www.adm.gov.ae/hse - hse@adm.abudhabi.

ae

Announcement
To all Building and Construction
Consultancy Offices
The Municipality of abu Dhabi City invites all Consultant
Offices operating in the Building & Construction Sector
to observe the following:
All contractors are obliged to prepare and submit
Health, Safety & Environment (HSE) plans or their
projects.
HSE plans to be approved by the consultant.
HSE plans have to be added to the requisites of
obtaining permits for starting construction and
infrastructure works.
This requirement has been put into effect as of
26/12/2010.
The guidlines for Developing HSE Plans can be
downloaded from the website
(www.adm.gov.ae/hse).
For inquiries please contact us on: hse@adm.abudhabi
or call the Municipalitys toll-free number.

80022220 www.adm.gov.ae/hse

www.adm.gov.ae/hse - hse@adm.abudhabi.ae

..................................................................................... 3

Introduction

................................................................................ 5

1. Project Details

2. Project Brief Description and Project Layout

3. EHS Management Requirements

............................................... 8

...................................................................................... 11

4. Planning

5. Implementation and Operations

6. Audit and Review

.................................................. 13

........................................................................ 17
................................................................................... 19

7. Appendices
8. Forms

...................................... 7

........................................................................................ 20

9. Checklists
10. Screen Windows

.................................................................................... 34
......................................................................... 54

With reference to The Municipality of Abu Dhabi City policy and the vision
of Department of Municipal Affairs, The Municipality of Abu Dhabi City and
based on Abu Dhabi - EHSMS framework is keen to support and assist
consultants, contractors and developers in building and construction sector
to establish and develop their EHS plans. This would improve the efforts
and measures to maintain high standards of EHS at construction projects in
order to protect people, assets and environment.
This booklet contains the basic elements for developing Environment,
Health and Safety (EHS) plan. The implementation of the EHS plan will
enhance the EHS standards to achieve best levels of environment, health
and safety compliance in construction sites in Abu Dhabi Emirate.

3.0 EHS Management

Requirements
3.1 Leadership & Commitment
Define how senior management lead by example and demonstrate
commitment through participation & communication with employees
on EHS issues.

3.2 EHS Policy:

Includes commitment towards continual improvement.
Contains commitment to comply with applicable

current legislations & other requirements.

It should be signed by the top management.

3.3 Organization, Roles & Responsibilities:

Project & EHS organizational chart.
EHS personnel roles & responsibilities.
Management of subcontractors and suppliers.
Project key personnel & their contacts.

3.4 Communication:
Regular and periodic meetings.
EHS alerts and notice boards.

3.5 Training:

Rewards, incentives, recognition & discipline.

EHS induction.
Toolbox talks.
Special EHS training and awareness.

3.6
3.7
3.8
3.9
3.10

Site Inspection and Monitoring

Incidents Reporting and Investigation
Site EHS Rules & Instructions
Personal Protective Equipment (PPE)
EHS Document Control and Recording System

10

4.0 Planning
4.1 Risk Management:
Identification of hazards, assessing the risks and specifying control
measures.

4.2 Legal and Other Requirements:

EHS laws, regulations, codes of practice, etc.

4.3 Emergency Management and Evacuation Plan

4.4 Site Security Plan and Access Control.
4.5 Permit To Work (PTW)
4.6 Traffic Management Plan
How to manage detours, diversions, road closure and vehicles
movement (refer to Traffic Engineering and Roads Safety Department
procedures and guidelines).

12

5.3 Environmental Arrangements

How to manage the environmental aspects and impacts by developing &
implementing control measures for the following:

Waste Management:

Include appropriate control measures for collection,

segregation and disposal for the waste with conformance
of Abu Dhabi Waste Management Center procedures and
guidelines.

Hazardous waste
Non-Hazardous waste

Soil, Water-Courses and Groundwater Pollution Protection:

Containment areas (bunding) for oil, fuel or chemicals

storage tanks
Washing area for concrete mixing trucks and pumps
Dripping trays for machinery, equipment and trucks
Oil spill combating kits or materials

(Refer to Abu Dhabi Environment Agency - EAD

guidelines, standards and codes of practice).

Air Pollution Protection:

Dust suppression program

Air emission (periodic maintenance programs for the

engines of vehicles, trucks, equipment, plants,
machinery, etc.)

16

6.0 Audit and Review

Contractor shall define the basis under which internal & external EHS
auditing and management reviews will be conducted.

