All ESH Form PDF

TCS CONSTRUCTION SDN BHD
ENVIRONMENTAL, SAFETY & HEALTH INDUCTION FORM

(BORANG INDUKSI ALAMSEKITAR, KESELAMATAN & KESIHATAN)
Project (Projek) : Company (Syarikat):
Name (Nama) : Designation (Jawatan) :

Work (Kerja) : Date (Tarikh) :
1. 0 Occupational Safety & Health 1994, Act 514 & EQA 1974, Act 127 (Akta 514, KKP 1994 & Akta 127, Alamsekitar 1974)
1.1 Section 15 – 18, OSHA 1994, Act 514
1.2 Section 24 – 27, OSHA 1994, Act 514
1.3 Section 22 – 25, 29A & 34(B), EQA 1974, Act 127
2.0 ESH Policy & Objectives (Polisi & Objektif AKK)
2.1 ESH Policy (Polisi AKK)
2.2 ESH Objectives (Objektif AKK)
3.0 Personal Protective Equipment (Alat Perlindungan Diri)
3.1 Safety Helmet (Topi Keselamatan) 3.6 Work Attire (Pakaian)
3.2 Safety Shoes (Kasut Keselamatan) 3.7 Welding Shield (Pelindung Kimpalan)
3.3 Safety Harness (Abah abah Keselamatan) 3.8 Dust Mask (Pelindung Muka)
3.4 Ear Plug / Muff (Plug / Muff Telinga) 3.9 Respirator (Alat Pernafasan)
3.5 Eye Protection (Pelindung Mata) 3.10 Gloves (Sarung Tangan)
4.0 Safe & Unsafe Acts / Conditions (Tindakan / Keadaan Selamat & Tidak Selamat)
4.1 Sling / Lifting Operation (Kerja Pengangkatan) 4.8 Electrical (Letrik)
4.2 Earthworks / Excavation (Kerja Tanah / Pengorekan) 4.9 Plant /Equipment (Loji/Peralatan)
4.3 Scaffolding / Netting (Perancah / Jaring Keselamatan) 4.10 Welding (Kimpalan)
4.4 Machineries Guarding (Pengadang Mesin) 4.11 Confined space (R/Terkurung)
4.5 Housekeeping (Kekemasan) 4.12 Working Platform (Planta Kerja)
4.6 Working at height (Kerja Tempat Tinggi) 4.13 Access/Egress (Masuk /Keluar)
4.7 Demolition / Blasting (Meroboh / Peletupan) 4.14 Hacking Activities (Hentakan)
4.15 Launching work (Beam etc)
5.0 Environment (Alamsekitar)
5.1 Environmental Aspects & Impacts (Air, Water, Noise Pollution & Vibration)
5.2 Waste Control (Construction, Domestic, Scheduled Waste)
5.3 3R Practices (Reduce, Reuse & Recycle)
5.4 Conservation of Natural Resources / Energy Saving (Water, Electricity & Fuel)
6.0 Others (Lain-lain)

6.1 Emergency Procedure (Prosedur Kecemasan) ( Accident, Incident, Illness, Injury & Fatality)
6.2 Accomodation (Kediaman)
6.3 Personal Hygiene (Kebersihan Diri)
6.4 Drugs & Alcohol (Dadah & Alkohol)
6.5 Health & Welfare (Kesihatan & Kebajikan)
6.6 Security (Sekuriti)
6.7 Penalty (Denda)
6.8 Video Presentation (Pertunjukan Video)
6.9 Safety Induction Construction Worker by CIDB (Kursus Induksi Keselamatan pekerja Binaan oleh CIDB)
CIDB Green Card (Kad Hijau) S/N : Validation Date :
I hereby acknowledge that I have received a Health & Safety Induction in the language that I understand. I duly acknowledge and
confirm that the above mentioned items and topics have been covered in the induction attended by me.
Saya dengan ini mengesahkan bahawa saya telah menerima latihan induksi Kesihatan dan Keselamatan di dalam
bahasa yang saya fahami. Saya mengesahkan bahawa kesemua perkara di atas telah diterangkan kepada saya.
Inducted by (Induksi diberi oleh):
Name (Nama) : Name (Nama) :

IC or Passport (KP atau Passport) : Designation (Jawatan) :
Doc. Ref. : TCS/PI/ESHIF Rev. No. : 0 Issue Date : 21 MAY 2018

SITE WORKERS REGISTRY LIST

COMPANY NAME CONTACT PERSON
ADDRESS
Name Signature
SUBMISSION BY Designation
Contact No
Name Signature
ENDORSED BY (Project Manager or Safety
Designation
and Health Officer)
Contact No
WORK PERMIT COMPANY WORK PERMIT CIDB GREEN CARD
NO NAME NRIC / PASSPORT NO CIDB VALIDITY NATIONALITY
NAME VALIDITY NO
2
3
4
5
6
7
8
9
Conduct By : Varified By :
Name : Name :
Designation : Designation :
Date : Date :
Doc. Ref. : TCS/PI/SWRL Rev. No. : 0 Issue Date : 21 MAY 2018

FIRST AID LOG
PROJECT NAME : …………………………………………………………………………….

PROJECT CODE : ……………………………………………………………………………
LOCATION OF TREATMENT & REMARKS

NO DATE & TIME NAME & IC / PASSPORT DESCRIPTION OF INJURY / HEALTH
INCIDENT / ACCIDENT ATTENDED BY
Checked By : Varified By :
First Aider Safety & Health Officer
Name : Name :
Date : Date :
Doc. Ref. : TCS/PI/FAL Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
FIRST AID KIT INSPECTION FORM

GENERAL INFO
LOCATION INSPECTION RESULT
USEB BY SATISFACTORY
SIZE POOR (REPLACE)
INSPECTED BY
NAME SIGNATURE
DESIGNATION
COMPANY
DATE / TIME
ENDORSED BY
NAME SIGNATURE
DESIGNATION
COMPANY
DATE & TIME
NO CHECKLIST Yes No REMARKS

LOCATION
IS THE FIRST AID BOX LOCATED IN A PROMINENT AND
1
ACCESSIBLE POSITION / AREA?
ARE EMPLOYEES INFORMED AND AWARE OF THE LOCATION OF
2
FIRST AID BOX?
DO ALL EMPLOYEES HAVE ACCESS TO THE FIRST AID BOX
3
DURING ALL WORK SHIFTS
IDENTIFIABILLITY
CAN THE FIRST AID BOX BE CLEARLY IDENTIFIED AS A FIRST AID
1
BOX?
IS THE FIRST AID BOX CLEARLY MARKED WITH THE GREEN
2
CRESCENT ON A WHITE BACKGROUND?
CONTENTS
ARE THE CONTENTS APPROPRIATE TO THE INJURIES AND
1
ILLNESSES AT WORKPLACE?
DOES THE FIRST AID BOX CONTAIN SUFICIENT QUANTITIES OF
2
EACH ITEMS?
IS AN EMPLOYEE TRAINED IN FIRST AID RESPONSIBLE FOR
3
MAINTAINING THE FIRST AID BOX?
4 ARE THE CONTENTS APPROPRIATE LABBLED?
5 ARE THE CONTENTS WITHIN THEIR "USE BY" DATE?
6 ARE THE CONTENTS ADEQUATELY STORED?
RELEVANT INFORMATION
IS THERE A LIST OF CONTENTS PROVIDED IN THE FIRST AID
1
BOX?
2 ARE EMERGENCY TELEPHONE NUMBERS CLEARLY DISPLAYED?
ARE THE NAME, LOCATION AND EXTENSION NUMBER OF THE

3
NEAREST FIRST AIDER CLEARLY INDICATED?
TRAINING
HAVE SELECTED EMPLOYEES RECEIVED TRAINING IN THE USE
1
AND MAINTENANCE OF FIRST AID BOX
IS A RESPONSIBLE PERSON APPOINTED TO TAKE CHARGE OF
2
FIRST AID ARRANGEMENT (SUPERVISOR)

Name : Name :
Date : Date :
Doc. Ref. : TCS/PI/FAIF Rev. No. : 0 Issue Date : 21 MAY 2018

CONTENT OF FIRST AID BOX
No. Name of Items In Stock Expired Date Remarks
1 5 Triangular bandages 130cm x 90 cm x 90cm

2 Sterile Eye Pads
3 Non- Sterile 4x4" gauze pads
4 Sterile 4x4" gauze pads
5 Sterile 10x10" gauze pads
6 Elastic bandage
7 4 Roller bandages 7.5 cm
8 4 Roller bandages 3 cm
9 4 Roller bandages 2.5 cm
10 Cold pack compress gel
11 Burn sheet/ dressing
12 Pairs of gloves (disposable / non sterile)
13 Stainless steel bandage scissors
14 Adhesive tape
15 Sterile multi-trauma dressing/ gauze
16 Alchohol prep pads
17 Cetavlon
18 Cotton buds
19 Barrier device for CPR (pocket mask, face shield)
20 Elastoplasts / sterile adhesive dressing
21 Safety pin for triangular bandages
22 Thermometer
23 First aid manual
24 Waterproof waste bag
25 Inventory of box contents ( checklist)
Name : Name :
Date : Date :
Doc. Ref. : TCS/PI/CFAB Rev. No. : 0 Issue Date : 21 MAY 2018

ESH WALKABOUT
A) REF.NO. B) DATE C) TIME D) SAFETY OFFICER E) ENGINEER/SUPERVISOR F) PROJECT MANAGER G) OTHERS
OBSERVATION / FINDING OF ESH WALKABOUT

NO. H) OBSERVATION / FINDING I) ACTION J) ACTION PARTY K) DATE L) REMARKS
CONFIRMATION/FOLLOW-UP/REVISION ( 5 WORKING DAYS)

NO. ITEM DATE STATUS / REMARKS
1.
2.
3.
Conducted By : Varified By :
Site Safety Supervisor Safety & Health Officer

Name : Name :
Date : Date :
Doc. Ref. : TCS/PI/ESHW Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
SAFETY & HEALTH INSPECTION CHECKLIST
Project : Site Location :
Construction stage / status during inspection :

Inspection Date : Inspection Time :
Inspected by : Weather :
Acceptability Remarks
(i.e. specify location, good practices,
No. Items to be checked problem observed, possible cause of non-
YES NO N/A conformance and/or proposed
corrective/preventative action)
1. SH Management
SH Policy displayed and disseminated
SH Manuals
SH Procedures
SH Instructions
Project ESH Plan
Work permit for dangerous work
SH Management Programme
SH Training / Awareness
SH Induction
Training for Competent Person
SH information dissemination
2. Site SH Committee
Organisation Chart
Chairman and secretary’s Appointment Letter
Committee Members’ Appointment Letter
Regular Meetings
Workplace Inspection by Committee
Sub Contractor and workers participation
Incident / accident investigation
Management cooperation
Action from report and suggestions
Action on the unsafe act
3. Plant, Machinery & Equipment (PME)

Valid certificate of fitness
Competent operators (Tower Crane / Mobile
Crane / Crawler Crane)
PME guarding
Inspection of PME before use
Handling system
Lifting work supervision
Preventive maintenance
Training
Inspection of tools
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 1 of 5
No. Items to be checked (i.e. specify location, good practices, problem
YES NO N/A observed, possible cause of non-conformance
and/or proposed corrective/preventative action)
4. Working / Loading Platform

PE design drawing and calculation
Safe working load signage
Barrier
Maintenance
Platform housekeeping
Proper platform
Safe access way on the platform
5. Scaffold
PE design drawing and calculation
Scheduled inspection
Maintenance
Stable foundation
Competent erector
Signage
6. Opening Edges / Floor Opening

Barrier / covering provided
Proper barrier / covering
Warning signage
Inspection and maintenance
7. Working at heights
Proper PPE
Safe working platform
OSH Instruction
Supervision
Training
Life line provided
8. Access / Egress
Safe access and egress
Overhead protection cover
Adequate lighting
Safe ladder
Traffic control
9. Public Safety
Warning signage
Hoarding
Security Officer at entrance
Traffic Control Officer
Traffic Control in the project site
No. Items to be checked YES NO N/A (i.e. specify location, good practices, problem
observed, possible cause of non-conformance
and/or proposed corrective/preventative action)
10. Electrical safety

