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Sr # 01 – HOUSEKEEPING Yes No Remarks

1. Passage Ways / Walk Ways Clear

2. Garbage, Debris, Scrap removed
3 Hoses and left over materials removed
4 Oily rags, Lagging, Used Chemical Drums, etc. removed.
5 Trash Bins / Drums / Other disposal facilities provided.
6 Materials Properly Stacked.
02 - MACHINERY Yes No Remarks
7 Green square
8 Pre-use checklist completed
9 Rotating equipment & drive belts guarded
10 Start & stop controls clearly signed
03 – PPE Yes No Remarks
11 Helmet, Coverall, Boot
12 Eye protection
13 Ear protection
14 Dust mask
15 B.A
16 Other PPE required
04 – LIFTING EQUIPMENT Yes No Remarks
17 Authorized Operator only operates the equipment.
18 Valid Statutory Certificate for the equipment by an Authorized
Third-Party Agency is available (mention the due date of check
in ‘remarks’ column).
19 Equipment rated Capacity is legibly marked.
20 Hook safety latch is in place and is in good condition.
21 Load Chart / Load Indicator provided and in good working
condition.
22 Signal man is available, where required.
Tag line is provided to guide the load.
23 Barricades are properly insulated around swing radius.
24 All Rigging materials are in good condition.
05 – EMERGENCY PROCEDURES Yes No Remarks
21 Assembly point posted
22 Marshalling point identified
23 Fire extinguishers accessible/ identified
24 First aid box
25 People aware of emergency procedures

06 – EXCAVATION Yes No Remarks

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26 Excavated material away from the edge

27 Safe access to the excavation
28 Is shoring required
29 Sufficient hazards warning signs
07 – SCAFOLDING & ladder Yes No Remarks
30 The Scaffolds are erected as per the relevant Standard / Code /
Regulations.
31 Hand Rail & Mid Rails are provided.
32 Scaffold materials are in good condition.
33 Erection is done by Competent Person.
34 Access Ladder is properly positioned / secured / insulated.
35 Access Ladder Rungs are safe, free from Protruding Bolts,
Clamps, etc.
36 Structural Stability is good (free of movement).
37 Scaffold Inspection and Tagging system is being followed.
08 - PROCEDURES Yes No Remarks
38 Work permit posted on site
39 Compliance with permit conditions
40 Tool box talk
41 Method Statements in place
42 Near misses reporting
09 - Electrical Yes No Remarks
43 All electrical equipment color coded
44 Properly insulated
45 No damages or broken wires
46 ELCB fitted
47 Conditions of Cables routed are proper.
48 Warning Signs provided.
10 -Painting:
48 Paint Handling / Painting Persons are properly trained.
49 Provision of Sign Boards for the respective area is available.
50 Respiratory Protection is available.
51 100 % Compliance on using proper PPEs
11- Fire Fighting Facilities
52 Appropriate / Adequate Fire Extinguishers are available and are
in good condition.
53 Tags with Valid date of Statutory Check is available for all
extinguishers (mention the due date of check in ‘remark’
column).
54 Adequate Fire Hydrant System (Points, Hoses, Branch Pipes,
Exclusive Water Tank Facility, etc.) is available.
55 Fire Extinguishers & Fire Hydrant Points are easily accessible.

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56 Men at site are aware of the proper operation of extinguishers &

hydrant facilities.
57 Emergency Numbers and Emergency Response Procedures are
prominently displayed / communicated to all working
personnel.
58 Appropriate / Adequate Fire Extinguishers are available and are
in good condition.
59 Tags with Valid date of Statutory Check is available for all
extinguishers (mention the due date of check in ‘remark’
column).
12 -Vehicle Inspection (Random Check):
60 Valid authorization for entry into site location is obtained.
61 Vehicle exhaust system is leak proof and is fitted with Spark
Arrestor.
62 Parking of the vehicle is in approved area only.
63 All Lights are operable and covered with standard lens.
64 Proper Rear View Mirror is available.
65 Horn is in good condition.
66 Brake is in good condition.
67 Valid authorization for entry into site location is obtained.
68 Vehicle exhaust system is leak proof and is fitted with Spark
Arrestor.
69 Parking of the vehicle is in approved area only.
13- Health & Hygiene:
70 Drinking Water Facility is proper.
71 Washing Facility is proper and sufficient.
72 Toilets are proper and clean.
73 Rest Room / Shelter is Clean & Hygienic.
74 Dresses / PPEs / Tools are kept Properly & Orderly.
75 First Aid Box is available at site.
76 Drinking Water Facility is proper.
77 Washing Facility is proper and sufficient.
14 - Environmental Checks
79 No Spill of Oil / Chemicals / Solvents.
80 Noise Level is OK / protected by respective PPE (mention the
noise level of the location in ‘remarks’ column).
81 Proper disposal of wastes / debris is being followed
82 No Spill of Oil / Chemicals / Solvents.
15 - HSE Posters / Signs:
83 Provided adequate Posters / Signs at site.
84 Are in Good Condition.

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16 - Air Compressors:

85 Pressure Relief Valve is Operational.

86 Air Pressure Gauges are properly working.
87 Hoses & Connections are good.
88 Guards are in Position.
89 No Oil Leakage Found.
90 Tag indicating valid Statutory Check of Pressure Relief Valve
is available – (mention the due date of check in ‘remarks’
column).
17 - Hand Tools:

91 Chisels, Hammer wrenches / Other Striking Surface Tools are

free of Mushrooming.
92 Tools are used properly and for Specific Tasks for which they
are designed.
93 Tools are properly maintained and inspected.
94 Modified Tools are not in use.
95 Chisels, Hammer wrenches / Other Striking Surface Tools are
free of Mushrooming.
18 - Electric Welding Machine:

96 Authorized Person only performing the task.

97 General Condition is good.
98 Location & Placement condition is good.
99 Appropriate Fire Extinguisher is available.
100 Welding Leads, Cables & Ground Clamps in good condition
(no damage noticed).
101 Ground is attached to working item or as near as possible (not
through structure supports / beams, etc.).
102 Proper ELCB protection is available.
103 Operators Shut Downing the Machine properly, when not in
use.
104 Exhaust system is Leak Proof and fitted with Spark Arrestor.
19 - Gas & cutting Equipment:

105 Oxygen / Acetylene Cylinder stored in Upright Position.

106 Cylinders approximately marked and Color – Coded.
107 Cylinder Caps are put back / insulated when not in use.
108 Pressure Gauges conditions are good.
109 Regulators are in proper & good condition.
110 Hose / Tube is in good condition and is properly clamped.
111 Flash back arresters provided.
112 Adequate & Appropriate Fire Extinguisher / Water Hose are
available.
113 100 % compliance on using Welding Hat.

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COMMENTS / RECOMMENDATIONS

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