18

7.1 Checklists
(not required submission to the municipality, just for guidance).

7.2 Risk Assessment

(required to be submitted to the municipality attached with the EHS
plan).

7.3 EHS Performance quarterly Report

(required to be submitted to the municipality on quarterly basis).

7.4 Incidents Report

(required to be submitted to the municipality whenever there is a
reportable incident).

7.5 EHS Induction Training

(not required submission to the municipality, just for guidance).

7.6 Toolbox Talks

(not required submission to the municipality, just for guidance).
NB: All EHS records should be kept on site and shown when requested.

21





  



 

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269*,=<
1*?.
8,,>;;.-
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*;.
524.5B
=8
8,,>;
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.7?2;876.7=
*7-8;
=1.;.
2<
*
<2072/2,*7=
1.*5=1
;2<4
=8
@8;4.;<
*7-8;
=1.
,866>72=B

#2072/2,*7=
5870=.;6
;.6.-2*=287
*7-
;.0>5*=8;B
27=.;?.7=287
@255
+.
;.:>2;.-
0%&3"5&
0--65*0/
/$*%&/5
#>+<=*7,.<
8;
6*=.;2*5<
1*?.
.<,*9.-
=1.
<2=.
,*><270
9855>=287
8/
*-3827270
*;.*<
@12,1
6*B
;.:>2;.
,87=*276.7=
,5.*7
>9
*7-8;
;.6.-2*=287
27?85?270
8=1.;
*0.7,2.<
*7-8;
*--2=287*5
;.<8>;,.<
78=
*?*25*+5.
=8
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<2=.
6*7*0.6.7=

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;.?.;<2+5.
.7?2;876.7=*5
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;.6.-2*=287
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27=.;?.7=287
6*B
+.
;.:>2;.-

31

EHSInductionTraining

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

InducteesName:

InductionDate:

Topicstodiscuss
S/N

Description

ProjectDescription

EHS
CompanyHSEPolicy

YES

IntroductionofKeyPersonnel

SiteLayoutandwelfareFacilities(restarea,toilet,etc.)

SiteRules(e.g.drug&alcohol&smokingpolicy,differentsignage,nohorseplaying,
wearingPPEs,avoidwearingJewelries,etc.)

Environment&WasteDisposal

Workpermits

RiskAssessment/RiskRegister

AccidentReporting

OtherRelevantTopicsforDiscussion(ifapplicable)

ManagementofChange(newprocess,equipment&machinery,procedures,etc.)

Relevant&applicablelaws,regulations

Signature&Remarks

EmployeesSignature:

Remarks:

Conductedby:________________________________
JobTitle:________________________________

Remarks:

Signature:________________________________

32

Note:Forguidanceanditisnotlimitedtoitscontent

NO

Remarks

Tool Box Talk

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Date:____________________________________________________________ Location:__________________________________________________

A. Specific job to be carried out:

B. Topics Discussed:
1.

4.

2.

5.

3.

6.

C. Name and Signature of workers attended

Name

Signature

Name

Signature

Conducted By:

Name

Job Title

Signature

Note: For guidance and it is not limited to its content

33

Inspection Checklists
The inspection checklists include the
followings:

34

Confined Spaces
Traffic Management
Electrical Installation
Environment
Excavations
Fire & Emergency
Hazardous Substances
Housekeeping
Ladders
Lifting Equipment & Gears
Machinery
Portable Tools
Personal Protective Equipment (PPE)
Scaffolds
Site General
Vehicles & Mobile Equipment
Welding & Gas Cutting
Welfare Facilities
Working Platforms & Cantilevers

Checklist
Confined Spaces

Ref. No. : ADM/HSED/FM/004/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and proposed
corrective action plan)

Hazards identified, risk evaluated, assessed &

communicated before commencement of work.
Permit To Work implemented & posted in place.
Mechanical and / or electrical isolation of the confined
space done.
Adequate ventilation to ensure a sufficient supply of air
conducted.
Cleaning & purging to remove all hazardous (flammable
& or toxic) gases & fumes performed.
Testing of oxygen concentration conducted to
acceptable standard level.
Detecting of flammable & or toxic gases conducted to
ensure their absence or below minimum levels.
Provision of emergency retrieval system (full body
harness, tripod and hoist)
Availability of the backup personnel or rescue
attendants.
Use of non spark tools / devices (intrinsically safe tools
or devices).
Sufficient lighting is available.
Proper PPE & SCBA (Self Contained Breathing
Apparatus) is used.
Suitable access / egress provided.
Area or surrounding isolated with barriers & or cones
and suitable signage in place (where applicable).
Approved By:
Position

Name

Date

Signature

HSE
Engineer / Manager
EHS Engineer/Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

35

Checklist
Traffic Management

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.