Warning signage
Proper installation
Designated person
Wiring
Information or training
Inspection
11. Workers’ Quarters

Isolated from working area
Housekeeping
Separate access to quarters
Fire protection equipment
Comfortability at the quarters
Ventilation System
Children in the quarters
Authority approval on design
Separate cooking area
Adequate toilets
Adequate bath place
12. Material handling & storage

Material handling
Suitable store
Material arrangement
Hazardous material storage
Warning signage
Housekeeping
13. Housekeeping
Housekeeping programme
Proper waste disposal
Material storage
Adequate access way
Inspection
Drainage condition at the surrounding area
Proper disposal area
Signages
14. Health and Welfare

Canteen / food / water
First Aid Box
Accommodation / sanitation
Personal Protective Equipment provided
Ear plug provided
Noise monitoring done
YES NO N/A (i.e. specify location, good practices,
No. Items to be checked problem observed, possible cause of
non-conformance and/or proposed
corrective/preventative action)
15. Formwork
PE drawing and calculation
Inspection
Designated person
16. Personal Protective Equipment

Provided and recorded
Training of proper usage of PPE
Supervision of proper usage
Warning signages on PPE
17. Excavation
Excavation site with guarding of fences
Warning signages posted at exit and entrance
Warning light placed at night
Checked by designated person after rainstorm
Excavated material not placed at least 610mm
from edge
More than 1.2m provided with ladder
More than 4m in depth in accordance with
design and drawing by PE
Permit to work maintained for all works
18. Blasting
Blasting permit
Shot Firer’s license
Evacuation procedure
Warning Notice given to all residence in the
vicinity
Signages
19. Traffic Management

Designated person
Signages
Lighting (visibility and illumination)
Emergency Vehicles
Flag Man
20. Chemical Safety

Register of Chemicals
Handling, Storage and Labelling
Assessment of risk
PPE usage
Chemical Safety Data Sheet for Chemical
(i.e. specify location, good practices, problem
No. Items to be checked observed, possible cause of non-
YES NO N/A conformance and/or proposed corrective
/preventative action)
21. Confined Space

Competent gas tester
Permit to work
Checklist usage
Designated person
PPE usage
22. Health and Safety Equipment

Fire Equipment
Fire Extinguisher
Gas Detector
Noise Dosimeter
22. Other OSH Hazards / Issues
Acceptability : YES - Acceptable NO – Unacceptable N/A – Not Applicable

Remarks : [ESH Officer / Supervisor]
Inspected By :
Signature : ………………………. Date :
Name :
Remarks : [Project Manager]
Verified By :
Name :
TOOL BOX TALK BRIEFING FORM

Project :
Sub Contractor Name :

Trade : Date :
Today's Topics Name of Workers Signature
PPE, Housekeeping, Electrical compliance, 1.
Excavation works, Scaffolds compliance
Handling Tools & Equipments, Fire Prevention, 2.
Hot works ( Safe Method ), Ladders, Working on
heights, Warning sign/ barricade, Accidents 3.
reporting, Facilities usages, Inspection ,
Incidents review & prevention methods, 4.
Health compliance, Horse play, Dress code,
Security procedures, Materials handling, Others 5.
6.
7.
Potential Hazards / Enviromental Impact
8.
Fall from heights, Falling objects, Slip and fall, Hit by
objects, Caught in between, Collapse of machinery 9.
Electricution, Fire, Chemical spillage,Noise,
Water pollution, Air pollution, Open burning 10.
11.
Control Measures
12.
Wear proper PPE, Use proper plugs / ear muff,
Permit to work, Use proper signages, Report unsafe 13.
acts and condition, HIRADC (Eliminate, Subtituation,
Engineering, Signages & Administrative and PPE ) 14.
Comply to FMA. Act 139, OSHA, Act 514,
EQA, Act 127, CIDB, Act 520, 15.
JKR Arahan Teknik (Jalan) 2C/85
16.
Tool Box Briefing conducted by __________________________
…………………………. ………………………….
ESH Officer/SHO/SSS Manager ESH/SH
(Name and Signature) (Name and Signature)
Doc. Ref. : TCS/PI/TBTBF Rev. No. : 0 Issue Date : 21 MAY 2018

TCS CONSTRCUTION SDN BHD
Personal Protective Equipment (PPE) Distribution

(Alat Perlindungan Keselamatan)
Signature / Issued Date

Respiratory
No Name ID Safety Shoes Safety Helmet Hand Protection Ear Protection Eyes Proctection Safety Harness Remark
Protection
Note: Occupational Safety and Health Act 1994 (OSHA Act 1994), Part VI, Section 24 (1) (c) - to wear or use at all times any protective equipment
or clothing provided by the employer for the purpose of preventing risks to his safety and health.
Doc. Ref. : TCS/PI/PPED Rev. No. : 0 Issue Date : 21 MAY 2018

ENVIRONMENTAL INSPECTION CHECKLIST
Project : Site Location :

Construction stage / status during inspection :
Inspection Date : Inspection Time :
Inspected by : Weather :
Remarks
Acceptability
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
1. Air Pollution Control
1.1. Are the construction sites watered to
minimize dust generated?
1.2. Are stockpiles of dusty materials
covered or watered?
1.3. Cement debagging process
undertaken in sheltered areas
1.4. Are all vehicles carrying dusty loads
covered/watered over prior to leaving
the site?
1.5. Are demolition work areas watered?
1.6. Are dusty roads paved and/or
sprayed with water?
1.7. Are dust controlled during percussive
drilling or rock breaking?
1.8. Are plant and equipment well
maintained? (any black smoke
observed, please indicate the
plant/equipment and location)
1.9. Is dark smoke controlled from plant?
1.10. Are there enclosures around the
main dust-generating activities?
(e.g. grout mixing)
1.11. Hoarding provided along boundaries
and properly maintained (any
damage / opening observed, please
indicate the location).
1.12. Are speed control measures applied?
(e.g. speed limit sign)
1.13. Others (please specify)
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 1 of 6
Remarks
Acceptability
2. Water Pollution Control
2.1. Are water discharge licenses valid?

2.2. Are conditions of the license
compiled with? (check the monitoring
records and observe physically)
2.3. Are wastewater treatment system
being used and properly maintained
on site? (e.g. desilting tank)
2.4. Are there any wastewater discharged
to the stormdrains? Is the wastewater
being treated?
2.5. Are measures provided to properly
direct effluent to silt removal
facilities? (e.g. provide earth bunds /
U-channels)
2.6. Are u-channels and manholes free of
silt and sediment?
2.7. Are sedimentation traps and tanks
free of silt and sediment?
2.8. Are all manholes on-site covered and
sealed?
2.9. Are sandbags/earth bund adopted to
prevent washing away of sand/silt
and wastewater to drains, catchpit,
public road and footpath?
2.10. Are vehicles and plants cleaned
before leaving the site?
2.11. Are wheel washing facilities well
maintained to prevent overflow,
flooding sediment?
2.12. Is sand and silt settled out in wheel
washing bay and removed?
2.13. Is the public road/area around the
site entrance and site hoarding kept
clean and free of muddy water?
2.14. Is domestic water directed to septic
tanks or chemical toilets?
Remarks
Acceptability
3. Noise Control
3.1. Is the CNP (Construction Noise
Permit) valid for work during
restricted hours?
3.2. Are copies of the valid Construction
Noise Permits posted at site
entrance/exit?
3.3. Do air compressors and generators
operate with doors closed?
3.4. Is idle plant/equipment turned off or
throttled down?
3.5. Any noise mitigation measures
adopted (e.g. use noise barrier /
enclosure)?
3.6. Are silenced equipments utilized?
4. Waste Management
4.1. Is the site kept clean and tidy? (e.g.
litter free, good housekeeping)
4.2. Are separate chutes used for inert
and non-inert wastes?
4.3. Are separated labelled containers /
areas provided for facilitating
recycling and waste segregation?
4.4. Are construction wastes / recyclable
wastes and general refuse removed
off site regularly?
4.5. Are construction wastes collected
and disposed of properly by licensed
collectors?
4.6. Are chemical wastes, if any, collected
and disposed of properly by licensed
collectors?
4.7. Does chemical waste producer
license covers all major chemical
wastes produced on site?
4.8. Are chemical wastes properly stored
and labelled?
4.9. Are oil drums and plants/equipments
provided with drip trays?
Remarks
Acceptability
4.10. Are drip trays free of oil and water?
4.11. Is there any oil spillage? Clean-up
the contaminated soil immediately?
4.12. Is litter, foam or other objectionable
matters in nearby water drain/sewer
cleaned?
4.13. Are asbestos wastes handled by
registered professionals?
5. Storage of Chemicals and Dangerous Goods

5.1. Are chemicals stored and
labelled properly?
5.2. Does storage of DG comply with
license conditions (include types
and quantities if DG store is
available, check the DG store
license)?
5.3. Are proper measures to control
oil spillage during maintenance
or to control other chemicals
spillage? (e.g. provide drip trays)
5.4. Are spill kits / sand / saw dust
used for absorbing chemical
spillage readily accessible?
6. Protection of Flora, Fauna and Historical Heritage

6.1. Are disturbance to terrestrial flora
minimized (e.g. plants to be
preserved)?
6.2. Are disturbance to terrestrial
fauna minimized (if rare species
identified)?
6.3. Any historical heritage exists on
site? If yes, ensure appropriate
measures taken to preserve it
Remarks
Acceptability
7. Resource Conservation
7.1. Is water recycled wherever
possible for dust suppression?
7.2. Is water pipe leakage and
wastage prevented?
7.3. Are diesel-powered plants and
equipments shut off while not in
use to reduce excessive use?
7.4. Are energy conservation
practices adopted?
7.5. Are metal or other alternatives
used to minimize the use of
timber?
7.6. Are materials stored in good
condition to prevent deterioration
and wastage (e.g. covered,
separated)?
7.7. Are pesticides used under the
requirement of Agriculture,
Fishers and Conservation
Department?
8. Emergency Preparedness and Response

8.1. Are fire extinguishers / fighting
facilities properly maintained and
not expired? Escape not blocked
/ obstructed?
8.2. Are accidents and incidents
reported and reviewed, and
corrective & preventive actions
identified and recorded?
Remarks
Acceptability
Remarks : [ESH Officer / Supervisor]
Inspected By :
Name :
Remarks : [Project Manager]
Verified By :
Name :
MONTHLY ESH INSPECTION REPORT
Criteria S NI U List Deficiencies Remark
WELDING AND CUTTING

Fire extinguisher in the area
Screens and shields
Goggles, gloves and clothing
Equipment condition
Electrical equipment grounded
Power cable condition
Flammable materials protected
Inspection for fire hazards
PERSONAL PPE
Hard hats
Safety shoe
Eye protection
Safety belt
Hearing protection
Respirator / Mask
FALL PROTECTION
Workers using safety belt at height
Lanyard noy more than 1.8m
Anchorage point adequate
Safety belt & yard in good condition
Guardrail / Warning sign provided
ELECTRICAL INSTALLATION
System and cords grounded
Cords & cable in good condition
Electrical danger poster
Proper fire extinguisher
No smoking zone with sign
Qualified personnel doing work
LEGAL REQUIREMENT
Site safety policy
Site safety committee
Designated person
Safety & Health meeting
Monthly Safety Report
Site registration with DOSH
Comment by Safety & Health Officer :
Signature :
Comment by Project Manager :
Signature :
Page 3 of 3
Doc. Ref. : TCS/PI/MIESHR Rev. No. : 0 Issue Date : 21 MAY 2018

