12/1/201712/1/2017

ACCIDENT/INCIDENT REPORT

Report No. :______________

Name of Site :_________________ Date :____________________
Name of Work :________________ Contractor :_______________

Type of Accident/Incident : Fatal Other Lost Time Non Loss Time First-Aid Case

Name of the injured : _______________________________________

Age : _______________________________________

Fathers Name : _______________________________________

Sub-Contractor M/s : _______________________________________

Date & Time of Accident/Incident : ____________________________

Location : _______________________________________

Brief description of Accident/Incident :

Cause of Accident/Incident :

Nature of Injury/Damage :

Medical Aid provided/Actions taken :

Intimation to local Authorities (If Applicable) :

Date :

Copy to : job designation: signature:

 12/1/201712/1/2017

FIRE EXTINGUISHER CHECKLIST

GASAL SIGMA PROJECT
INSPECTED BY :
INSPECTED FOR THE MONTH OF :

EQUIPMENT NUMBER :
STATUS :

DESCRIPTION OF REQUIREMENTS 1 2 3 4 5

Serial No.

Type of Fire Extinguishers

Capacity

Location

Date Serviced

Next Service Date

Contents Checked (DCP/CO2)

Cartridge status

Hose

Safety lock pin

No corrosion

Is any Physical Damage for the cylinder

Correctly placed ergonomically (1.5m)

Accessibility

ANY ADDITIONAL INFORMATION :

Inspection by :

Signature :

Date :
12/1/201712/1/2017

DAILY FORK LIFT CHECK LIST

REG. NO:

MAKE:

CAPACITY:

NO DESCRIPTION CONDITION REMARKS

1. GENERAL CONDITION

2. HYDRAULIC SYSTEM

3. HORN

4. FORK CARRIER UPPER LIMIT

5. STEERING

6. GAUGES IN CABIN

7. TYRES CONDITION

8. TYRES AIR PRESSURE

9. FIRE EXTINGUISHER

10. REVERSE ALARM

11. CAUTION ROTTERY LIGHT

12. LIGHTS

13. OIL LEAK

14. DIESEL LEAK

OPERATOR: DATE:
12/1/201712/1/2017

DAILY SAFETY INSPECTION

PROJECT NUMBER - )
ITEM DESCRIPTION YES Remark
SCAFFOLDS
1. Employees working off scaffolds using fall protection as required? Yes
2. Is there safe access for all of the scaffolds? Yes
3. Are scaffolds having Top Rail, Mid-Rail and Toe Boards? Yes
4. Any modification done on scaffold, other than scaffolders? no
5. Are stairways with four or more steps equipped with stair rails? Yes
6. Are scrap generated removed from the scaffold at the end of the day? Yes
7. Do all scaffolds have the appropriate tags? Yes
8. Do all scaff-tags signed by inspector within seven days? Yes
9. Do all ladders extend 3 feet above landings platform? Yes
10. No stacking of construction material on the scaffold platform? no
11. Employees working on scaffold follow the scaff-Tag system? Yes
Are ropes placed beside access point / ladders for raising materials? Yes
HOT WORK PERMIT
12 Is PTW (Permit To Work) required? no
13 All permit conditions are being fulfilled? n/a
14 Proper working shield provided during Hot Work? no