Description
Evaluation Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert
youryour
observation,and
(insert
observation,proposed
and
corrective
action
plan) action plan)
proposed
corrective

Advance warning signs boards.

Roadwork signs boards.
Guide signs boards.
Digital or LED* signs boards.
Arrows signs boards.
Delineators.
Cones.
Tubular flexible posts (bollards).
Painted pavement markings.
Raised pavement markings.
Water filled plastic barriers.
Concrete barriers.
Longitudinal crashworthy barriers
Warning lights (flashing lights & beacons).
Street lighting.
Temporary traffic lights.
Rumble strips
Crash cushion (shock absorber)
Buffer zones
Tapers
Flaggers
Pedestrian walkways.
Construction lane access / egress
Fences
Glare screens
Turning radius and lane width.
Approved By:
Position

Name

Date

EHS Engineer
Engineer/Manager
HSE
/ Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

36

Note: For guidance and it is not limited to its content

Signature

Checklist
Electrical Installation

Ref. No. : ADM/HSED/FM/004/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your
your observation,and
(insert
observation, andproposed
corrective corrective
action plan)action plan)
proposed

Electrical hazards identified and all associated risks have

been assessed.
Permit To Work (PTW) is used & available on site for
electrical work.
All electrical installations commissioning and repairing
carried out by competent electricians.
All electrical installation and appliances comply with the
relevant international standards.
All external electrical installations are weather proof .
All electrical installations provided with Earth Leakage
Circuit Breakers (ELCB).
All distribution boards are locked and signed.
Cables/wires running across the site are in good
condition, properly protected & checked regularly.
Cables are free of joints, & only industrial sockets used
for extending cables.
No naked wires inserted into electrical sockets, & only
earthed & fused plugs to be used.
Sockets are not overloaded.
Level of lighting suitable for the task.
Tag out / lock out system implemented .
Approved By:
Position

Name

Date

Signature

EHS Engineer
Engineer/Manager
HSE
/ Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

37

Checklist
Environment

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert your observation,and proposed
(insertyourobservation,and
corrective action plan)
proposedcorrectiveactionplan)

Wasteissegregated&collectedatdesignated
appropriateareas(hazardousfromnon-hazardous)&
adequatewastecontainers/skipsprovided.
Wasteisremoved/disposedregularly&accordingtothe
AbuDhabiWasteCenterguidelines.
Properoil/chemicalsleakage&spillcontrolinplaces
(tanksbunding,drippingtrays,oilspillresponse
materials).
Allocationofdesignatedareaforwashingconcrete
mixers&pumps.
Propercollection&disposalofwastewater&sewage
water.
Propermanagementofnoisegeneratedfromtheproject,
byinstallingnoiseenclosuremeasures(e.g.silencers,&
workscheduling).
Dustand/orfumescontrolmeasureshavebeen
implemented.
Regularmaintenanceformobileequipment,vehicles&
machines.
ApprovedBy:
Position

Name

Date

EHS Engineer/Manager
HSEEngineer/Manager
DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

Note:Forguidanceanditisnotlimitedtoitscontent

38

Signature

Checklist
Checklist
Excavation
Excavations

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
your observation,and proposed
(insertyourobservation,and
corrective
action plan)
proposedcorrectiveactionplan)

assessed.
Suitableaccess/egressprovided.
Fallingprotectionsysteminstalledproperly(i.e.barriers,
stopblocker,toeboards,conesandwarningtapes
etc).
Appropriatesupportingsystem/method(shoring,
buttering,orstepping)
Spoilheapsstableandkeptinsafedistancefromthe
edgeoftrenches
Oxygentestedandgaseslevelswithinacceptablelevel
(forexcavationwithdepthmorethanmeter).
Emergencypreparednessplandeveloped,
communicatedandimplemented
Propersignage&warninglights(warningsigns,tapes,
etc)andinstructions(i.e.PTW,emergencynotice..etc)
displayed.
permissionsobtained&displayedvisibly.
Excavatorsareingoodworkingcondition
Propertrainingandawarenessdeliveredtoallinvolved
employees(i.e.toolboxtalk&specializedtraining).
ApprovedBy:
Position

Name

Date

Signature

HSEEngineer/Manager
EHS Engineer/Manager

DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

Note:Forguidanceanditisnotlimitedtoitscontent

39

Checklist
Fire&Emergency

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert your observation,and proposed
(insertyourobservation,and
corrective action plan)
proposedcorrectiveactionplan)

Fireriskassessmentoftheprojectiscarriedout&the
controlmeasuresimplemented.