ENVIRONMENT, SAFETY AND HEALTH (ESH) MONTHLY PROGRAMME

Project :
Month :
Year :
NO DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
1 DIRECT AND INDIRECT WORKERS REGISTRY DAILY
2 ESH INDUCTION DAILY
3 TOOL BOX BRIEFING WEEKLY
4 MONTHLY ESH INSPECTION WEEKLY
5 WEEKLY TOWER CRANE CHECKLIST WEEKLY
6 WEEKLY MOBILE/CRAWLER CRANE INSPECTION WEEKLY
7 SCAFFOLD INSPECTION CHECKLIST WEEKLY
8 WEEKLY ESH INSPECTION WEEKLY
9 ARC WELDING EQUIPMENT MONTHLY INSPECTION MONTHLY
10 OXY ACETYLENE INSPECTION FORM MONTHLY
11 FIRST AID KIT INSPECTION FORM MONTHLY
12 GENERATOR SET INSPECTION CHECKLIST MONTHLY
13 AIR COMPRESSOR INSPECTION FORM MONTHLY
14 PPE INSPECTION FORM MONTHLY
15 ELECTRICAL TOOLS INSPECTION MONTHLY
16 FIRE EXTINGUISHER INSPECTION MONTHLY
17 LIFTING GEAR INSPECTION FORM MONTHLY
18 EXCAVATION CHECKLIST WEEKLY
19 ESH REPORT MONTHLY
20 SITE ESH COMMITTEE MEETING MONTHLY
22 LARVACIDING/ FOGGING WEEKLY
23 NOISE, VIBRATION, AIR & WATER MONITORING WEEKLY
24 WASTE DISPOSAL WEEKLY
25 SILT TRAP &, SILT FENCE WEEKLY
: APPROVED BY APPROVED BY :
: NAME NAME :
: DESIGNATION DESIGNATION :
Doc. Ref. : TCS/PI/ESHMP Rev. No. : 0 Issue Date : 21 MAY 2018

INCIDENT / ACCIDENT NOTIFICATION FORM
Report No: HQ (Name of Department):

Site (Project / Project Ref):
1. Date and time of incident:
2. Exact location of incident:

3. Description of incident (enclosed photos where necessary):
4. Particular of injured persons:

Name I/C or Passport Nationality Company Trades
5. Particular of identifier or witness:

Name Company Remark
6. General Notes
Reported by: (ESH Manager / Officer / Supervisor)

Date:
Cc: Head – COO and relevant HOD / HOP.
Doc. Ref. : TCS/PI/FAL Rev. No. : 0 Issue Date : 21 MAY 2018

INCIDENT / ACCIDENT INVESTIGATION REPORT
PART A (To be completed by Leader of Investigation Team and returned to Project Manager)
Report No:
Investigation team:
Name Designation
1. (Leader)
2.
3.
4.
5.
Terms of references: Attachment #
1. To visit the site of incident.

2. To make observations at the scene of incident / accident.
3. To obtain photographs / sketches of the incident / accident scenario.
4. To interview the victims and witnesses.
5. To obtain written method statements / work procedures and related work records.
6. To obtain copy of related HIRADC analysis.
7. To find out the line of communication of the workplaces and to interview key personnel
involved where necessary.
8. To obtain any other relevant information.
9. To examine and analyses the information collected above.
Category of incident:
Incident
(1) Accident
Injury Serious Bodily Injury
Ill Health Occupational Poisoning / Disease
Fatality Fatal Injury
(2) Near-miss Dangerous Occurrence
When and where did the incident occur?
Enclosed Attachment #
Description of the incident:
DOC. REF. : TCS/PI/IAIR REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 1 OF 3
Description of property or environment damage (if any):
How and why did the incident occur?
Findings of the investigation:
(List out underlying ESH deficiencies and other factors that might be causing or contributing to the occurrence of incidents)
Reported by / Submitted by:
Team Leader: Date:

Received by / Submitted by:
OHS Manager / Environmental Manager: Date:

Commented by:
HOD / HOP Date:
PART B (To be completed by OHS Manager / Environmental Manager)

Need for corrective action:
(NCR No……………..)
Risks and actions:
Opportunities for continual improvement:
Disciplinary action / Penalty
Insurance claims:
Form JKKP 6 completed & sent

Form JKKP 7 completed & sent
Form JKKP 8 updated & sent
The results of the investigation (especially lessons learnt) has been communicated to following personnel:
ESH Committee Chairman
Client / HOD / HOP
Staff / Representative
Sub-Con / Supplier
Other interested parties.
Signature: (Safety & Health Officer)
Name: Date:
MONTHLY SAFETY ANALYSIS
Month : Year :
Project :
Description Current month Previous Month Year-To-Date Remarks

Fatality
Lost Time Accident
Non-Lost Time Accident
Total Days Lost / Charged
Total Man hours Worked
Average workers Per Day at Site
Frequency Rate
Severity Rate
Near-Miss
Lost Time Accident = For Injuries Resulting In > 4 Days Off Work
Frequency Rate = Number of Lost Time Accident x 100,000

Total man hours worked
Severity Rate = Total Days Lost / Charged x 100,000

Total man hours worked
Prepared by : Verify by :
……........................................... ……...........................................
Name : ……………………… Name : ………………………
Position : ……………………… Position : ………………………
Date : ……………………… Date : ………………………
Doc. Ref. : TCS/PI/MSA Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
EMERGENCY DRILL REPORT
Project Name / Code : …………………………………………………………………………….
……………………………………………………………………………
Date of Emergency Drill
Type of Emergency Drill
Department / Section / Project
Starting Time
Completion Time
Number of participants
(name list attached)
Participation Rate
Name of Officer
(conducted the drill)
Suggestion Items
Action Plan
Prepared by: Position:
Signature: Date:
DOC. REF. : TCS/PI/EDR REV. NO. : 0 ISSUE DATE : 21 MAY 2018

STOP WORK ORDER
STOP WORK ORDER

(Unsafe Condition)
DO NOT
1.0 DETAIL :
2.0 NOP/NOI No. :
REMOVE
3.0 EFFECTIVE DATE : JANGAN
TANGGALKAN
ISSUED BY
Name: ………………………………………………
Safety and Health Officer
Doc. Ref. : TCS/PI/SWO Rev. No. : 0 Issue Date : 21 MAY 2018

PERMIT TO WORK
Permit No.: ………………………
Workplace: ………………………………………… Date applied: ………………………………

Location: ………………………………………… Duration of work: ……………………………… To: ………………………………….….
Applicant Detail: Hazard Involved:
1. Name of Sub-Contractor ……………………………………………………………………… ……………………………………………………………………..
2. Name of Supervisor In Charge: …………………………………… Tel No: …………………………………… Signature: ……………………………… ……………………………………………………………………..
3. Name of Designated Person: ……………………………………… Tel No: …………………………………… Signature: ……………………………… ………………………………………………………………………
Type of Activity & Pre-Entry Checklist

Hot Work Excavation Working at Height Crane Operation Night Work
Fire Extinguisher Safe Access / Egress Safe working platform Valid Certificate of Fitness To apply relevant permit for any activity at night
Welding set condition Barricade (holes / edges) Training on PPE Competent Operator To provide sufficient lighting (Working
Safe Surrounding Shoring Suitable P.P.E Signalman / Rigger place/Suitable P.P.E/Access & Egress
PPE for Hot Work Suitable P.P.E Provision of Safety Anchorage Lifting equipment Condition List of workers (attached)
Barricade work area Underground Utilities Inspection Workers fit to work Crane Condition
I have checked both the job and the permit. I understand the nature, extent of the work, the precautions and Approval and Authorization (By Authorized Personnel)
procedures to be followed in completing the work safely:
I hereby approve the work operation to be executed accordingly.
Description Name Date Time Signature
Checked By (Work I hereby cancel this Permit To Work due to the following non-conformities/reasons:
Supervisor) : (All operations related to this work activity shall be halted. Applicant shall be required to apply for new
Checked & Verified By Permit To Work prior to resuming the work activity)
(Safety Personnel) :
Signature:……...................... Name :……………………… Position:………………. ……. Date: …………………
Validity of Permit
(Refer to validity of permit for each activity as per attachment)
Renewal (if applicable)
Date Time valid until Authorized Signature Checked By (Work Supervisor) Date Checked By (Safety Personnel) Date Remarks
1
2
3
Permit Close-Out
i. Permit Applicant ii. Authorized Personnel
The work activity is complete, all persons accounted for, and the work site has been left in safe All works associated to this Permit To Work has been completed and the related documentation has
condition. The related documentation has been submitted to TCS Authorized Personnel. been submitted to me. I hereby confirm the closed-out status of this Permit To Work.
Signature:……...................... Name :……………………… Position:………………. ……. Date: ………………… Signature:……...................... Name :……………………… Position:………………. ……. Date: …………………
Doc. Ref. : TCS/PI/PTW Rev. No. : 0 Issue Date : 21 MAY 2018

CHEMICAL SUBSTANCE PERMIT

PERMIT NO. TCS/PTW/CH/ DATE
TYPE OF WORK LOCATION
CONTRACTOR DURATION
SUPERVISOR NAME H/P NO.

WORKER(S) NAME 1.
2.
3.
4.
5.
6.
CHEMICAL (S)
NAME
PERSONAL PROTECTIVE EQUIPMENT
Safety helmet Hi-visibility vest Protective Mask
Safety boot Gloves Respirator
DOCUMENTATION REQUIRED
RFI MSDS / CSDS
INSPECTION ITEMS YES NO REMARKS

MSDS / CSDS provided
Clear labelling of chemical container
Suitable & adequate PPE given to all workers
Proper chemical storage
Spillage protection
Disposal of container
Exposure control (ie exhaust fan)
Barricade and warning signage
Emergency response arrangements
Workers received safety & health briefing
Others:
Jointly inspected by,
TCS HSE SIGNATURE
PIC/ SUPERVISOR SIGNATURE
Doc. Ref. : TCS/PI/PTWCSP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 2
CHEMICAL SUBSTANCE PERMIT
ISSUANCE AUTHORITY
In the event of non-compliance, this permit is automatically invalid and TCS reserves the right to stop work. TCS HSE
Department will not be responsible for any inconvenience caused by the stop work order.
DATE ISSUED VALIDITY
ISSUED BY SIGNATURE
APPROVED BY SIGNATURE
PERMIT EXTENSION
DATE TCS HSE ISSUED BY APPROVED BY
PERMIT CLOSURE
Remarks on site condition:
TCS HSE SIGNATURE
Doc. Ref. : TCS/PI/PTWCSP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 2 of 2
CONFINED SPACE WORK PERMIT
PERMIT NO. TCS/PTW/CSW/ DATE
TYPE OF WORK LOCATION
CONTRACTOR DURATION
SUPERVISOR NAME H/P NO.
WORKER(S)
NAME
PERSONAL PROTECTIVE EQUIPMENT (PPE)

Safety helmet Hi-visibility vest Full body harness
Safety boot SCBA Respiratory protection
DOCUMENTATION REQUIRED
RFI Gas monitoring record
ITEMS YES NO REMARKS

