compan Doc. No.
y logo
company name Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: FIRST AID BOX CHECKING
Location
Item No. Items as per Factories Act, 1948 Expiry Date Remark
1 Small sterilized dressings
2 Medium- size sterilized dressings
3 Large- size sterilized dressings
4 Large-size sterilized burn dressings
5 (15 gms) Packets sterilized cotton wool
A bottle containing a two per cent alcoholic
6
solution of iodine
7 Salvolatile Solution Bottle (Savlon)
8 Roll of adhesive plaster
9 A snake-bite lancet
10 Packet of potassium permanganate crystals
11 Scissor
12 First Aid Booklet
13 Aspirin Tablets
14 Ointment for burns (Burnol)
A bottle of a suitable surgical anti-septic
15
solution (Dettol)
Monthly Checking Done
Name :
Sign :
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Fire Extinguihser - Master list
Extingui-
sher Location Type Capacilty Remarks
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
28
29
30
31
32
33
34
35
36
37
38
39
2 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Fire Extinguihser - Master list
Extingui-
sher Location Type Capacilty Remarks
No.
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
3 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Fire Extinguihser - Master list
Extingui-
sher Location Type Capacilty Remarks
No.
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
4 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Fire Extinguihser - Master list
Extingui-
sher Location Type Capacilty Remarks
No.
118
119
120
121
122
123
5 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: CO2 EXTINGUISHER CHECKING
Quarterly Checks Yearly Checks
Extingui- Condition of Weight of CO2 Extinguisher
sher Location Capacilty Discharge Remarks
No. Safety Pin & Discharge Condition of Gross / Full Actual As on Diffrence in
Horn,
Seal Tube Valve Weight Weight Weight
Handle
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
6 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: CO2 EXTINGUISHER CHECKING
Quarterly Checks Yearly Checks
Extingui- Condition of Weight of CO2 Extinguisher
sher Location Capacilty Discharge Remarks
No. Safety Pin & Discharge Condition of Gross / Full Actual As on Diffrence in
Horn,
Seal Tube Valve Weight Weight Weight
Handle
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Quarterly Checking Done Yearly Checking Done
Name : Name :
7 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: CO2 EXTINGUISHER CHECKING
Quarterly Checks Yearly Checks
Extingui- Condition of Weight of CO2 Extinguisher
sher Location Capacilty Discharge Remarks
No. Safety Pin & Discharge Condition of Gross / Full Actual As on Diffrence in
Horn,
Seal Tube Valve Weight Weight Weight
Handle
Sign : Sign :
8 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: DCP EXTINGUISHER CHECKING
Quarterly Checks Yearly Check
Extingui- Condition of CO2 Cartridge
sher Location Capacity Safety DCP Remarks
No. Squeeze Discharge Inner Powder Gross / Full Actual As Diffrence in
Pin &
Nozzle Tube Container Weight on Weight Weight
Seal
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
9 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: DCP EXTINGUISHER CHECKING
Quarterly Checks Yearly Check
Extingui- Condition of CO2 Cartridge
sher Location Capacity Safety DCP Remarks
No. Squeeze Discharge Inner Powder Gross / Full Actual As Diffrence in
Pin &
Nozzle Tube Container Weight on Weight Weight
Seal
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
10 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: DCP EXTINGUISHER CHECKING
Quarterly Checks Yearly Check
Extingui- Condition of CO2 Cartridge
sher Location Capacity Safety DCP Remarks
No. Squeeze Discharge Inner Powder Gross / Full Actual As Diffrence in
Pin &
Nozzle Tube Container Weight on Weight Weight
Seal
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
11 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: DCP EXTINGUISHER CHECKING
Quarterly Checks Yearly Check
Extingui- Condition of CO2 Cartridge
sher Location Capacity Safety DCP Remarks
No. Squeeze Discharge Inner Powder Gross / Full Actual As Diffrence in
Pin &
Nozzle Tube Container Weight on Weight Weight
Seal
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Ok Ok Ok Ok NA NA NA NA
Quarterly Checking Done Yearly Checking Done
12 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: DCP EXTINGUISHER CHECKING
Quarterly Checks Yearly Check
Extingui- Condition of CO2 Cartridge
sher Location Capacity Safety DCP Remarks
No. Squeeze Discharge Inner Powder Gross / Full Actual As Diffrence in
Pin &
Nozzle Tube Container Weight on Weight Weight
Seal
Name : Name :
Sign : Sign :
13 of 27
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: MECHANICAL FOAM EXTINGUISHER CHECKING
Quarterly Checks Yearly Checks
Extingui- Condition of Weight of CO2 Cartridge
sher Location Capacity Remarks
No. Safety Pin Discharge Foam Movement Gross / Full Actual As Diffrence in
& Seal Tube Solution of wheels Weight on Weight Weight
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Ok Ok Ok Ok NA NA NA
Quarterly Checking Done Yearly Checking Done
Name : Name :
Sign : Sign
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
Month: ABC EXTINGUIHSER CHECKING
Quarterly Checks
Extingui- Condition of
Capacity
sher Location Remarks
(Kg)
No. Safety Pin & Discharge Nitrogen
Nozzle
Seal Tube Pressure
Quarterly Checking Done
Name :
Sign :
logo Doc. No.
company name Rev. No.
Issue/Rev. Date
Month: SAFETY EYE WASHER CHECKING
Monthly checking
Condition of
Sr. No. Location Remarks
Hand Foot Any leakage Drain Pipe
Body wash Eye wash
operated operated
Shower Showers
valve Valve
1 Near Bay 05 Entrance Ok Ok No Ok
2 Near DM Plant Ok Ok No Ok
Monthly Checking Done
Name :
Sign :
00
12.11.2010
Remarks
logo
company name
Month: SELF CONTAINED BREATHING AP
Monthly checking
Condition of
Sr. No. Location
1 Near Bay 05 Entrance Ok Ok
2 Near DM Plant Ok Ok
Monthly Checking Done
Name :
Sign :
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
TAINED BREATHING APPARATUS CHECKING
checking
Remarks
No Ok
No Ok
logo
company name
Month: AIR LINE CABINET CH
Monthly checking
Condition of
Sr. No. Location
1
2
Monthly Checking Done
Name :
Sign :
Doc. No.
Rev. No. 00
Issue/Rev. Date 12.11.2010
AIR LINE CABINET CHECKING
checking
Remarks