Goodhousekeepingpractices&dailyremovalofwaste.
designatedareaallocated.
PermitToWork(PTW)procedureforhotworks.
Evacuationplandeveloped&distributed.Emergency
communicated.
Adequatemeansofescapeallocated&unobstructed.
sitemaintained&inspectedregularly.
testedregularly.
Emergencysignage&assemblypointsareinplaces&
communicatedtoallparties.

ApprovedBy:
Position

Name

Date

HSEEngineer/Manager
EHS Engineer/Manager
DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

40

Note:Forguidanceanditisnotlimitedtoitscontent

Signature

Checklist
HazardousSubstances

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert your observation,and proposed
(insertyourobservation,andproposed
corrective action plan)
correctiveactionplan)

Properlystored,ventilated,isolated,&suitablesigns
displayed.
MaterialSafetyDataSheet(MSDS)available,and
communicatedtoconcernedpersonnel.

Emergencyescape&breathingapparatusavailable,
testedandingoodcondition
AppropriatePPEisprovidedtotheworkeranditisworn
duringthework.
Hazardoussubstancescontainers/drumshaveeligible
labeling&protectedfromleakageorspillage.
Emptyhazardoussubstancescontainers,drums&
receptaclesshouldbeproperlymaintained&controlled.
ApprovedBy:
Position

Name

Date

Signature

EHS Engineer/Manager
HSEEngineer/Manager
DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

Note:Forguidanceanditisnotlimitedtoitscontent

41

Checklist
Housekeeping

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
your observation,and proposed
(insertyourobservation,and
corrective
action plan)
proposedcorrectiveactionplan)

Clearandsafeaccesstoworkarea.
Propermaterialsstackingandanyloosematerialshave
beenproperlysecured.
orderliness
Constructionwasteanddebriscollectedindesignated
areas.
Adequaterubbishcontainersandrubbishremoveddaily.
Oldtimberde-nailed&allsteelbarscapped.

ApprovedBy:
Position

Name

Date

EHS Engineer/Manager
HSEEngineer/Manager
DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

Note:Forguidanceanditisnotlimitedtoitscontent

42

Signature

Checklist
Ladders

Ref.No.:ADM/HSED/FM//
IssuanceDate:July
IssueNo.:

GeneralInformation
CompanyName:

ProjectName:

ConductedBy:

Date:

Poor:Absenceofmajorcontrolmeasures(highrisk),worktobestoppedandriskassessmenttobereviewedimmediately.
Fair:Someminorcontrolsaremissing(mediumrisk),additionalcontrolmeasurestobeimplemented.
Good:Allrequiredcontrolsareinplace(lowrisk),onlymonitoringisrequired.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert your observation,and proposed
(insertyourobservation,and
corrective action plan)
proposedcorrectiveactionplan)

Properlymanufactured(nohandmadewoodenladders).
Allladdersareingoodcondition&suitableforthetask.
Positionedatsuitableworkingangleat otohorizontal.
Securedtop&bottom,andextendedmeterabovethe
platformlevel.
Intermediatelandingplaceprovidedforladdersrise
morethanmeters.
stiles.
Extendableladdersareproperlysecured(i.e.extension
Rungsclearofgrease,oilorotherslipperysubstances.
glassladderscanbeusedinstead).
protectioncage
Laddersshouldbecheckedbeforeuse&regularly
maintained.
ApprovedBy:
Position

Name

Date

Signature

EHS Engineer/Manager
HSEEngineer/Manager
DistributionandAcknowledgment:
ProjectManager
ProjectEngineer

Note:Forguidanceanditisnotlimitedtoitscontent

43

Checklist
Checklist
Lifting
Equipmentand
and Gears
Gears
Lifting
Equipments

Ref. No. : ADM/HSED/FM/004/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
(insert your
your observation,and
observation, andproposed
corrective
plan)action plan)
proposed action
corrective

Cranes & slings certified by 3rd party, inspected &

maintained regularly & records maintained.
Lifting plan / procedure prepared & communicated.
All lifting equipments & gears are inspected & certified by
3rd party.
Operator & rigger are competent (third party trained). The
driver & operator are licensed.
Slings, wires, ropes, chains, belts, hooks, shackles are in
good condition, appropriate for job & inspected regularly &
records maintained.
Load charts known & considered before any lifting begins.