No Painting work near or bellow Hot Work. no

15 Adequate Nos.of Fire Extinguishers provided at Hot Work area? Yes
16 Floor of the work platform covered with Fire Blanket? Yes
17. Flash Back Arrestor provided at the Oxy, Acetylene cylinder? Yes
18 Are the hoses in good condition? Yes
19 No flammable material stored near Hot Work area? no
20 Any specific observation by CLIENT for the day? no
PERSONAL PROTECTIVE EQUIPMENT
21. Is personal protective equipment used by every one? Yes
22. Is eye protection provided and used by every body? Yes
23. Is face protection being used during Grinding & Cutting? Yes
24 Are adequate PPE stocks available at store? Yes
25. Are all affected workers using fall protection as required? Yes
26 Any violation observed by CLIENT today? no
HEALTH AND HYGINE
27. Are first aid boxes provided at work station? Yes
28 Are adequate emergency first aid medicines available? Yes
29 Are cool drinking water provided at site? Yes
30 Water cooler filter changed as required? Yes
31 Drinking water tank cleaned at regular interval? Yes
32 Are Toilets & Wash places clean & tidy at all time? Yes
HOUSE KEEPING
29. Are work areas cleared of scrap material? Yes
30. All floor openings are covered or guarded? Yes
31. Are electric cables properly guarded on road crossing? n/a
32. Are elevated welding leads secured safely by tie rope? Yes
33. Are elevated cutting hoses secured safely by tie rope? Yes
34 Are compressed gas cylinders stored away from ignition sources? Yes
35 Is gas cylinder secured on trolley? Yes
36 Empty gas cylinders removed from the work area? Yes
37 Any oil leak from the generator? no
MATERIAL STORAGE
38 Is the generator placed on site as per CLIENT approval? Yes
12/1/201712/1/2017

39. Are storage areas barricaded to limit access? no

40. Is the storage material blocking any walkways? no
41. Is the wooden pieces used for storage of pipe spools shifted after use? no
HYDRO TESTING
42. Is the area barricaded & cautionary notice board displayed? n/a
43. Are two pressure gauges provided on the line? -
44. Are the pressure gauges tested & certified? -
45. Is the permit for the Hydro Test in Place? -
46. The concern Supervisor is in place? -
47. Is safety valve in place? -
ELECTRICAL TOOLS & CABLES
48. Is welding cable in good condition? Yes
49. Any cable found damaged at more than one location? no
50. Has Electrician checked the cables regularly? Yes
51 Is the damaged cable replaced? Yes
52 Are Electric cables arranged & laid properly on site? Yes
53. Is ELCB installed on the Generator & on Panel Board? Yes
54. Are Portable Electrical Tools inspected regularly by electrician? Yes

55. Any electrical plug or socket damaged due to vehicle movement? no

56. Is the Generator & Panel Board grounded with copper rod? Yes
Is the Generator & Panel Board provided with fire extinguisher? Yes
SAFETY SIGNS
57 Are safety signs on work place? Yes
58 Is the Emergency Assembly Point available at work site? Yes
 12/1/201712/1/2017

WEEKLY SCAFFOLDING INSPECTION

Location: Date: 16/12/06
No.
PROJECT NUMBER - )
ITEM DESCRIPTION YES Remark
SCAFFOLDS
1. Is there safe access for all of the scaffolds? YES
2. Are scaffolds having Top Rail, Mid-Rail and Toe Boards? YES
3. Are stairways with four or more steps equipped with stair rails? YES
4. Do all scaffolds have the appropriate green tags at access? YES
5. Do all scaff-tags signed by inspector within seven days? YES
6. Do all ladders extend 3 feet above landings platform? YES
7. No stacking of construction material on the scaffold platform? NO
8. Ground level-no man- hole/ no excavation/ no pavement? NO
9. Base plate resting on ground? YES
10. Verticality of uprights(Plumb) YES
11. Horizontal level of ledgers YES
12. Standards fixed at equidistant (not more than 2 meters apart and 1.3 meters YES
from wall or structure)
13. Ledgers fixed inside the standards at a vertical distance not more than 2 meter YES
14. Ledgers not projected more than 6 inches at the end or corners NO
15. Scaffold boards over lap less than 150 mm and 50mm on transoms YES
16. Transoms not project out more than 6 inches NO
17. Bracing run diagonally or zig zag from ledger to ledger and upright to upright YES

18. Scaffold boards rest squarely and evenly on the transoms YES
19. Double transoms to be placed where the end boards meet and no over hangs YES
boards by more than 4 (four) times its thickness and not less than 50 mm
20. Each scaffold board should have 3(three) supports(transom) YES
21. The width of working platform a) for footing not less than 80cm YES
22. b) for material stocking- not less than 100cm YES
23. Guard rails between 90 cm and 115 cm above the platform YES
24. Toe boards must be at least 15 cm above the working platform YES
25. Access ladders from ground to scaffold platform secure properly at top and YES
bottom
26. Every 3 (three) meters climbing a rest platform should be available YES
12/1/201712/1/2017

DAILY CRANE CHECK LIST

CRANE OPERATOR NAME:

CRANE NO: ... .