Work location is isolated from sources of danger
Work location has been drained/ vented
Dangerous deposits have been removed
Atmosphere free from hazardous gas
Gas monitoring conducted by an authorised person
Adequate supply of fresh air to the work location
Adequate lighting provided
Communication system established (specify method)
Body harness attached to mechanical retrieval system/ lifeline
Emergency response equipment available
Workers received safety & health briefing (copy of
attendance)
Warning signage
Others:
Jointly inspected by,
TCS HSE SIGNATURE
Doc. Ref. : TCS/PI/PTWCSWP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 2
CONFINED SPACE WORK PERMIT
ISSUANCE AUTHORITY
In the event of non-compliance, this permit is automatically invalid and TCS reserves the right to stop work. TCS HSE
Department will not be responsible for any inconvenience caused by the stop work order.
DATE ISSUED VALIDITY
ISSUED BY SIGNATURE
APPROVED BY SIGNATURE
PERMIT CLOSURE
Remarks on site condition:
TCS HSE SIGNATURE
Doc. Ref. : TCS/PI/PTWCSWP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 2 of 2
SCAFFOLDING INSPECTION CHECKLIST
Project Name : ………………………………………………………………………………….………………..……..
…………………………………………………………………………………………………………..
Site Location : …………………………………………………………………………………………………………..
Designated Person : ………………………………………………………………………………………………………….
Name of Competent : …………………………………………………………………………………………………………..
Scaffolds / Company : …………………………………………………………………………………………………………..
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………...
Type of Scaffolding : ………………………………………………………………………………………………………….
DOSH Registration No : ………………………………………………………………………………………………………….
Project Status : ………………………………………………………………………………………………………….
Person In Charge : ………………………………………………………………………………………………………….
Date of Inspection : ………………………………………………………………………………………………………….
Time : ………………………………………………………………………………………………………….
Inspected By : ………………………………………………………………………………………………………….
Comments : ……………………………………………………………………………………………………….
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………....
………………………………………………………………………………………………………
Results of Checking : Good Average Poor
Doc. Ref. : TCS/PI/SIC Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 3
Acceptability
No Items To be Checked Remark
Yes No
1. Is scaffold erected on firm ground?
2. Are proper sole plate used?
3. Are proper base plate fitted to all standards or legs of

scaffolds?
4. Are scaffold component connection fitted correctly?
5. Is standard connected end with either sleeve coupler or joint

pin?
6. Is ledger bracing connected to the standards with right angle

coupler or ledger with swivel coupler?
7. Is horizontal bracing or lacing provided every 5 lift of frame to

both inner and outer standards?
Tie back provided:
a) At every two (2) lift or at every floor starting from base or
maximum 4 meter.
b) Spaced no further than one bay from ends in

staggered manner.
c) Spaced not more than 3 bays or 7.5 meters apart
whichever is lesser.
d) Effective temporary tie at top most working level, or arm
lock at least two lift at upper most.
8. Is working platform provided as:
a) Continuous working platform at construction level.
b) Isolated working platform provided with proper

guardrails and toe board.
c) Size of working platforms are 635mm, 860mm or

1000mm.
9. Is proper access and egress to working platform
provided?
10. Is the space between face of building to working platform,
460mm or less?
11. Are scaffold designed check by P.E for 15meter height?
12. Are scaffold erected one lift above top most construction level?
13. Are scaffold component and fittings shows no sign of

deterioration?
14. Is scaffold and working platform free from debris, unused
formwork and scaffold component?
Acceptability
Yes No
15. Tube and fitting:
a) Is ledger connected to the standard with right
angle coupler?
b) Is transom connected to the standard with right
angle coupler?
c) Is bracing for tube and modular scaffold provided?
d) Is diagonal bracing connected either to projecting

transom with right angle coupler or to standard
with swivel coupler?
16. Is foot tie fitted to both inner and outer standards?
17. Is peripheral net properly installed?
18. Is the designated person undergoing training?
19. Is there any maintenance checklist?
20. Is there any log book for inspection record?

Non-Conformance : Action / Correction :
Re-Inspection : Remarks :
Checked By : (TCS Scaffolder) Verified By : (TCS OHS Officer)
Signature : ………………………………….………. Signature : ………………………………….……….

Name : ………………………………….………. Name : ……………………………….………….
Date : ………………………………….………. Date : ………………………………….……….
: ………………………………….……….
DAILY INSPECTION CHECKLIST FOR PASSENGER HOIST
Acceptability
Yes No
s
1. Passenger Hoist Identification No (PMA) is
conspicuously displayed & valid till
2. Hoist max loading capacity notice is conspicuously
displayed
3. 2 X 9 kg portable fire extinguishers (type ABC dry
powder) are in good working condition
4. Electrical main switch box is securely locked and the
key is kept by the hoist operator
5. Housekeeping in and around the cage is satisfactory
6. Outer cage sliding / bi-parting doors are working
satisfactorily
7. Inner cage sliding / bi-parting doors are working
satisfactorily
8. Emergency stop button is working effectively
9. Top and bottom limit switches are working effectively
10. Roof and floor of cage is in good condition
11. The bracket and mask section is tightened firmly
12. The tooth tracks are in good condition
13. Last maintenance date
Checked By : TCS Site Safety Supervisor Verified By : TCS OHS Officer

Name : ………………………………….………. Name : ………………………………….……….
Date : ………………………………….………. Date : ………………………………….……….
Doc. Ref. : TCS/PI/DIPH Rev. No. : 0 Issue Date : 21 MAY 2018

TOWER CRANE DAILY INSPECTION CHECKLIST
(PEMERIKSAAN HARIAN KREN MENARA)
Type of Crane : Asset Code No. :

PMA No. : Crane No. :
DATE/TARIKH
SEBELUM OPERASI MON/ISNIN TUE/SELASA WED/RABU THU/KHAMIS FRI/JUMAAT SAT/SABTU SUN/AHAD
PAGI
NAMA :
BIL PERKARA
1 JANAKUASA :
AIR
PELINCIR
EARTHING
2 KABEL LETRIK
3 STARTER LEG
4 TANGGA MENAIK
5 SKRU / PASAK
6 DRAM HOIST
7 KABEL HOIST
8 HOIST MOTOR
9 KOTAK GEAR
10 SLEWING MOTOR
11 SLEWING TABLE
12 WIRE SHEAVE
13 TROLLY MOTOR
14 TROLLY RODA
15 PEMADAM KEBAKARAN
PERMULAAN OPERASI
16 BLOCK & HOOK
17 TROLLY SPEED
18 TROLLY BRAKE
19 HOIST SPEED
20 HOIST BRAKE
21 BOOM SPEED
22 BOOM PARKING BRAKE
23 SUIS LOAD LIMIT
24 SUIS MOVEMENT LIMIT
25 SUIS HOIST LIMIT
26 SUIS TROLLY LIMIT
27 LAMPU KREN
28 SPOT LIGHT
29 HON
30 SIREN
SELEPAS OPERASI
PETANG
NAMA :
31 PENYAMBAR
32 KILAT
33 KEBERSIHAN
34 KABIN LAMPU
STATUSISYARAT
(MORNING) / KEADAAN (PAGI)
STATUSSUIS MEMATIKAN
(AFTERNOON) KREN
/ KEADAAN
(PETANG)
Verified by / Disahkan oleh :
STATUS / KEADAAN (A) Working / Baik (B) Breakdown / Rosak (C) Repair / Dibaiki (D) Standby / Bersedia
Remark / Catatan :
Prepared by / Disediakan oleh : Verified by / Disahkan oleh :
……........................................... ……...........................................
Name : ……………………… Name : ………………………
Position : ……………………… Position : ………………………
Date : ……………………… Date : ………………………
Doc. Ref. : TCS/PI/TCDIC Rev. No. : 0 Issue Date : 21 MAY 2018

WEEKLY TOWER CRANE CHECKLIST
Project Code :
Project Name :
Location :
Operator's Name : Date :
JKKP Registration No : Crane PMA No :
No Checklist In Order Need Attention Remarks

1 Generator Set / Electricity
2 Radio Communication
3 Cabin Housekeeping
4 Foundation Base
5 Bolts and nuts on tower / mast
6 Resting Platform - 6 metres
7 Ladders
8 Wire Ropes
9 Fire Extiguisher
10 Horn / Siren
11 Crane Motor
1 Counter Weight
13 Hook / Block
14 Swing Lock
15 Lights
16 Lighting Protector
17 Earth Wire
18 Signal Man
SAFETY LIMIT SWITCHES

1 Trolley
2 Hoisting
3 Trolley Speed Limit Switch
Check / Inspected by : Verified by :
…………………………. ………………………….
Site Safety Supervisor Safety and Health Officer
(Name and Signature) (Name and Signature)
This Checklist shall be done by the Site Safety Supervisor (SSS) and submitted to Safety and Health Officer (SHO).
Doc. Ref. : TCS/PI/WTCC Rev. No. : 0 Issue Date : 21 MAY 2018

MONTHLY TOWER CRANE CHECKLIST
Project Date
Model Registration
Owner Location
PMA No Validity
Acceptability
No Items to be checked Remarks
Yes No
1. Base (Dates Checked - every 3 months)
a) Bolts checked for torque
b) Grillage steelwork welding checked for distress
2. Mast (Dates Checked - every 3 months)

a) Bolts checked for torque and pins fitted
b) Welding checked for patent distress
c) Access ladder in good repair
d) Intermediate ladder platforms in place
3. JIB (Dates Checked - every 3 months)

b) Jib Support braces / stays checked for distress
4. Counter Jib (Dates Checked - every 3 months)

b) Jib Support braces / stays checked for distress
c) Counterweight secured
5. Ropes (Dates Checked - Weekly)

a) Greased
b) Checked for wear
c) Checked for all ropes laying in all sheaves and
correctly on their drums
d) Fixture to hook block
6. Pulleys (Dates Checked - Weekly)

a) Bearings greased and checked for wear
7. Brakes (Dates Checked - Weekly)

a) Slewing, cutting, hoisting and trolley checked
8. Limit Switches (Dates Checked - Weekly)

a) Checked and overhauled
9. Controls ( Dates Checked - Daily)

a) Tested and functioning
DOC. REF. : TCS/PI/MTCC REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 1 OF 2
MONTHLY TOWER CRANE CHECKLIST
Acceptability
No Items to be checked Remarks
Yes No
10. Safety Devices ( Dates Checked - Daily)
a) Overload device tested
b) Slew alarm, anti-collision device tested
(where fitted)
c) Load radius charts in operator cab
d) Out of service free slew operating
e) Maintenance slew lock functional and disengaged
f) Windows are clean
11. Motor
a) Electric checked for safety
b) All cables securely clamped supported
c) Diesel motor serviced, no fuel leaks etc
d) Hydraulic hoses checked. No oil leaks reservoir
checked
e) Meter speed / power within normal limits
12. Configuration
a) Changes since initial installation
b) Re-overload test applied
The above checks where applicable, have been carried out as indicated. The crane manufacturer’s / supplier’s own
schedule of routine checks and inspections have also been fully complied with and recorded.
Checked By : (TCS’ Operator) Verified By : (TCS OHS Officer)

Name : ………………………………….………. Name : ………………………………….……….
Date : ………………………………….………. Date : ………………………………….……….
DOC. REF. : TCS/PI/MTCC REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 2 OF 2
WEEKLY MOBILE / CRAWLER CRANE CHECKLIST
Project Date
Model Registration
Owner Location
PMA No Validity
Acceptability
No Items To be Checked Remarks
Yes No
1. Operator Competency Certificate issued by JKKP
(validity)
2. Slewing Alarm
3. Reversing Alarm Complete with Flashing Light
4. Boom Angle Indicator
5. Load Chart and Load Indicator
6. Over Hoist on Main and Auxiliary Hoist Alarm / out off
7. Over Boom Cut Out
8. Fire Extinguisher in Cab
9. Crane Hook with Safety Latch
10. Ropes Sleeves Condition
11. Out riggers (Mobile Crane)
12. Tires / Track Condition (Mobile / Crawler Crane)
13. Slings Condition
14. Warning Horn in Cab
Checked By : TCS Safety Site Supervisor Verified By : TCS OHS Officer

Name : ………………………………….………. Name : ………………………………….……….
Date : ………………………………….………. Date : ………………………………….……….
Doc. Ref. : TCS/PI/WMCC Rev. No. : 0 Issue Date : 21 MAY 2018

DAILY INSPECTION CHECKLIST FOR MATERIAL HOIST
No Items To be Checked Acceptability Remarks

Yes No
1. Material Hoist Identification No (PMA) is
conspicuously displayed & valid till
2. Hoist max loading capacity notice is conspicuously
displayed
3. 2 X 9 kg portable fire extinguishers (type ABC dry
powder) are in good working condition
4. Electrical main switch box is securely locked and the
key is kept by the hoist operator
5. Housekeeping in and around the cage is satisfactory
6. Outer cage sliding / bi-parting doors are working
satisfactorily
7. Inner cage sliding / bi-parting doors are working
satisfactorily
8. Emergency stop button is working effectively
9. Top and bottom limit switches are working effectively
10. Roof and floor of cage is in good condition
11. The bracket and mask section is tightened firmly
12. The tooth tracks are in good condition
13. Last maintenance date
Checked By : (TCS Operator) Verified By : (TCS OHS Officer)

Name : ………………………………….………. Name : ………………………………….……….
Date : ………………………………….………. Date : ………………………………….……….
Doc. Ref. : TCS/PI/DIMH Rev. No. : 0 Issue Date : 21 MAY 2018