Load
Load indicators, alarm
alarms&&other
othersafety
safety devises are
devices
are operational.
operational.
Ground condition checked & required corrective actions
implemented.
Outriggers are operational & sole plate provided.
Lifting operation area barricaded & suitable sign boards are
in place.
Approved By:
Position

Name

Date

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

44

Note: For guidance and it is not limited to its content

Signature

Checklist
Machinery

Ref. No. : ADM/HSED/FM/004/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

Machine maintained in good working order regularly and

records kept on site.
Machine operated according to the manufacturer
instructions.
Competent operators trained and certified.
Good overall condition and regular maintenance.
All suitable guard provided
All electrical installations are protected and free of
damages (circuit breakers, plugs, wires).
Protection against weather condition.
Emergency stop button and other safety devices are
operational and clearly marked.
Safety signs and manufacturer instructions clearly
displayed and properly followed.
Suitable PPE provided and properly used
Approved By:
Position

Name

Date

Signature

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

45

Checklist
Portable Tools

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

Electrical Tools:
Power cables present no hazard or obstruction &
connections are appropriate, earthed & fused.
User competent & authorized.
Guard is fitted, adjusted & tool in good condition.
Emergency stop is available & operational.
Manufacturer instruction is available & followed.
All hoses, couplings & fittings of correct rating.
Pneumatic Tools:
Hoses, couplings & fittings inspected & maintained
regularly.
Tools secured to the hose by positive means to prevent
disconnection.
Air supply lines protected from damage, maintained &
inspected regularly.
Safety device is provided for air hose with large diameter.
Manufacturer instruction is available & followed.
Manual (unpowered) Tools:
Tool checked & inspected before use.
Home-made tool is not used & tool fits the job.
Suitable PPE provided for all above types of tools.
Approved By:
Position

Name

Date

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

46

Signature

Checklist
Personal Protective Equipment (PPE)

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

PPE policy and signage displayed.

Minimum PPE (i.e. helmet, safety boots, hi-visibility vest,
& safety glasses) provided to all employees & records
maintained.
PPE checkpoint on the entrance.
PPE comply with the relevant international standards &
clearly marked (i.e. CE or EN mark).
Users trained on using, maintenance, and storage of PPE.
Additional PPE have been provided as appropriate for
those who are executing critical activities (e.g. full body
harness for working at height, full face mask, & respiratory
apparatus, etc).
PPE correctly selected based on the task risk assessment.
Regularly inspected, cleaned and maintained and/or replaced as deemed necessary.
Approved By:
Position

Name

Date

Signature

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

47

Checklist
Scaffolds

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

All scaffolds erected, inspected, altered & dismantled by

competent team.
Clear and visible signage and scaff-tag
Access ladder provided and properly secured
Sound scaffolding materials free of damage
Platforms are properly made of planks, free of damage,
tied & no gaps between planks/timbers.
All platform blanks tied down properly
Proper falling protection provided (guard rail/hand rail, mid
rail, toe board, mesh/bricks guard & safety net).
Scaffolding properly secured ties, and all braces properly
installed.
Sole/base plate or timber provided.
Overhead protection provided.
Mobile scaffold provides with guard rails, toe board, full &
proper platform, access ladder & wheels locked.
Personal protective equipments provided and properly
used (full body harness connected to fixed anchor or
life line)
Approved By:
Position

Name

Date

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

48

Signature

Checklist
Site General

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

Availability of the site safety sign board.

Proper site security and appropriate fencing (e.g. closed
metallic boards, hoarding).
Site visitors induction training procedure.
Sufficient site offices and car parking.
Adequate safety signage / notice boards.
Availability of the EHS
HSE documents & records(e.g. EHS
HSE
manual, EHS
HSE plan, risk assessment, work permit, incidents reports, induction & toolbox talk records, inspection
records, & training records, etc)
Approved By:
Position

Name

Date

Signature

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

49

Checklist
Vehicles and Mobile Equipment

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.
Description
Evaluation

Item

Good

Fair

Poor

N/A

Remarks
(insert your observation, and
proposed corrective action plan)

Vehicles & mobile equipment are licensed by concerned

authority .
Driver/operator is licensed and competent.
Engine in good operational condition.
No visible leaks
Windows & mirrors are clean & obstruction free.
Seat is in good condition and seat belt functioning
properly.
Lights / indicators / wipers / horns properly operational
Tyres free of damage and fully inflated
Reversing alarm & beacons working properly
Periodical inspection & maintenance & record kept
Provided with fire extinguisher and first aid box, and in
good condition
Provided with the noise silencer/enclosure.
Approved By:
Position

Name

Date

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

50

Note: For guidance and it is not limited to its content

Signature

Checklist
Welding and Gas Cutting

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.