EQUIPMENT NO:

MAKE: .

TYPE OF CRANE: .

CAPACITY: .

DATE OF LAST LOAD TEST:

DATE OF NEXT EXAMINATION: .

No DETAILS OK NOT REMARKS

. OK
A BEFORE ENGINE START ---- ------ -------------------
1 Engine Oil Level
2 Coolant Level
3 Hydraulic Oil Level
4 Wire Rope Hoist Drum Condition, Sheaves
5 Tire Condition & Inflation pressure
6 Air Reservoir {Drain Water} Check Weekly
7 Glass, Mirror, Warning Lights,
8 Accident or Damage
9 First Aid Box, Fire Extinguisher.
10 OPERATORS MANUAL, LOAD CHARTS
11 CURRENT TEST CERTIFICATE
B ENGINE START-UP CHECKS ---- ------ --------------------
1 Engine Oil Pressure
2 Torque Converter Oil Pressure
3 Inlet, Exhaust {Air Filter & Muffler} Choke Indicator
4 Volt Meter
5 Fuel Level
6 Air Pressure
7 Horn, Wiper, Turn Signals, Alarm Light
8 Transmission Oil Level
9 Parking Brake, Engine idler controller
10 Gear shift & Suspensions
11 Steering Front & Rear
C ENGINE START {OPERATOR CABIN} ---- ------ ---------------------
1 Computer Display
2 Safety Systems (Anti two blocks, Boom Angle) Cutoff
3 Speed, Boom Hoist, Main Hoist, Swing, Telescopic
4 Indicators Angle, Load Moment, Safe Load, Wind Speed
5 Swing Brake & Parking Brake
6 Central Lubricant Systems
7 Level Indicator Out Riggers
8 Counter weight Attachments
12/1/201712/1/2017

D OTHERS ---- ----- --------------------

1 Hook Block, Safety Latch
& Headache Ball
2 Wire Connection ( socket, clips)
No DETAILS OK NOT REMARKS
OK
3 Out Riggers Mat
4 Crawler Drive Chains
5 Battery Terminals & Cables
6 Battery water Level
7 Safe Load Indicator
8 Boom Hoist Breaks
9 Boom
10 Manual Boom Section
11 Swing Fly Jib
12/1/201712/1/2017

HOT WORK CHECKLIST

Location: Client: Project No.:

Date: Time: Evaluator:

No. ITEMS
1 There is a written procedure for Hot Works on site Yes No
N/A
2 Hot Work Permit is required for Hot Works on site/storage yards Yes No
N/A
3 A competent person is assigned for hot works on site Yes No
N/A
4 The permit is applied daily and a copy displayed on site Yes No
N/A
5 The safety measures are indicated on the permit complied Yes No
N/A
6 A fire watchman is available during hot works Yes No
N/A
7 The fire watchman is identified on site Yes No
N/A
8 Workers performing hot works are provided with adequate protective Yes No
clothing, welding shield and leather gauntlet gloves N/A
9 Dry powder fire extinguishers are located within close proximity to hot Yes No
work areas and they have been inspected N/A
10 A proper fire retardant blanket is provided/used to control slag/sparks Yes No
from falling down N/A
11 There is Mandatory warning signs provided at the hot work area or the Yes No
area beneath N/A
12 The hot work area is barricaded adequately Yes No
N/A
13 All combustibles are cleared away from hot work area Yes No
N/A

Remarks:

\
12/1/201712/1/2017

HOUSE KEEPING & WASTE DISPOSAL CHECKLIST

Location: Client: Project No.:

Date: Time: Evaluator:

