Safety Department checklist format

SAFETY DEPARTMENT REQUEST FOR INSPECTION Department Head Subcontractor Date Time Location Equipment to be inspected

Participant

Requester

Inspected / Approved By

Acknowledge By

H.O.D, Subcontractor

Maintenance Depart.

Safety Depart.

Name Signature Date Inspection Results : Inspection passed – Machine allowed to use. Inspection Failed – Machine was rejected & not allows using. Inspection accepted – Machine allowed using but comments need to be rectified & comply. Date Line

- From ______________ until ________________ (Close date : _________ )

Remarks / Comments: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ * Please attach copies of :a. b. c. d.

PMA / PMT Competency Certificate Certificate of Registry Crew List

e. Safety Construction Certificate f. Insurance Certificate g. Others

* Whichever applicable

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT S.No 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

YNESB/OSHEF/03

DAILY PLANT SAFETY INSPECTION CHECKLIST Description Yes Foremen on job area All employees wearing proper eye/head protection? All wearing hearing protection where necessary? All wearing protective clothing where necessary. All wearing respiratory protection where necessary? All wearing adequate safety shoes/gloves? All overhead workers using safety belts? Line? If required? Is proper permit at job site attained? All provisions on permit satisfied? All hot work/entry permits as required? Is fire watchman on duty alert & knowledgeable of duty? Equipment properly locked out /tagged out? Electrical connections/cords, proper twist lock connections? Welding machines, sand blusters etc properly grounded? All necessary blind installed/blind list ok? Has shoring been done as necessary? Have underground drawing been checked for safe excavation? Roads properly blocked if necessary? Scaffolding properly installed? Ladders properly used? Tools properly used? Proper lifting method s/material handling? Proper/approved lighting in use? Retainer pin or air hose/tools connections? Hose reels or hoses used properly? Compressed gas cylinders secured upright? Good house keeping Special warning posted if necessary Labels affixed to chemical container.

No

N.A

Other Items /Comments Supervisor : _________________

Safety Officer : _________________

Name

: _________________

Name

: _________________

Date

: _________________

Date

: _________________

Signature : _________________

Signature : _________________

SAFETY DEPARTMENT

YESB/OSHEF/04/01

Fr ,Rev 0,01.02.2009

LOCATION: Items Inspected

WEEKLY PLANT INSPECTION CHECKLIST

1. Housekeeping a. Access b. Stairways c. Signs d. Lighting e. Waste Disposal

Items Inspected 2.Hazardous Material a. MSDS Available b. Register Available c. Signboards Posted d. Proper Storage e. Labeling g. Fire Protection

3. PPE a. Safety Helmet b. Safety Boots c. Eye Protection d. Ear Protection e. Gloves f. Overall/Apron g. Filter/Dust mask

4. Work At Height a. Working Platform b. Safety harness c. Lifeline d. Tools Secured e. Barricade area below f. Fall Arrest Equipment g. Access

5. Lifting Activity a. Crane b. Lift Permit/Prelift Check c. Barricade/Signs d. Signalman e. Taglines g. Vehicle Entry Permit

6. Confined Space a. Permit Obtained b. Gas Test Done c. Standby Person d. Proper Ventilation e. Lifeline g. Explosion-proof Lights h. BA (if necessary)

h. Supervision 7. Equipments (W/Set, Generator, Compressor) a. Guards b. Emergency Stop c. Fire Extinguisher d. Oil Leaks e. PMT f. Earthing g. Leads/Cables h. Oil/Fuel/Radiator Cap

Tick Yes No

Remark

Tick Yes No

Remark

8. Work Areas a. Housekeeping b. Ladders/Platforms c. Hand Tools d. Obstruction e. Access f. Floor Opening g. Overhead Works h. Emergency Exits

9. Electrical a. ELCB Functional b. Industrial Cable c. Proper Connections d. Correct Plugs e. BD Condition f. Cable Management

SAFETY DEPARTMENT LOCATION:

YNESB/OSHEF/04/02

WEEKLY PLANT INSPECTION CHECKLIST

Fr ,Rev 0,01.02.2009

Items Inspected

Tick Yes No

Comments

Items Inspected Yes

11.Weld/Cut/Grind a. Cylinder Secured b. Flash-back Arrestor c. Regulator/Hose/Torch d. Fire Extinguisher e. Hand Tools f. PPE g. Hot Work Permit h. Housekeeping

12.Scaffolding a. Tagging Available b. Access c. Walkways d. Working Platforms e. Handrails/Guardrails f. Toe-boards g. Tie-back/Bracing h. Ground Condition