Description
Evaluation Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
your your
observation,and
(insert
observation,proposed
and
corrective
action
plan) action plan)
proposed
corrective

Hazard identification & risk assessment conducted, & required control

measures have been implemented.
Valid & approved permit to work available all time & displayed in visible
location.
Working area properly contained & warning signs displayed.
All flammable / combustible materials have been removed from the
working area or properly protected from spark.
All possible health effects (acute and chronic) have been identified and
proper control measures implemented.
Sufficient ventilation has been provided.
Task is carried out by competent person (s).
Adequate / sufficient fire fighting equipment are available in the
working area during & after the work.
Suitable PPE provided and used all the time.
Electrical Arc Welding:
Welding leads and returns cables have the same length, properly
installed & protected, & free of damage.
Electrical cables are in good condition, free of damage, & properly
protected.
Industrial plugs & sockets provided.
Electrode holders are fully insulated & free of damage.
Earth connection bolted or clamped to ensure a good electrical
contact.
Welding machine frame effectively grounded.
Gas Welding and Cutting:
Different gas cylinders are clearly identified and marked.
Different types of Gas cylinders have been separated, properly stored,
and not exposed to direct sun.
Proper training on handling gas cylinders for all users (this will include
clothing, moving cylinders, hazards and precaution measures.etc).
Cylinder attachments (regulators, hoses, non-return valves, flashback arrestors, blowpipes) are maintained in good working order and free of damage.

Approved By:
Position

Name

Date

Signature

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer
Note: For guidance and it is not limited to its content

51

Checklist
Welfare Facilities

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.

Description
Evaluation Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
youryour
observation,and
(insert
observation,proposed
and
corrective
action
plan) action plan)
proposed
corrective

Adequate ablutions / toilets / washing facilities.

Appropriate clean & cool rest area with clean & cold
drinking water.
Food storage facility.
Changing rooms with facility for keeping protective
clothing used at work (locker).
Prayer area clearly identified & kept clean all the time
Safe access & egress to and from the facility
Welfare facilities are in clean good hygienic condition.
Designated smoking area with proper fire fighting
equipments
Approved By:
Position

Name

Date

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

52

Signature

Checklist
Working Platforms and Cantilevers

Ref. No. : ADM/HSED/FM/003/10

Issuance Date: July 2010
Issue No.: 01

General Information
Company Name:

Project Name:

Conducted By:

Date:

Poor: Absence of major control measures (high risk), work to be stopped and risk assessment to be reviewed immediately.
Fair: Some minor controls are missing (medium risk), additional control measures to be implemented.
Good: All required controls are in place (low risk), only monitoring is required.

Description
Evaluation Evaluation

Item

Good

Fair

Poor

N/A

Remarks
Remarks
(insert
your your
observation,and
(insert
observation,proposed
and
corrective
action
plan) action plan)
proposed
corrective

Platform is properly designed (the minimum dimension

are in accordance with the safety standards) and
suitable for the purpose.
Platform free of damage and in good condition.
All platform planks tied down properly with no gaps
between planks.
Proper falling protection provided (handrail, mid-rail, toe
board, boy harness, lifeline & safety net).
Load capacity identified and clearly marked.
Platforms are not used to carry another platform.
Adequate bracing / outriggers installed (Mobile Elevated
Working Platforms MEWP).
3rd party inspection. Regular maintenance & adherence
to the manufacturers manual (MEWP & cradles).
Cantilever provided with guard rail, mid rail, toe board, &
mesh / bricks guard.
Cantilever should not be overloaded
(apply only tested load).
Cantilever must be inspected whenever installed,
altered, or shifted by competent person.
Proper PPE should be provided.
Approved By:
Position

Name

Date

Signature

EHS Engineer/Manager
HSE
Engineer / Manager
Distribution and Acknowledgment:
Project Manager
Project Engineer

Note: For guidance and it is not limited to its content

53

The following screen windows illustrate the steps on how to

upload the EHS plan into the Building Permits Electronic System
(CDP).

54

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