WEEKLY INSPECTION CHECKLIST FOR LOADING PLATFORM

Acceptability
No Items To be Checked Remarks
Yes No
1. Floor checked metal plate (12mm thick) on sound
beams
2. Stay wires approved for S.W.L. 3 Tons and in good
tension
3. Bull dog clip S/U - bolts for security stay wires in
correct size and position
4. Approved S.W.L. 3 Ton turn buckles for tightening
stay wires in good anchoring position
5. I Beam props to secure platform structure are straight
and plumb
6. Guard rails are in position
7. Loading platform is painted red and consciously
marked
8. Max S.W.L. 2 Ton sign in consciously displayed
9. Floor stopper (bracket) under platform is securely
welded
10. No working beyond this line sign put up at platform
Checked By : (TCS Operator) Verified By : (TCS OHS Officer)

Name : ………………………………….………. Name : ………………………………….……….
Date : ………………………………….………. Date : ………………………………….……….
Doc. Ref. : TCS/PI/WILP Rev. No. : 0 Issue Date : 21 MAY 2018

FIRE EXTINGUISHER INSPECTION FORM

PROJECT NAME DATE OF INSPECTION
Condition
Fire Extinguisher Type of Size /
Serial Number Location Date of Refill Date of Expiry Remarks
Number Extinguisher weight A NR D NM
10
11
12
General Remarks:
Key: A = Acceptable at time of inspection NR = Needs re-filling / re-charging
D = Damaged – Must be removed from site NM = Needs maintenance
Checked By: ______________________________ Position : __________________________ Signature: _________________________
Doc. Ref. : TCS/PI/FEIF Rev. No. : 0 Issue Date : 21 MAY 2018

LIFTING GEAR INSPECTION FORM
Condition Marking Status

Item : Location : Serial Number & SWL : Remarks :
A B C AM BM CM
Inspected By : _____________________ Condition Key: Marking Status Key: (ID, SWL, Colour
Position : _____________________ A = Acceptable at time of inspection Code)
AM = Acceptable at time of inspection
Signature : _____________________ B = In poor condition BM = Poor marking status
Date : _____________________ CM = To be re-tested / marked
C = Damaged – to be removed from site
Doc. Ref. : TCS/PI/LGIF Rev. No. : 0 Issue Date : 21 MAY 2018

FORKLIFT’S DRIVER DECLARATION FORM
PENGISYTIHARAN TANGGUNGJAWAB PEMANDU FORKLIFT
Nama Saya / My Name :

No. Pekerja / Staff No :
No. Kad Pengenalan / Identity Card No :
Jawatan / Position : Gambar /
Bahagian / Section : Photo
No. Lesen Pemandu (asal) /
Driving License No. :
Lesen Kelas / Class :
Saya sebagaimana nama dan butir-butir di atas, telahpun menjalani latihan teori dan praktikal berkaitan dengan Forklift. Saya
faham tentang peraturan-peraturannya dan sedia menjalankan operasi Forklift dengan cara yang selamat.
I am as the above, declared that I was trained theoretically and practically about forklift safety driving. I hereby understand all
the regulations and I will always driving in safe.
Saya juga bersedia mematuhi peraturan-peraturan yang telah ditetapkan sebagaimana di bawah;
I agree to comply to all regulations as below;
1. Saya akan sentiasa memandu forklift dengan cara yang selamat.

I will always drive in safely.
2. Saya akan memeriksa forklift mengikut “Daily Maintenance Checklist” pada setiap hari sebelum operasi dijalankan.
I will daily check the forklift before start work with “Daily Maintenance Checklist”.
3. Saya akan menyimpan KUNCI di dalam “KEY BOX” setiap kali selepas operasi dijalankan.
I will keep the key in key box after operation.
4. Saya tidak akan membiarkan KUNCI berada pada forklift jika tiada operasi dijalankan.
I will not leave the forklift’s key at forklift if no operation.
5. Saya tidak akan benarkan forklift atau kunci forklift diberi kepada pemandu yang tiada lesen memandu dan tidak
didaftarkan.
I will not give forklift or key to unregistered drivers.
6. Saya tidak akan membenarkan penumpang berada pada forklift.
I will not give permission to passenger on forklift.
7. Saya tidak akan jalankan baikpulih atau membuat perubahan pada forklift oleh diri sendiri kecuali merujuk kepada
ketua saya.
I will not repair or modify the forklift without referring to section head.
8. Saya akan melaporkan sebarang kemalangan atau kerosakan kepada ketua saya seberapa segera.
I will inform to leader for any incident or damages.
9. Saya adalah pemandu sah pemegang lesen memandu sebagaimana di atas. Jika saya hilang kelayakan sebagai
pemandu sah tersebut, saya juga akan hilang kelayakan sebagai pemandu forklift.
I’m a competence driver as the above. If I lost the competency, I will also unable be a forklift driver
Disaksikan oleh
Tandatangan / Tandatangan /
: :
Signature Signature
Nama Ketua /
Nama / Name : :
Leader’s Name
Tarikh / Date : No. k/p / i/c No. :
Tarikh / Date :
Doc. Ref. : TCS/PI/FDDF Rev. No. : 0 Issue Date : 21 MAY 2018

FORKLIFT~ DAILY CHECKLIST FOR THE MONTH OF _______________, 20......
Project Code/Name: Ref. No.:
Model Variation: Capacity With Mast Vertical Drivers Name : -

Chassis No: Max.Lift Height:
Mast:
Tire: 2000 1810 1655 Kgs
Attachment:
Truck Weight:
500 600 700 MM
ITEM DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Engine Oil Level
2 Check Cooling System (Water)
3 Check Fan Belt Tension
4 Check Air Filter
5 Check Hydraulic Oil Level
6 Check Battery Water Level
7 Check Fuel Line For Leaks (Diesel)
8 Check Brake Fluid Level
9 Check Automatic Transmission Oil Level
10 Check Under Carriage For Any Oil
11 Check Tyre, Bolts & Nuts Condition
12 Check All Meter At Panel
13 Check Handbrake Operation
14 Check Steering Wheel Play
15 Check Rear Axle
16 Check Back Rest
17 Check Mast Assembly and Fork Condition
18 Check Overhead Guard
19 Warm-Up The Engine For 5 Minuts
20 Check Smoke Colour
21 Check operation Hydraulic, Lifting
22 Check Lifting Chain Tension
23 Others
NOTE: PLEASE WEAR SAFETY HELMET, BOOTS AND GLOVES (COTTON) BEFORE OPERATING THE FORKLIFT.
Inspected By : Verified By :
Name : _____________________ Name : _____________________

N
Position : _____________________ Position : _____________________
P
Date : _____________________ Date : _____________________
D
Doc. Ref. : TCS/PI/FDCM Rev. No. : 0 Issue Date : 21 MAY 2018

EXCAVATION CHECKLIST FORMAT
No Checks Yes No Comments

1 Are there any nearby surface hindrance?
2 Are there any underground installation?
3 Are there proper access and egress provided?
4 Are excavated area exposed to vehicular traffic?
5 Are excavated area expose to falling loads?
6 Are excavated area barricaded and warning system provided for mobile
equipment?
7 Are area inspected for hazardous atmospheres?
8 Are precautions taken for hazards associated with water accumulation?
9 Are adjacent structurers are stable?
10 Are protections of employees from loose rock or soil?
11 Are sufficient fall protection considered for the job?
12 Are sufficient slope provided with respect to soil type? (Pls. mention the
angle)
13 Are tripping hazards & nails removed / protected from the site?
14 Are mechanical equipments used to assist employees? (If yes explain)
15 Are platforms, staircases, ladders & railings inspected for use?
16 What is the excavation depth? In meter
17 Are rescue equipments in place?
18 Are roll off protection in place?
19 Are adequate shoring provided?
20 Are trench box provided and in good condition?
Inspected by :…………………………………. Verified by :……………………………………………...
Date of inspection :…………………………………. Date verified :……………………………………………...
Doc. Ref. : TCS/PI/ECF Rev. No. : 0 Issue Date : 21 MAY 2018

RCB
ON SITE / FORTNIGHTLY INSPECTION CHECKLIST FOR EARTH
MOVING EQUIPMENT
ON SITE MOBILIZATION FORTHNIGHTLY
MONTH : ____________200__
(Please tick appropriate box)
EQUIPMENT
MODEL NUMBER
CONTRACTOR
PROJECT
DATE OF INSPECTION
NEXT INSPECTION
No Check Items Result Remarks

1 Do the indicators of temperature of cooling water, oil and
oil pressure correctly operate?
2 Does the engine start smoothly without abnormal sound?
3 Is there any trouble for fuel supplying devices? (jet pump,
smudge, leakage)
4 Is there any trouble for lubricant devices?
(oil volume, smudge, leakage)
5 Is there any defect for cooling effect?
(water volume, tension belts, blocking of cores)
6 Is the exhaust gas system in good condition?
7 Are level handles, brake pedals, brake lock in good
operating condition?
8 Are the clutch and brake for driving in good condition?
9 Are the main clutch and transmission in good condition?
10 Is the winch in good operatable condition?
11 Are cables, lamps, alarms free from damage?
12 Are tension of truck-link, driving chains adequate?
Seat belt (damage, missing)
13 Are hoses, pipes not damaged and no leakage?
14 Are there no crack, defacement, or deformation in soil
plates, bucket frame, ripper and arms?
15 Are all bolts and fastener surely tightened?
16 Reverse / slew audio / visual alarms and side mirrors
available?
OBJECT: BULLDOZER, SCRAPER, TRACTOR SHOVEL, POWER SHOVEL, EXCAVATOR ETC
Inspected by
Signature
(Name)
Witnessed by
Signature
(Name)
Company Name Date
Doc. Ref. : TCS/PI/EME Rev. No. : 0 Issue Date : 21 MAY 2018

BORE RIG-DAILY CHECKLIST

PROJECT NAME : ………………………………………………………… DATE : DD/MM/YY
** Inspection should be made every 10 hours operation / on a daily basis before operation started
Figure: Lubrication and maintenance parts
Doc. Ref. : TCS/PI/BRDC Rev. No. : 0 Issue Date : 21 MAY 2018 Page 1 of 2
BORE RIG-DAILY CHECKLIST

** Inspection should be made every 10 hours operation / on a daily basis.
ITEMS PRESCRIBE SERVICE NOTE
Grease
1
Check fixing pins are tights and secure
ROPE SWIVEL
Test swivel rotates freely
2
Inspect for wear and damage
KELLEY BAR
Inspect for excessive wear broken wires or other
3 damage
CROWD ROPE Check fix points are secure
OR
Check cylinder are leak free
CROWD CYLINDER Check fixing pins are secure
Clean piston rods
Clean the tool
4
Inspect teeth, chisel and auger for wear,
DRILLING TOOL
Replace with new or rebuild by welding as required
5 Check cylinders are free leak

MAST POSITIONING Check fixing pins are tight and secure
ASSEMBLY Clean piston rods
6 Inspect for excessive wear, broken wires or other

MAIN AXULIARY ROPE damage
7 Check cylinder are leak free
BOOM CYLINDERS Clean piston rods
8 Check lines and hoses are leak free of damage
HYDRAULIC Check tank oil level
Check oil level
Check water coolant level
9
Check air filter, clean as required
ENGINE
Check V-belts
Clean cooling ribs
10 Check for wear and damage
CRAWLER TRACK Check chain tension
ASSEMBLE Clean thoroughly at end of working day
Keep windows clean
11
Keep control panels clean
OPERATOR CABIN
Keep inside tidy
Checked By : (TCS Operator) Verified By: (TCS OHS Officer)

Signature : ………………………………… Signature : …………………………………
Name : ……………………………… Name : ………………………………
Date : ……………………………… Date : ………………………………
Doc. Ref. : TCS/PI/BRDC Rev. No. : 0 Issue Date : 21 MAY 2018 Page 2 of 2
MAINTENANCE INTERVAL SCHEDULE (DOZER)