13.Machinery a. Inspection Certificate b. Noise c. Oil Leakage d. Smoke Emission

14.Fire Equipment a. Extinguisher(type/qty) b. Hydrant/Hose/Nozzle c. Smoke/Heat Detector d. Suppression System

15.First Aid a. First Aid Box b. Signage c. Adequate Stock d. Readily Accessible

16.Hygiene/Welfare a. Toilet Facilities b. Drinking Water c. Canteen d. Garbage Disposal e. Housekeeping f. Rest Area/Surau

17.Radiography a. Area Barricaded b. Warning Lights c. Worker Competency d. Storage of Isotape e. Work Permit

Tick No

Comments

Audit Conducted by : 1. 2. NAME Audit Attend by : Contractor/ H.O.D 1. 2. 3. 4. 5. 6. NAME

DESIGNATION

SIGNATURE / DATE

DESIGNATION

SIGNATURE / DATE

SAFETY DEPARTMENT YNESB/OSHEF/05 CRANE / SKY LIFT INSPECTION CHECKLIST (INITIAL / QUARTERLY) Contractor

Crane Operator

Inspection Date

Fr ,Rev 0,01.02.2009

Crane Type DOSH Reg. No. S/No

Crane No. PMA No Item Description

Tick Yes

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

Rated Capacity PMA Expiry Remarks No

Tires in good condition and inflated All wheels off the ground Oil leakages Lifting/Rigging equipments acceptable Horn/buzzer/hazard lights functional Valid Road Tax/ Insurance Lights/signals in working condition Any damage to wire ropes Operator registered with DOSH Valid PMA Fire extinguisher available Load chart available Any welds/visible cracks on the boom Outriggers fully extended and pads available Noise/smoke level acceptable Extension jib safely secured Height limit alarm functioning Hoist brakes functioning View from operator cabin not restricted Boom angle indicator accurate Lifting blocks/hooks in good condition Safety latches in good condition Barricades and signs installed Taglines available Signalman available Operator/Signalman familiar with signals Crane crew safety briefed Attached are true copies of:Valid PMA

Load Chart

Operator’s Competency Cert. (DOSH/JPJ License) Inspection Result

NAME & SIGNATURE CRANE SUPPLIER

Contractor

:

PASSED

Road / Insurance Tag Reg. FAILED

ACCEPTED WITH COMMENT

DATE LINE: …………

NAME & SIGNATURE SAFETY OFFICER

NAME & SIGNATURE YARD MANGER

SAFETY DEPARTMENT YNESB/OSHEF/06 CRANE / SKY LIFT INSPECTION DAILY CHECKLIST Crane Inspection Operator Date

Fr ,Rev 0,01.02.2009

Crane Type

Crane No. PMA No

DOSH Reg. No. S/No 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

Item Description

Tick Yes No

Rated Capacity PMA Expiry Remarks

Tires in good condition and inflated All wheels off the ground Oil leakages Lifting/Rigging equipments acceptable Horn/buzzer/hazard lights functional Valid Road Tax/ Insurance Lights/signals in working condition Any damage to wire ropes Operator registered with DOSH Valid PMA Fire extinguisher available Load chart available Any visible cracks on the boom Outriggers fully extended and pads available Noise/smoke level acceptable Extension jib safely secured Height limit alarm functioning Hoist brakes functioning View from operator cabin not restricted Boom angle indicator accurate Lifting blocks/hooks in good condition Safety latches in good condition Barricades and signs installed Taglines available Signalman available Operator/Signalman familiar with signals Crane crew safety briefed Remark :

SAFETY DEPARTMENT YNESB/OSHED/07 Date : ___________ DAILY WELDING & CUTING MACHINE CHECKLIST NO 1

DESCRIPTION

YES

NO

N/A

REMARKS

STARTER & WIRING SYSTEM IN GOOD CONDITION

Fr ,Rev 0,01.02.2009

2

GAS HOSES AND COUPLING IN GOOD CONDITION

3

FIRE EXTINGUISHER IN PLACE

4

FREE FROM COMBUSTIBLE MATERIAL

5

WELDING MACHINE INSPECTED

6

IS THE MACHINE EARTHED

7

IS THE GAS CYLINDER UPRIGHT AND SECURED

8

IS FLASH-BACK ARRESTOR AVAILABLE

9

RESPONSIBLE PERSON FOR THE INSPECTION OF WELDING MACHINE AND EARTHING : NAME:____________________ ____ DESIGNATION:_____________ ____