No. ITEMS
1 There is a regular housekeeping program documented for all contractors to Yes No
follow N/A
2 Adequate refuse bins are provided at various points on site for refuse disposal Yes No
N/A
3 The refuse bins are cleared of debris daily Yes No
N/A
4 Working areas are maintained in a clean and orderly condition Yes No
N/A
5 Storage yards are maintained in a clean and orderly condition Yes No
N/A
6 The site offices are maintained in a clean and orderly condition Yes No
N/A
7 All spilled materials or liquids are cleaned up immediately Yes No
N/A
8 Hazardous waste, metal scrap and other general waste are disposed separately Yes No
on site N/A
9 There are sufficient bins and they are identified for easier disposal Yes No
N/A
10 The site building areas are maintained in a clean and orderly condition Yes No
N/A
11 Pits, confine spaces, and excavations are cleared of waste debris/stagnant Yes No
water daily N/A
12 The wood with sharp protruding nails is disposed or the nails are either Yes No
removed or bent and the wood stacked in an orderly manner N/A
13 Scaffold platforms are kept in a clean and orderly condition daily Yes No
N/A
14 Loose tools and equipments are kept in a tool box Yes No
N/A
15 Passageways and walkways are kept free of obstruction at all times Yes No
N/A
16 A minimum number of toilets and washing facilities are provided and Yes No
maintained N/A
17 Platforms are erected, maintained and housekept daily Yes No
N/A

Remarks:
 12/1/201712/1/2017

PPE CHECKLIST

Location: Client: Project No.:

Date: Time: Evaluator:

No. ITEMS
1 All contractors including vendors and visitors are informed of the basic site PPE Yes No N/A
requirements
2 Training has been provided to each employee required to use /wear PPE Yes No N/A
3 All personnel on site are wearing the PPEs adequate Yes No N/A
5 Mandatory PPE signs are put up at various locations on site Yes No N/A
6 All workers are issued with ear-plugs and is used when required Yes No N/A
7 The contractors have provided adequate hand protection and gloves Yes No N/A
8 Approved respirators are provided for emergency use when needed Yes No N/A
9 There is a written respirator program Yes No N/A
10 A spill kit is available to clean up spilled toxic or hazardous materials Yes No N/A
11 Protective equipment is maintained in a sanitary condition at all times Yes No N/A
12 Harnesses used are inspected regularly and the inspection is documented Yes No N/A
13 Rubber shoes with steel toe cap are used if required Yes No N/A
14 The site has eyewash facilities within work area in case of emergency Yes No N/A
15 PPEs are inspected regularly for any defects and it is documented Yes No N/A
16 Workers use ear plugs when working at high noise areas or machinery Yes No N/A
17 Workers check their PPE daily prior to start working Yes No N/A

Remarks:
12/1/201712/1/2017

SAFETY OBSERVATION REPORT

Sl Observations Location Status

no
1 It is observed that manlift is operating
with out banksman/flag man.
2 It is observed that we did two critical
erection during bad weather(that time
wind speed was 10.5 m/s)
3 Found that Rockwool packet is open,
which are kept in the wooden box
4 Found that shim plates are obstructed
the walk way since a week(Tripping
Hazard)
5 Paints, thinner&acetone are stored in
container without any adequate
protection. Separate storage area need
to arrange.
6
Found metal scrap, need to remove

7 Observed that Sivaprasad cutting shim

plates with gas cutting machine
without any adequate protection.(no
face shield and gloves& not protect the
existing pipeline)
8 Observed that our drinking water filter
became black
9 Observed in two times that our lifting
team not providing enough Tag Line
while they are doing lifting.
10 Found that metal cutting waste since
morning (Tripping Hazard)
11 It is observed that missing signages in
worksite such as scaffolding work
ongoing(erection&dismantling),Hot
work ongoing.
12 It is observed that lack of power
distribution board(220 and 110)
13 Observed that Ravi, doing arc welding
very close to the diesel machine with
the supervision of welding foreman
14
Found that scattered nails since 2 days
15 Found that welding is ongoing but
there is no fire extinguisher.