PROJECT : DATE:
LOCATION : EQUIPMENT:
INDO: REGISTERED:
YEAR OF MGG PMA NO.
ENGINE NO. SERIAL NO.
HOUR METER OPERATOR
HOUR
ITEM DESCRIPTIONS REMARK
10 50 250 1000 2000
1 Alarm Test/ Replace
2 Brake Indicators and Gauges Test/ Adjust
3 Cooling system level Check/ Top Up
4 Engine Oil Level Refill
5 Fuel Check/Adjust/Replace
6 Fuel Tank Water & Sediment Check/ Top Up
7 Hydraulic system oil level Check/ Replace
8 Transmission Oil Level Check/ Adjust
9 Walk around inspection Clean/ Replace
10 Window & wind screen Check/ Top Up
11 Pivot Shaft oil Level Check/ Top Up
12 Ripper Linkage and Cylinder Bearing Clean/ Replace
13 Track pin Clean/ Replace
14 Alternator and fan belt Lubricate
15 Battery Lubricate
16 Breaking system Check
17 Bulldozer Tilt Brace Tighten
18 Cooling System Additive Lubricate
19 Engine Oil and Filter Change
20 Equalizer Bar Pins Change
21 Final Drive Oil Level Clean
22 Track Adjustment Change
23 Transmission Oil Filter Check/ Top Up
24 Engine Crankcase Breather Check/ Top Up
25 Fuel System Primary Filter Check/ Top Up
26 Fuel System Secondary Filter Check/ Adjust
27 Fuel System Change
28 Fuel Tank Cap & Fill Screen Drain
29 Hydraulic System Oil Filter Drain
30 Recoil Spring compartment oil level Change
31 Transmission oil filter Clean
32 Lift Cylinder York Bearing Change
33 Rollover protective Clean
34 Torque Converter Scavenge Screen Change
35 Transmission Magnetic Screen Change
36 Transmission Oil Change
37 Transmission Oil Filter Change
38 Engine Valve Lash Change/ Adjust
39 Engine Valve Rotator Inspect/ Replace
40 Final Drive Oil Change
41 Hydraulic System Oil Change
42 Hydraulic System Oil Filter Inspect
43 Track Roller Frame Inspect
44 Track Roller Frame Guide Inspect/ Replace
45 Cooling System Coolant (DEAC) Change
46 Cooling System Extended Lift Cooling Extended Add
47 Cooling System Water Temperature Regulator Clean
Doc. Ref. : TCS/PI/MISD Rev. No. : 0 Issue Date : 21 MAY 2018

MAINTENANCE INTERVAL SCHEDULE (EXCAVATOR)

PROJECT : DATE:
INDO: REGISTERED:
YEAR OF MGG PMA NO.
HOUR METER OPERATOR
HOUR
10 50 250 1000 2000
1 Bucket & Link Pins Check/Grease
2 Bucket Teeth for Wear and Looseness Check/Replace
3 Coolant Water Check/Top Up
4 Fuel Tank Sump Drain
5 Fuel Hose Leaks & Cracks Check/ Replace
6 Hydraulic hoses & lines for leak Check/ Replace
7 Hydraulic oil level Check/Top up
8 Oil Level Check/Top up
9 Window & wind screen Clean
10 Battery Check/Top up
11 Fan belt tension Check/Replace/Adjust
12 Track sag Check/Adjust
13 Water separator Check/Replace
14 Front joint pins & link pins Check/Grease
15 Air cleaner element Check/Replace
16 Hydraulic Oil Tank Sump Drain
17 Swing Reduction Gear Oil Level Check/Top up
18 Transmission Pump Oil Level Check/Top up
19 Travel Reduction Gear Oil Level Check/Top up
20 Engine oil bypass filter Change
21 Engine oil bypass filter Change
22 Engine oil main filter Change
23 Fuel filter Change
24 Hydraulic Tank Oil Filter Change
25 Swing Bearing Check/Grease
26 Swing Internal Gear Check/Grease
27 Radiator & Oil Cooler Core Clean
28 Engine Valve Clearance Check/Adjust
29 Feed Pump Strainer Clean
30 Pilot Oil Filter Change
31 Pump Transmission Oil Change
32 Swing Reduction Oil Change
33 Hydraulic Oil Change
34 Hydraulic Oil Filter Change
Doc. Ref. : TCS/PI/MISE Rev. No. : 0 Issue Date : 21 MAY 2018

MAINTENANCE INTERVAL SCHEDULE (VIBRATOR ROLLER)
PROJECT : DATE:
INDO: REGISTERED:
YEAR OF MGG PMA NO.
HOUR METER OPERATOR
HOUR
10 50 250 1000 2000
1 Alarm Test/Replace
2 Brake Test/Adjust
3 Engine oil level Check/Adjust/Replace
4 Fuel Refill
5 Fan belt condition Check/Adjust/Replace
6 Hydraulic Check/Top up
7 Radiator coolant level Check/Top up
8 Scraper setting Check/Top up
9 Air cleaning element Check/Replace
10 Battery Check/Top up
11 Drum Oil level Check/Top up
12 Hydraulic Hoses & Lines Check/Replace
13 Rubber Element & Fastening Check/Replace
14 Steering Joints Lubricate
15 Steering cylinder bracket Lubricate
16 Tyre pressure Check
17 Wheel nut Tighten
18 Control & moving joints Lubricate
19 Engine oil Change
20 Engine oil filter Change
21 Hydraulic oil cooler Clean
22 Hydraulic oil level Change
23 Rear axle planetary gear oil level Check/Top up
24 Transfer gearbox oil level Check/Top up
25 Torque Hub Oil Level Check/Top up
26 Engine Valve Clearance Check/Adjust
27 Fuel filter Change
28 Fuel tank condensed water Drain
29 Hydraulic Tank Venting Filter Drain
30 Supply Pump Strainer Change
31 Drum Oil Clean
32 Hydraulic Tank Change
33 Hydraulic Oil Clean
34 Pump Drive Oil Change
35 Rear Axle Planetary Gear Oil Level Change
Doc. Ref. : TCS/PI/MISVR Rev. No. : 0 Issue Date : 21 MAY 2018

SIDE BOOM OPERATOR DAILY CHECKLIST

PROJECT CODE/NAME : _____________________________________________________________________________________________________________
NAME OF OPERATOR : _________________________________ MACHINE SERIAL NO. : _______________________________
MONTH/YEAR : _______________________________
(Please tick of cross where applicable) OK Un-satisfaction (US) MACHINE DESCRIPTION : _______________________________
DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water
level
Fan belt condition
Alternator belt
condition
Main hoist wire
rope
Boom hoist wire
rope
working light
Swing/propel
alarm
Boom structure
Instrument gauge
Hydraulic system
Guards
Electric wiring
Electrical
connection
Operator initial
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/SBODC Rev. No. : 0 Issue Date : 21 MAY 2018

DUMP TRUCK OPERATOR DAILY CHECKLIST
PROJECT CODE/NAME : _________________________________________________________________________________________________________
MONTH/YEAR : _______________________________
(Please tick of cross where applicable) OK Un-Satisfaction (US) MACHINE DESCRIPTION : _______________________________
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water level
Fan belt condition
Alternator belt
condition
Gear oil level
Head light
Rear light
Signal light
Swing/propel alarm
Horn
Instrument gauge
Wiper blade
Tyre
Brake system
Hydraulic system
Pneumatic hoses
Safety relieve valve
Electric wiring
Electrical
connection
Operator initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/DTODC Rev. No. : 0 Issue Date : 21 MAY 2018

MOTOR GRADER OPERATOR DAILY CHECKLIST
PROJECT CODE/NAME : _______________________________________________________________________________________________________________________
MACHINE DESCRIPTION : _________________________________ MONTH/YEAR : _______________________________
(Please tick of cross where applicable) OK Un-satisfaction (US)
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water level
Fan belt condition
Alternator belt
condition
Gear oil level
Head light
Rear light
Signal light
Swing/propel alarm
Horn
Instrument gauge
Wiper blade
Tyre
Brake system
Hydraulic system
Guards
Pneumatic hoses
Safety relieve valve
Electric wiring
Electrical
connection
Operator initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/MDODC Rev. No. : 0 Issue Date : 21 MAY 2018

BACK HOE OPERATOR DAILY CHECKLIST
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water
level
Fan belt condition
Gear oil level
Head light
Rear light
Signal light
Working light
Swing/ propel
alarm
Horn
Instrument
gauges
Tyre
Brake system
Out-rigger
system
Hydraulic system
Guards
Electric wiring
Electrical
connection
Operator initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/BHODC Rev. No. : 0 Issue Date : 21 MAY 2018

BACK PUSHER OPERATOR DAILY CHECKLIST
(Please tick of cross where applicable) OK Un-Satisfaction (US)
Engine oil level
Fuel level
Radiator coolant
Battery water
level
Fan belt condition
Alternator belt
condition
Gear oil level
Head light
Rear light
Signal light
Working light
Horn
Instrument
gauges
Tyre
Brake system
Hydraulic system
Guards
Electric wiring
Electrical
connection
Operator initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/BPODC Rev. No. : 0 Issue Date : 21 MAY 2018

BULLDOZER OPERATOR DAILY CHECKLIST
Engine oil level
Fuel level
Track system
Radiator coolant
Power shift oil
Battery water
level
Fan belt
condition
Alternator belt
condition
Gear oil level
Working light
Swing/ propel
alarm
Instrument
gauges
Brake system
Hydraulic
system
Guards
Electric wiring
Electrical
connection
Operator initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/BODC Rev. No. : 0 Issue Date : 21 MAY 2018

VIBRATING ROLLER OPERATOR DAILY CHECKLIST
(Please tick of cross where applicable) OK Un-Satisfaction (US)
Engine oil level
Fuel level
Radiator
coolant
Battery water
level
Fan belt
condition
Alternator belt
condition
Gear oil level
Working light
Swing/propel
alarm
Horn
Tyre
Brake system
Hydraulic
system
Guards
Electric wiring
Electrical
connection
Operator
initial
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Date : ………………………............ Date : ………………………............
Doc. Ref. : TCS/PI/VRODC Rev. No. : 0 Issue Date : 21 MAY 2018

EXCAVATOR OPERATOR DAILY CHECKLIST
MONTH/YEAR : _______________________________
(Please tick of cross where applicable) OK Un-Satisfaction (US) MACHINE DESCRIPTION : _______________________________
Engine oil level
Fuel level
Radiator
coolant
Battery water
level
Fan belt
condition
Alternator belt
condition
Gear oil level
Working light
Swing/ propel
alarm
Horn
Instrument
gauges
Wiper blade
Load indicator
Boom angle
device
Hydraulic
system
Guards
Electric wiring
Electrical
connection
Operator
initial
Doc. Ref. : TCS/PI/EODC Rev. No. : 0 Issue Date : 21 MAY 2018

EXCAVATOR WEEKLY CHECKLIST
Ref. No.:
Project Name:
Month:
Company:
Model : Vehicle No. :

Manufacturer : Capacity :
Operator Name : NRIC No. :
License Type : Validity :
Date of Inspection : Date of Deployment :
CHECKLIST ITEMS
DATE / EVERY THURSDAY
NO CHECKLIST ITEMS Week 1 Week 2 Week 3 Week 4 REMARKS
1 Engine Condition
2 Diesel Level
3 Engine Oil Level
4 Water Level
5 Cabin
6 Hydraulic Condition
7 Contril Level
8 Bucket
9 Tires
10 Exhaust
11 Headlight
12 Reverse Light
13 Siren
OTHERS REMARKS
Subcontractor/Supplier Maincontractor/Client
INSPECTED BY APPROVED BY (PM) ACKNOWLEDGE BY
Name: Name: Name:
Position: Position: Position:
* This form must submitted to maincontractor/client Safety & Health Department on the fourth week
* Please keep this inspection list in proper storage
Doc. Ref. : TCS/PI/EWC Rev. No. : 0 Issue Date : 21 MAY 2018