10

ARE THESE PPE PROVIDED: SAFETY GLASSES FACE SHIELD GLOVES

11

ARE THE HAND TOOLS IN GOOD CONDITION

12

ARE THE ELECTRICAL CONNECTIONS SAFE

13

ARE THE LEADS / CABLES IN GOOD CONDITION AND PLACED OVEREAD

14

ARE SCREENS IN PLACE

16

CUT OFFS REMOVED AND PLACED IN DRUMS

17

HOUSEKEEPING ACCEPTABLE

18 IS COMPLETED AND APPROVED JSA AVAILABLE REMARKS

Responsible Person On site : _______________ Name

_________________________ Signature

___________ Date

SAFETY DEPARTMENT YNESB/OSHEF/08 Date : ___________ QUARTERLY WELDING & CUTING MACHINE CHECKLIST NO

DESCRIPTION

1

STARTER & WIRING SYSTEM IN GOOD CONDITION

2

GAS HOSES AND COUPLING IN GOOD CONDITION

3

FIRE EXTINGUISHER IN PLACE

YES

NO

N/A

REMARKS

Fr ,Rev 0,01.02.2009

4

FREE FROM COMBUSTIBLE MATERIAL

5

WELDING MACHINE INSPECTED

6

IS THE MACHINE EARTHED

7

IS THE GAS CYLINDER UPRIGHT AND SECURED

8

IS FLASH-BACK ARRESTOR AVAILABLE

9

RESPONSIBLE PERSON FOR THE INSPECTION OF WELDING MACHINE AND EARTHING : NAME:________________________ DESIGNATION:_________________

10

ARE THESE PPE PROVIDED: SAFETY GLASSES FACE SHIELD GLOVES

11

ARE THE HAND TOOLS IN GOOD CONDITION

12

ARE THE ELECTRICAL CONNECTIONS SAFE

13

ARE THE LEADS / CABLES IN GOOD CONDITION AND PLACED OVEREAD

14

ARE SCREENS IN PLACE

16

CUT OFFS REMOVED AND PLACED IN DRUMS

17

HOUSEKEEPING ACCEPTABLE

18 IS COMPLETED AND APPROVED JSA AVAILABLE REMARKS

Checked by :

Area : Responsible Person On site :

Name : Signature :

Acknowledged By : _______________ Name

_________________________ Signature

___________ Date

SAFETY DEPARTMENT

YNESB/OSHEF/09

Date: ____________ QUARTERLY CHECKLIST FOR LIFTING SLING, CHAIN AND WIRE ROPE

Statutory and licensed equipment/machinery Location : Colour code: Inspected item

Non -statutory and licensed equipment/machinery Department/section Visual inspection

Remarks

Fr ,Rev 0,01.02.2009

Yes

No

N.A

a. Is lifting chain/sling/wire in good working order(visual check)? b. Is safe working load clearly labeled on individual lifting chain/sling/wire? c. Is there a register to encompass all lifting chains/slings/wires? d. Any signs of worn or frayed slings/wires? e. Is standard operating procedure for using lifting chains/slings/wires? f. Is there clear access to retrieve or return lifting chains/slings/wires? g. Any signs of excessive corrosion on lifting chains/wires? h. All fastening devices intact? i. Is there any proper storage for lifting chains/slings/wires? j. Is there a record a proper functional and load testing on lifting chains/slings/wires? k. Is there any signs of proper maintenance of lifting chains/sling/wires? l. Is there any sign-in or signed-out procedure of retrieving/returning lifting chains/sling/wires? m. Are lifting chain/slings/wires appropriate for their use? Note : Responsible persons must record and maintain the monthly checklist for 24 months Checked by :

Area : Responsible Person On site :

Name : Signature :

Acknowledged By : _______________ Name

_________________________ Signature

SAFETY DEPARTMENT

___________ Date

YNESB/OSHEF/10

Date : ____________ DAILY CHECKLIST FOR LIFTING SLING, CHAIN AND WIRE ROPE

Statutory and licensed equipment/machinery Location

Non -statutory and licensed equipment/machinery Department/section

Fr ,Rev 0,01.02.2009

Inspected item

Visual inspection Yes

No

Remarks

N.A

a. Is lifting chain/sling/wire in good working order(visual check)? b. Is safe working load clearly labeled on individual lifting chain/sling/wire? c. Is there a register to encompass all lifting chains/slings/wires? d. Any signs of worn or frayed slings/wires? e. Is standard operating procedure for using lifting chains/slings/wires? f. Is there clear access to retrieve or return lifting chains/slings/wires? g. Any signs of excessive corrosion on lifting chains/wires? h. All fastening devices intact? i. Is there any proper storage for lifting chains/slings/wires? j. Is there a record a proper functional and load testing on lifting chains/slings/wires? k. Is there any signs of proper maintenance of lifting chains/sling/wires? l. Is there any sign-in or signed-out procedure of retrieving/returning lifting chains/sling/wires? m. Are lifting chain/slings/wires appropriate for their use? Note : Responsible persons must record and maintain the daily checklist for 24 months

