raised by (Name):

PAKAT
WHAT WHY
(CODE)
PLAN * ASSESS * KEEP LOOKING * AGREE ACTION * TAKE NOTE
ACTION / REMARKS
FINDINGS Date

Follow-up required
DISCUSSION AND AGREED ACTION TARGET DATE
Yes No

DATE FOLLOW-UP / REMARKS STATUS

WHAT WHY
What hazardous act / condition did you see? Why did the hazardous act / condition occur?

PPE HOUSEKEEPING
A) Head protection not worn Z) Access block by construction NOT AWARE
B) Eye protection not worn AA) Tools / materials disorganised
C) Face protection not worn BB) Poor / Improper roping off 1) Not informed
D) Ear protection not worn CC) Accumulation of rubbish 2) Language problem
E) Protective clothing not worn 3) Not reading permit
F) Safety shoes not worn ENVIRONMENT 4) Wrong interpretation of risk
G) Hand protection not worn DD) Water is being polluted 5) Wrong instruction
H) PPE in bad condition EE) Air being polluted 6) No procedure
I) Wrong PPE for the job FF) Too much noise 7) Forgotten
J) Substandard PPE NN) Soil being polluted 8) Behaviour & Attitude (intentionally)

TOOLS / EQUIPMENT PERMIT / PROCEDURES

K) Wrong tool for the job GG) Work without permission AWARE
L) Tools in bad condition HH) Wrong permit
M) Tools not inspected II) Procedure not followed 9) Negligence
N) Misuse JJ) Wrong instruction on permit 10) Work condition (Including weather)
OO) Vehicles / Transportation abuse KK) Permit procedure not followed 11) Worksite layout
12) The design of equipment / tools
MATERIAL HANDLING POSITIVE CARDS 13) Work habits
O) Too heavy for manual lifting LL) In safe condition 14) Lack of skill
P) Wrong mechanical manual lifting MM) Behaviour & Attitude 15) Time pressure
Q) Lifting tool not inspected 16) Not requested
R) Chemicals not properly handled VEHICLE 17) Physical limitations
S) Waste not properly handled PP) Driving Recklessly 18) Not supplied/available
QQ) Not Wearing seat belt 19) Lack of ownership
POSITIONS OF PEOPLE RR) Road traffic violation – 20) Behaviour & Attitude (not intentionally)
T) In danger of struck by e.g. speeding, no entry & etc
U) In danger of striking against
V) In danger of caught by
W) In danger of fall / slip / trip

N.B. If there is no unsafe act / condition during a visit, congratulate the person involve and put your remarks in the card. Revision: February 2004