MOBILE CRANE CHECKLIST
Project Name/Code :
Date /Tarikh : NO ITEM/BUTIR CONDITION/KEADAAN REMARKS/CATATAN
1 PMA
WEEKLY INSPECTION CHECKLIST
2 CERTIFICATE OPERATOR
IF CONDITIONS ARE SATISFACTORY / Jika Keadaan Memuaskan 3 COMMUNICATION DEVICE (WAKIE TALKIE)
x IF SEVICE IS REQUIRED / Jika Servis Diperlukan 4 FIRE EXTINGUISHER
5 LOAD CHART
6 PPE
7 CARRIER STRUCTURE
8 WHEEL NUTS
9 CABIN
10 CONTROL DEVICE AND SWITCHES
11 LOAD INDICATOR
12 RADIUS INDICATOR
C 13 WARNING LIGHT
14 HON
15 DIESEL TANK
16 BATTERY
17 WIRE ROPE
18 BOOM TELESCOPIC
19 FLY-JIB
20 HOISTING
21 LUFFING
22 SLEWING TABLE
23 HYDRAULIC
24 OUT-RIGGER
25 STEEL PLATE
26 CRANE POSITION
27 COUNTER WEIHGT
28 LEADDDER
29 TIRE
30 MAIN BLOCK
31 SAFETY LACTH
32 CHAIN
33 HOOK LOCK & SHAKLE
REMARKS
INPECTED BY VERIFIED BY APPROVED BY
Diperiksa Oleh Disahkan Oleh Diluluskan Oleh
NAME/Nama : NAME/Nama : NAME/Nama :
Date/Tarikh : DATE/Tarikh : DATE/Tarikh :

TIME/Masa : Time/Masa : Time/Masa :
Doc. Ref. : TCS/PI/MCI Rev. No. : 0 Issue Date : 21 MAY 2018

CRANE HAMMER HEAD CHECKLIST
Project Name/Code : Date/Tarikh :
FILL/Isikan:
DAILY INSPECTION CHECKLIST IF CONDITIONS ARE SATISFACTORY / Jika Keadaan Memuaskan
Senarai Semak Pemeriksaan Harian x IF SEVICE IS REQUIRED / Jika Servis Diperlukan
NO ITEM/BUTIR CONDITION/KEADAAN REMARKS/CATATAN

Alat Kawalan Dan Suis
2 ELECTRICAL CABLE
Kabel Elektrik
c
3 COMMUNICATION DEVICE
HAB
Alat Komunikasi
4 NO LEAKAGE
Tiada Kebocoran
5 LOAD INDICATOR
COUNTER WEIGHT ( ) Indikator Beban
Pemberat 6 RADIUS INDICATOR
Indikator Radius
7 WARNING LIGHT
WIRE ROPE CONDITION ( ) Lampu Amaran
Keadaan Tali Dawai 8 HON
Bunyi Siren
JIB PINS AND BOLTS ( ) 9 FIRE EXTINGUISHER
Pin Dan Bolt Jib Alat Pemadam Api
10 HOIST BRAKE
CABIN DOOR, WINDOWS, WIPER AND CONTROL GEAR ( ) Brek Hoist
Pintu, Tingkap, Pengelap Cermin Dan Kawalan Gear 11 HOIST MOTOR CONNECTION
Sambungan Motor Hoist
PLATFORM PINS AND BOLTS ( ) 12 TROLLEY BRAKE
Pin Dan Bolt Platform Brek Troli
13 TROLLEY LIMIT
MAST PIN AND BOLTS ( ) Had Limit
Pin Dan Bolt Mass 14 TROLLEY MOTOR CONNECTION
Sambungan Motor Troli
ACCESS LADDER AND HANDRAILS ( ) 15 HOOK BLOCK HEIGHT LIMIT
Tangga Akses Dan Rel Tangan Had Tinggi Block Cangkuk
16 LOAD CHART
BASE PINS AND BOLTS ( ) Carta Beban
Pin Dan Bolt Tapak 17 CERTIFICATE AND PMA
Sijil Orang Yang Kompeten Dan PMA
18 PPE-HELMET,SHOES,GLOVE AND HARNESS
PPE-Topi,Kasut,Sarung tangan, Abah-abah
INPECTED BY VERIFIED BY
Diperiksa Oleh Disahkan Oleh ADDITIONAL REMARKS / Catatan Tambahan
MACHINE OPERATOR(Pengendali Mesin) NAME/Nama :

NAME/Nama: DESIGNATION :
I/C : TIME/Masa :
TIME/Masa : DATE/Tarikh :
Doc. Ref. : TCS/PI/CHHC Rev. No. : 0 Issue Date : 21 MAY 2018

CRANE LUTFING CHECKLIST
Project Name/Code : FILL/Isikan:
DAILY INSPECTION CHECKLIST √ IF CONDITIONS ARE SATISFACTORY / Jika Keadaan Memuaskan DATE :
Senarai Semak Pemeriksaan Harian x IF SEVICE IS REQUIRED / Jika Servis Diperlukan TARIKH
NO ITEM/BUTIR CONDITION/KEADAAN REMARKS/CATATAN

Alat Kawalan Dan Suis
2 ELECTRICAL CABLE
Kabel Elektrik
3 COMMUNICATION DEVICE
Alat Komunikasi
HAB 4 NO LEAKAGE
Tiada Kebocoran
5 LOAD INDICATOR
COUNTER WEIGHT ( ) Indikator Beban
Pemberat 6 RADIUS INDICATOR
Indikator Radius
7 WARNING LIGHT
WIRE ROPE CONDITION ( ) Lampu Amaran
Keadaan Tali Dawai 8 HON
Bunyi Siren
JIB PINS AND BOLTS ( ) 9 FIRE EXTINGUISHER
Pin Dan Bolt Jib Alat Pemadam Api
10 HOIST BRAKE
CABIN DOOR, WINDOWS, WIPER AND CONTROL GEAR ( ) Brek Hoist
Pintu, Tingkap, Pengelap Cermin Dan Kawalan Gear 11 HOIST MOTOR CONNECTION
Sambungan Motor Hoist
PLATFORM PINS AND BOLTS ( ) 12 TROLLEY BRAKE
Pin Dan Bolt Platform Brek Troli
13 TROLLEY LIMIT
MAST PIN AND BOLTS ( ) Had Limit
Pin Dan Bolt Mass 14 TROLLEY MOTOR CONNECTION
Sambungan Motor Troli
ACCESS LADDER AND HANDRAILS ( ) 15 HOOK BLOCK HEIGHT LIMIT
Tangga Akses Dan Rel Tangan Had Tinggi Block Cangkuk
16 LOAD CHART
BASE PINS AND BOLTS ( ) Carta Beban
Pin Dan Bolt Tapak 17 CERTIFICATE AND PMA
Sijil Orang Yang Kompeten Dan PMA
18 PPE-HELMET,SHOES,GLOVE AND HARNESS
PPE-Topi,Kasut,Sarung tangan, Abah-abah
INPECTED BY/Diperiksa Oleh VERIFIED BY/Disahkan Oleh
ADDITIONAL REMARKS / Catatan Tambahan
MACHINE OPERATOR/Pengendali Mesin NAME/Nama :

NAME/Nama : DESIGNATION :
I/C : TIME/Masa :
TIME/Masa : DATE/Tarikh :
Doc. Ref. : TCS/PI/CLC Rev. No. : 0 Issue Date : 21 MAY 2018

HEAVY EQUIPMENT INSPECTION
TOWER LIGHT GENERATOR
Project Name: Ref. No.:
Company:
Model:
Capacity:
Manufacturer:
Date of Inspection:
Date of Deployment:
RESULT
NO ITEMS INSPECTED REMARKS
PASS FAIL
1 Tire Condition
2 Condition of Exhaust System
3 Condition of Electrical Control Panel
4 Drip Receiving Pan Provided
5 Condition of Machine Lifting Eye
6 Condition of Tower Bar
7 Battery Condition
8 Condition of Engine Cooling System
9 Engine Oil Level
10 Engine Oil Leakage
11 Grounding System Condition
12 Charges Fire Extinguisher Provided
13 Condition of Boom Hoisr Cable / Winch / Pulley
14 Condition Of Lamp / Lenses / Reflector Units
15 Out Rigger Condition (If Applicable)
16 Power Cable Condition (Damage / Joints)
17 ELCB Unit Provided
OTHERS REMARKS
Signature : Signature : Signature :
Name: Name: Name:

Doc. Ref. : TCS/PI/HEI-TLG Rev. No. : 0 Issue Date : 21 MAY 2018

HEAVY EQUIPMENT INSPECTION
PORTABLE POWER GENERATOR
Company:
Model:
Capacity:
Manufactor:
Date of Inspection:
Date of Deployment:
RESULT
NO ITEMS INSPECTED REMARKS
PASS FAIL
1 Condition of Exhaust System
2 Condition of Electrical Control Panel
3 drip Receiving Pan Provided
4 Battery Condition
5 Start / Stop Mechanism (Ignition Switch etc.)
6 Over-all Machine Condition
7 Engine Oil Level
8 Engine Oil Leakage
9 Grounding System Condition
10 Charged Fire Extinguisher Provided
11 Pulley Guard in Position
OTHERS REMARKS
Name: Name: Name:

Doc. Ref. : TCS/PI/HEI-PPG Rev. No. : 0 Issue Date : 21 MAY 2018

HEAVY MACHINERY FORKLIFT INSPECTION
Company:
Model:
Capacity:
Manufactor:
Operator Name:
NRIC No.:
License Type/Validity:
Date of Inspection:
Date of Deployment:
RESULT
NO CHECKLIST ITEMS REMARKS
PASS FAIL
1 Forklift body and Overhead Guard Condition.
2 Battery Cables / Clamps.
3 Head Light / Turn Indicator / Break Light Function.
4 Rotating Beacon light Function.
5 Mirror Condition.
6 Preventive Maintenance Records.
7 Ignition switch / Engine stop mechanism.
8 Drive Belts Condition.
9 Government / 3rd Party Certification provided (if required)
10 Fire Extinguisher Fitted and Charged.
11 Engine / Radiator Coolant / Break Oil Level.
12 Seat Belt Condition.
13 Hydraulic Oil Level.
14 Hydraulic RAM / Hoses / Fittings Leakage.
15 Load Chain / Anchor / Mast Assembly.
16 Tire Condition (Worn / Damage / Inflated).
17 Backup Alarm / Horn Function.
18 Fork Condition / Load Chart.
19 Hydraulic Control Levers / Steering Wheel.
20 Parking Brake / Foot Brake / Inching Brake.
21 Gauges / Indicators / Switches and Controls Conditions.
22 Hydraulic / Transmission Oil Leakage.
OTHERS REMARKS
Name: Name: Name:

Doc. Ref. : TCS/PI/HMFI Rev. No. : 0 Issue Date : 21 MAY 2018

Building & Civil Engineering Contractor (466772-H)
No.78A, Jalan SPU 1, Saujana Business Park, Bandar Saujana Putra, 42610 Jenjarum, Selangor Darul Ehsan
Tel: 03 - 5103 8899 / 9988 Fax: 03 - 5103 9889 Email: general@tcsconstruction.com.my
NOTIFICATION OF PENALTY
Project :
TO
You are hereby notified that you / your worker (s) have committed the following breach / non-compliance on QESH RULES
Description of Non-Compliance /
PHOTOGRAPH / SKETCH
Offence
In accordance with the TCS Construction HSE Management System, we are imposing a fine as specified below and will be
deducted from the progress payment / salary due to you.
Amount of Penalty Imposed ( RM )
ISSUED BY APPROVED BY ACKNOWLEDGEMENT

Signature: Signature: Signature:
Name: Name: Name:

Date : Date : Date :
DEPARTMENT ATTENTION
Project Director
DISTRIBUTION LIST
Quantity Surveyor
Finance
Doc. Ref.: TCS/PI/NP Rev. No. : 0 Issue Date: 21 May 2018

ESH MONTHLY REPORT

MONTH: XXXX 201X
Project Title : PROPOSED PHASE 8A1 DEVELOPMENT CONSISTING 356 UNITS OF DOUBLE
STOREY TERRACE HOUSES (20’ X 65’), 2 NOS OF TNB SUBSTATIONS AND 1
GUARDHOUSE ON PART OF LOT 11605 AT MAHKOTA HILLS, MUKIM LENGGENG,
NEGERI SEMBILAN DARUL KHUSUS FOR M/S KIA ACE DEVELOPMENT SDN BHD
Project No : T1801 Reference : TCS/ESHMR/T1801/2018
Activity Designation Signature Date
Prepared by : Name (SHO) dd/mm/yyyy
Approved by : Name (Project Manager) dd/mm/yyyy
Status :
Copyright © by TCS CONSTRUCTION SDN BHD. All Rights Reserved