Checked By : _____________________ Name

___________________ Signature

__________________ Date

BARBENDING,ROLLING & CUTTING MACHINE QUARTERLY INSPECTION CHECKLIST Company : Supervisor : Date :

Type : Model : Series No:

Inspection By : Next Inspection :

Tag No :

Fr ,Rev 0,01.02.2009

Item Description

Yes

No

N/A

Remarks

1. Body & Engine Condition 2. Starter & Wiring System 3. Noise 4. Leakage of Oil 5. Radiator & Fuel Cap 6. Belting damage, safety guard 7. Emergency Stop Button 8. Any Modification 9. Rotating part guard & protected 10. Condition of bending & cutting machine 11. Condition of bending & cutting table 12. Surrounding area cleanliness & obstructed 13. Used by trained / competent workers 14. Necessary PPE provided 15. Operating manual provided 16. Manufacturing stickers 17. Series / model stickers 18. Material proper store

Company :

Checked by :

Area :

Name :

Responsible Person On site :

Signature :

Acknowledged By : _____________ Name

_________________ Signature

___________ Date

SAFETY DEPARTMENT YNESB/OSHEF/12 BARBENDING, ROLLING & CUTTING MACHINE DAILY INSPECTION CHECKLIST Company : Supervisor : Date :

Type : Model : Series No:

Item Description

Yes

No

N/A

Remarks

Fr ,Rev 0,01.02.2009

1. Body & Engine Condition 2. Starter & Wiring System 3. Noise 4. Leakage of Oil 5. Radiator & Fuel Cap 6. Belting damage, safety guard 7. Emergency Stop Button 8. Any Modification 9. Rotating part guard & protected 10. Condition of bending & cutting machine 11. Condition of bending & cutting table 12. Surrounding area cleanliness & obstructed 13. Used by trained / competent workers 14. Necessary PPE provided 15. Operating manual provided 16. Manufacturing stickers 17. Series / model stickers 18. Material proper store

Checked By : _____________________ Name

___________________ Signature

__________________ Date

SAFETY DEPARTMENT YNESB/OSHEF/13 WRITTEN WARNING FOR SAFETY MISCONDUCT REPORT NO :

DATE :

NAME : DESIGNATION:

Fr ,Rev 0,01.02.2009

AFTER ISSUING VERBAL WARNING FOR CONTINUOS VIOLATION OF SAFETY REGULATIONS, IT HAS BEEN DEEMED NECESSARY TO NOW ISSUE AN OFFICIAL WRITTEN WARNING ANY FURTHER VIOLATIONS WILL RESULT IN IMMEDIATE REMOVAL OF YOURSELF FROM SITE AND DISMISSAL FROM THE COMPANY. REASON FOR ISSUING OF WARNING.

SAFETY OFFICER :

YARD MANAGER :

EMPLOYEE :

SAFETY DEPARTMENT YNESB/OSHEF/14 NOTIFICATION OF OVERTIME AND REST DAY/PUBLIC HOLIDAY WORK CONTRACTOR: Fill the appropriate row

DATE:

Overtime Works On :

_____/_______/_______

Time : From_________To_________

Rest Day Works On :

_____/_______/_______

Time : From_________ To_________

Public Holiday Works On :

_____/_______/_______

Time : From _________To_________

Specific Location of Work Area :

Supervisor in charge

Fr ,Rev 0,01.02.2009

Specific Work To Be Carried Out :

No Of Persons

: ______________________ (Name)

Signature ________________

Contractor’s Safety Personnel On Duty : ______________________ (Name)

________________

Contractor’s Authorized Personnel

________________

Contractor On Duty

: ______________________ (Name)

Approved by (YNESB PERSONALS)

Signature

Production Manager : __________________________(Name)

________________

Safety officer

________________

: __________________________(Name)

Safety Instructions: # To standby vehicle for Emergency Use throughout the working duration Note : # Normal day overtime work notification to be submitted to OSHED by or before 1700 hours on the intended working day # Rest day/Public Holiday work notification to be submitted to OSHED one (1) day prior to the intended working day

SAFETY DEPARTMENT

YNESB/OSHEF/15 Date :

HEAVY LIFTING PERMIT SECTION 1

DEPT/CONTRACTOR

LOCATION

DESCRIPTION OF WORK

SECTION 2

Item Description A. Normal lift