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Contractor name: Report No.
Location:
Project Manager Name: Date:
NA-Not Applicable C-Conformance, NC-Non-conformance, AFI-Areas for Improvement, AOE-Area of Excellence, Instructions
No. Inspection Parameters NA C NC AFI AOE I Comments
Personal Protective Equipment
1 Wearing PPE – Our Staff / Workers
2 Condition of the PPE - Our Staff / Workers
3 Wearing PPE – Contractor Staff / Workers
4 Condition of the PPE - Contractor Staff / Workers
5 Availability of PPE for visitors
Fire Fighting
6 Availability of Fire-fighting equipment
7 Maintenance of firefighting equipment
8 Certified Fire fighters’ availability Staff / Workers
9 Certified Fire fighters’ availability Contractor/Workers
First Aid
10 Availability of First aid kit
11 Certified First Aid personnel Staff
12 Certified First Aid personnel Contractor / Workers
Signage
13 Signage for fire extinguisher available & visible?
14 Emergency Exit route is displayed & visible?
15 Emergency exit signage available & visible?
16 Assembly Point signage available & visible?
17 Safety Warning signs Available & Visible?
18 Safety sign board at site entrance available?
No. Inspection Parameters NA C NC AFI AOE I Comments
Emergency Drill
19 Emergency mock drill conducted?
House Keeping & Work Environment
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20 Electrical cables, Cable Management Material Manage
21 Chemical spillage / Slippery Floors / proper disposal
22 Obstacles at path & Emergency Exit routes
23 Ventilation
24 Waste Segregation, Removal of waste, Housekeeping
25 Temperature conditions at work place
26 Lighting (Corridors, Staircase, Entry exits points)
27 Lighting at work station / working place
Welfare Facilities
28 Toilet Facilities/Toilet Hygiene
29 Workers Drinking Water
30 Shaded area for workers to eat & rest
31 Rest Shelter
32 Smoking Shelter
33 Maintenance of Mess hall equipment
Awareness & Training
34 HSE induction training to our Staff / workers
35 HSE induction training to our Contractors
36 Internal training /HSE Meetings
37 Notice Board Communication
38 Competency internal training / HSE Meeting
39 Tool box talks
Work Equipment
40 Equipment License / Inspection certificates /
approvals
No. Inspection Parameters NA C NC AFI AO I Comments
E
41 Equipment calibration certificates
42 Equipment & lifting gear
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43 Equipment maintenance records
44 Chemical Storage
45 Condition of Chemical Storage / oil spell
46 Chemical Handling
47 Fire Extinguisher
Others
48 Unsafe act, & condition Floors/Shaft/edge opening
49 Personal Protective Equipment
50 Ladder Safety / working plat form
Documents & Activity
51 (PTW) Permit to Work/documentation/induction
52 Lifting Activity / TPC / Calibration Certificate
53 Hot Works / Compress Gas Cylinder
54 Block works
55 Working at height
56 Scaffolding / Ladder
57 Compress gas cylinder
58 Material Management / access
59 Edge Protection/Barricade, close floor opening
60 Fall Hazards / Loose materials
61 Confined space
62 Equipment’s & Machine
63 Electrical & Cable management
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Designation Name Signature Date
Prepared By: HSE Engineer
Approved By: Resident Engineer