ESH MONTHLY REPORT

TABLE OF CONTENTS
No. Description Page – of –
i. EXECUTIVE SUMMARY 1 of 12
ii. ENVIRONMENT, HEALTH & SAFETY OBJECTIVES 1 of 12
1. MONTH 1 of 12
2. Workplace Description 1 of 12
3. HSE Statistics [Reg. 19(2) c] 1 of 12
4. SHO Report 1 of 12
5. Machinery, Equipment, Appliance, Substances, Process 1 of 12

or Manual Labour to Cause Bodily Injury [Reg. 19(2) d]
6. Any Machinery, Equipment, Appliance, Substances or 1 of 12

PPE Required for the Purpose of Minimizing Any Such
Risk [Reg. 19(2) e]
7. Recommendation Any Alteration to Structure and Layout 1 of 12

for OSH Purpose [Reg. 19(2) f]
8. HSE Promotion Program [Reg. 19(2) g] 1 of 12
9. Any Other Matters Related to OSH [Reg. 19(2) i] 1 of 12
10. Outstanding Matters from Previous Report [Reg. 19(2) h] 1 of 12
11. Comments by Person in Charge 1 of 12
12. Attachment – if have any related to ESH Report 1 of 12
Doc. Ref.:TCS/PI/MR Rev. No.:0 Issue Date: 21 May 2018 Page: 2 of 12

ESH MONTHLY REPORT

i. Executive Summary
Environment, Health & Safety
‘We have achieved above xxxx million safe man hours without lost time injury’
The ‘xxxx’ project has achieved Approx. xxx million cumulative man-hours worked up to (insert date)
The project has accomplished Zero LTI free man-hours worked since last LTI on (insert date last
incident)
 X No. First Aid cases occurred during the month of (insert current month)
 Total xxx nos of Construction Vehicles (please give example) were inspected and stick green
sticker after inspection during the month of (insert current month).
 Total xx nos of Safety trainings conducted at site and achieved xxxx man months during the
month of (insert current month).
 Total xxxx man-hour achieved from tool box briefings such as incident alerts, hazard & fire safety
to site etc. conducted at site.
 Xx Persons safety Induction conducted during the month of (insert current month).
 Total xx nos Housekeeping Inspection conducted at site during the month of (insert current
month).
 Xx nos Work Permit has been issued for (insert work activity) during the month of (insert current
month).
 Issued mandatory PPE to the workers and ensure its proper use at site and PPEs stock list has
been attached with the monthly report as Appendix 1

ESH MONTHLY REPORT

ii. Environment, Health & Safety Objectives
Objectives Measures Progress

Health & Safety:
Objectives Measures Progress

Environmental:

ESH MONTHLY REPORT
EHS Officer Monthly Report

Reg. 19, Occupational Safety and Health (safety and Health Officer) Regulation 1997
1.0 Month: January Year: 2018
2.0 Workplace Description
No Description Details
2.1 Project Name
2.2 Project Target (Man-hours Worked without LTI)
2.3 Man-hours Worked without LTI
2.4 Total Man-hours Worked (With or Without LTI)
3.0 HSE Statistics [Reg. 19(2) c]
3.1 Reactive Indicators
Item Description Unit IJM (Site) Subcontractor Overall Total

Previous This Total to Previous This Total to Staff +
Cumulative Month Date Cumulative Month Date Subcontractor
A No. of Manpower No.
B Manhours Worked Hrs 0 0 0 0
C Incident Cases No. 0 0 0 0
a) Fatality No. 0 0 0 0
b) Serious bodily Injury No. 0 0 0 0
c) Dangerous occurrence No. 0 0 0 0
d) Environmental incident No. 0 0 0 0
e) Occupational disease No. 0 0 0 0
f) Occupational poisoning No. 0 0 0 0
g) First Aid 0 0 0 0
h) Others ............................... No. 0 0 0 0
Doc. Ref.:TCS/EHS/MR Rev. No.:0 Issues Date: 21 May 2018 Page: 5 of 11
ESH MONTHLY REPORT

Item Description Unit Staff (Site) Subcontractor Overall Total
Previous This Total to Previous This Total to Staff +
Cumulative Month Date Cumulative Month Date Subcontractor
D No. of Lost Time Injury Cases No. 0 0 0
(LTI)
a) Incident (due to 2b) No. 0 0 0
b) Occupational disease No. 0 0 0
c) Occupational poisoning No. 0 0 0
E No. of Lost Workdays (LW) Days 0 0 0
a) Incident (due to 2a-2d) Days 0 0 0
b) Occupational disease Days 0 0 0
c) Occupational poisoning Days 0 0 0
F No. of Property Damage No. 0 0 0
Cases
a) Loss > RM 10,000.00 No. 0 0 0
b) Loss < RM 10,000.00 No. 0 0 0
G No. of Notices 0 0 0
a) NOI 0 0 0
b) DOE 0 0 0
c) Local Authority 0 0 0
d) KKM 0 0 0
H No. of Stop Work 0 0 0
a) NOP 0 0 0
b) DOE 0 0 0
d) KKM 0 0 0
I No. of Compound 0 0 0
a) NOI 0 0 0
b) DOE 0 0 0
d) KKM 0 0 0
ESH MONTHLY REPORT

3.2 Active Indicators
Previous Cumulative
No. Indicator This Month Total Total to Date
Total
1 HIRADC Establishment
2 HIRADC Review
3 Toolbox Meetings
4 On Job Training
5 Emergency Response Drills
6 HSE Committee Inspection
7 Daily/Weekly Observations
8 Environmental Monitoring Conduct
You See You Act
9 HSE Promotion/Campaign (Provide Details at 8.2)

ESH MONTHLY REPORT

4.0 SHO Report
4.1 Compliance with OSH Legal and Other Requirements [Reg. 19(2) a]
No Act/Regulation Issues Action Required Action By Due Date
4.2 Method of Establishing and Maintaining a Safe and Healthy Working Condition at the workplace [Reg. 19(2) b]
4.2.1 Site HSE Committee Meeting / Site HSE Management Review

(Summary of issues from project HSE meetings)
Sub-Contractor Name Issues Required Attention Action Taken Status
4.2.2 Environmental Monitoring Program
Elements Date Status (Pass / Fail) ; if fail please include Action Taken Status follow-up
the parameter
Air
Water
Noise/Vibration
Waste/Recycling
Flora/Founa

ESH MONTHLY REPORT

4.2.3 HQ Surprise Site Inspection
No. Date Inspected Previous Rating Current Rating Category Close Out Status
4.2.4 Internal/External Audit (i.e TCS Internal Audit, SIRIM Audit, Client Audit, Authority Audit)
No. Of CAR No. Of OBSERVATION Close Out Status

Type of Audit Audit Date
OHS EMS HSE OHS EMS HSE OHS EMS HSE
4.2.5 Project Corrective Action Request (CAR) Issued
No Sub-Contractor Name Description of Non-Conformance Action Taken by Project CAR Status

ESH MONTHLY REPORT

5.0 Machinery, Equipment, Appliance, Substances, Process or Manual Labour to Cause Bodily Injury [Reg. 19(2) d]
Type of Machinery, Equipment,

Appliance, Substances, Process Area of Concern Action Taken Status
or Manual Labour
6.0 Any Machinery, Equipment, Appliance, Substances or PPE Required for the Purpose of Minimizing Any Such Risk [Reg. 19(2) e]
Machinery, Equipment, Appliance, Substances or

Current Month Activity
Hazard Risk PPE Required
( Please refer to HIRADC documents)
Item Qty
7.0 Recommendation Any Alteration to Structure and Layout for OSH Purpose [Reg. 19(2) f]
No Item Location Action Required Status

ESH MONTHLY REPORT

8.0 HSE Promotion Program [Reg. 19(2) g]
8.1 Training Program Conducted ( i.e On Job Training, Internal or External)
Date Title Type (Internal/External/On Job Training) No of Participants
8.2 HSE Campaign Program
Date Details of Program Summary of Findings No of Participants

ESH MONTHLY REPORT

9.0 Any Other Matters Related to OSH [Reg. 19(2) i]
9.1 Issuances of Notices from Authority Body ( eg DOSH, DOE, CIDB or Local Authority)
Type of Notices
No Date Non-Conformance Issues Status
(NOI/NOP/Others)
9.2 Accident Investigation Status
Type of Project
No Accident Date Pending Action Action By
Accident Investigation Status
10.0 Outstanding Matters from Previous Report [Reg. 19(2) h]
Report Item No. Action Required

ESH MONTHLY REPORT
11.0 Comments by Person in Charge
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
Reported By: Acknowledged By PIC:
………………………………………. ……………………………………….
Name: Name:
Date: Date:
Note: This report to be produced and submitted to Person in Charge before the 10th every month.

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TCS CONSTRUCTION SDN BHD

ENVIRONMENTAL, SAFETY & HEALTH INDUCTION FORM

Name (Nama) : Designation (Jawatan) :

6.0 Others (Lain-lain)

Name (Nama) : Name (Nama) :

Doc. Ref. : TCS/PI/ESHIF Rev. No. : 0 Issue Date : 21 MAY 2018

SITE WORKERS REGISTRY LIST

Doc. Ref. : TCS/PI/SWRL Rev. No. : 0 Issue Date : 21 MAY 2018

FIRST AID LOG

PROJECT NAME : …………………………………………………………………………….

LOCATION OF TREATMENT & REMARKS

First Aider Safety & Health Officer

FIRST AID KIT INSPECTION FORM

NO CHECKLIST Yes No REMARKS

2 ARE EMERGENCY TELEPHONE NUMBERS CLEARLY DISPLAYED?

ARE THE NAME, LOCATION AND EXTENSION NUMBER OF THE

First Aider Safety & Health Officer

Doc. Ref. : TCS/PI/FAIF Rev. No. : 0 Issue Date : 21 MAY 2018

CONTENT OF FIRST AID BOX

No. Name of Items In Stock Expired Date Remarks

1 5 Triangular bandages 130cm x 90 cm x 90cm

First Aider Safety & Health Officer

Doc. Ref. : TCS/PI/CFAB Rev. No. : 0 Issue Date : 21 MAY 2018

A) REF.NO. B) DATE C) TIME D) SAFETY OFFICER E) ENGINEER/SUPERVISOR F) PROJECT MANAGER G) OTHERS

OBSERVATION / FINDING OF ESH WALKABOUT

CONFIRMATION/FOLLOW-UP/REVISION ( 5 WORKING DAYS)

Site Safety Supervisor Safety & Health Officer

SAFETY & HEALTH INSPECTION CHECKLIST

Project : Site Location :

Construction stage / status during inspection :

3. Plant, Machinery & Equipment (PME)

SAFETY & HEALTH INSPECTION CHECKLIST

4. Working / Loading Platform

6. Opening Edges / Floor Opening

SAFETY & HEALTH INSPECTION CHECKLIST

10. Electrical safety

11. Workers’ Quarters

12. Material handling & storage

14. Health and Welfare

SAFETY & HEALTH INSPECTION CHECKLIST

16. Personal Protective Equipment

19. Traffic Management

20. Chemical Safety

SAFETY & HEALTH INSPECTION CHECKLIST

21. Confined Space

22. Health and Safety Equipment

22. Other OSH Hazards / Issues

Acceptability : YES - Acceptable NO – Unacceptable N/A – Not Applicable

Remarks : [Project Manager]

TOOL BOX TALK BRIEFING FORM

Sub Contractor Name :

Tool Box Briefing conducted by __________________________

Doc. Ref. : TCS/PI/TBTBF Rev. No. : 0 Issue Date : 21 MAY 2018

Personal Protective Equipment (PPE) Distribution

Signature / Issued Date

Doc. Ref. : TCS/PI/PPED Rev. No. : 0 Issue Date : 21 MAY 2018

ENVIRONMENTAL INSPECTION CHECKLIST

Project : Site Location :

ENVIRONMENTAL INSPECTION CHECKLIST

2.1. Are water discharge licenses valid?

ENVIRONMENTAL INSPECTION CHECKLIST

ENVIRONMENTAL INSPECTION CHECKLIST

5. Storage of Chemicals and Dangerous Goods