Safety Department checklist format

Department HeadSubcontractor

Date

Time

Location

Equipment to be inspected

ParticipantRequester 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. PMA / PMT e. Safety Construction Certificateb. Competency Certificate f. Insurance Certificate

c. Certificate of Registry g. Othersd. Crew List

* Whichever applicable

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT

REQUEST FOR INSPECTION

SAFETY DEPARTMENT YNESB/OSHEF/03

DAILY PLANT SAFETY INSPECTION CHECKLISTS.No Description Yes No N.A

01 Foremen on job area02 All employees wearing proper eye/head protection?03 All wearing hearing protection where necessary?04 All wearing protective clothing where necessary.05 All wearing respiratory protection where necessary? 06 All wearing adequate safety shoes/gloves?07 All overhead workers using safety belts? Line? If required?08 Is proper permit at job site attained?09 All provisions on permit satisfied?10 All hot work/entry permits as required?11 Is fire watchman on duty alert & knowledgeable of duty?12 Equipment properly locked out /tagged out?13 Electrical connections/cords, proper twist lock connections?14 Welding machines, sand blusters etc properly grounded?15 All necessary blind installed/blind list ok?16 Has shoring been done as necessary?17 Have underground drawing been checked for safe excavation?18 Roads properly blocked if necessary?19 Scaffolding properly installed?20 Ladders properly used?21 Tools properly used?22 Proper lifting method s/material handling?23 Proper/approved lighting in use?24 Retainer pin or air hose/tools connections?25 Hose reels or hoses used properly?26 Compressed gas cylinders secured upright?27 Good house keeping28 Special warning posted if necessary29 Labels affixed to chemical container.

Other Items /Comments

Supervisor : _________________ Safety Officer : _________________

Name : _________________ Name : _________________

Date : _________________ Date : _________________

Signature : _________________ Signature : _________________

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT YESB/OSHEF/04/01

LOCATION: WEEKLY PLANT INSPECTION CHECKLIST

Items Inspected Tick Remark Items Inspected Tick RemarkYes No 2.Hazardous Material Yes No

1. Housekeeping a. MSDS Availablea. Access b. Register Availableb. Stairways c. Signboards Postedc. Signs d. Proper Storaged. Lighting e. Labelinge. Waste Disposal g. Fire Protection

3. PPE 4. Work At Heighta. Safety Helmet a. Working Platformb. Safety Boots b. Safety harnessc. Eye Protection c. Lifelined. Ear Protection d. Tools Securede. Gloves e. Barricade area belowf. Overall/Apron f. Fall Arrest Equipmentg. Filter/Dust mask g. Access

5. Lifting Activity 6. Confined Spacea. Crane a. Permit Obtained

b. Lift Permit/Prelift Check b. Gas Test Donec. Barricade/Signs c. Standby Persond. Signalman d. Proper Ventilatione. Taglines e. Lifelineg. Vehicle Entry Permit g. Explosion-proof

Lightsh. Supervision h. BA (if necessary)

7. Equipments (W/Set, 8. Work Areas Generator, Compressor) a. Housekeepinga. Guards b. Ladders/Platformsb. Emergency Stop c. Hand Toolsc. Fire Extinguisher d. Obstructiond. Oil Leaks e. Accesse. PMT f. Floor Openingf. Earthing g. Overhead Worksg. Leads/Cables h. Emergency Exitsh. Oil/Fuel/Radiator Cap

9. Electricala. ELCB Functionalb. Industrial Cablec. Proper Connectionsd. Correct Plugse. BD Conditionf. Cable Management

SAFETY DEPARTMENT YNESB/OSHEF/04/02

Fr ,Rev 0,01.02.2009

LOCATION: WEEKLY PLANT INSPECTION CHECKLIST

Items Inspected Tick Comments Items Inspected Tick CommentsYes No Yes No

11.Weld/Cut/Grind 12.Scaffoldinga. Cylinder Secured a. Tagging Availableb. Flash-back Arrestor b. Accessc. Regulator/Hose/Torch c. Walkwaysd. Fire Extinguisher d. Working Platformse. Hand Tools e. Handrails/Guardrailsf. PPE f. Toe-boardsg. Hot Work Permit g. Tie-back/Bracingh. Housekeeping h. Ground Condition

13.Machinery 14.Fire Equipmenta. Inspection Certificate a. Extinguisher(type/qty)b. Noise b. Hydrant/Hose/Nozzlec. Oil Leakage c. Smoke/Heat Detectord. Smoke Emission d. Suppression System

15.First Aid 16.Hygiene/Welfarea. First Aid Box a. Toilet Facilitiesb. Signage b. Drinking Waterc. Adequate Stock c. Canteend. Readily Accessible d. Garbage Disposal

e. Housekeeping17.Radiography f. Rest Area/Suraua. Area Barricadedb. Warning Lightsc. Worker Competencyd. Storage of Isotapee. Work Permit

Audit Conducted by :

1.2.

NAME DESIGNATION SIGNATURE / DATE

Audit Attend by : Contractor/ H.O.D1.2.3.4.5.6.

NAME DESIGNATION SIGNATURE / DATE

Fr ,Rev 0,01.02.2009


CRANE / SKY LIFT INSPECTION CHECKLIST (INITIAL / QUARTERLY) Contractor Crane

OperatorInspection Date

Crane Type Crane No. Rated CapacityDOSH Reg. No. PMA No PMA ExpiryS/No Item Description Tick Remarks

Yes No1 Tires in good condition and inflated2 All wheels off the ground3 Oil leakages4 Lifting/Rigging equipments acceptable5 Horn/buzzer/hazard lights functional 6 Valid Road Tax/ Insurance7 Lights/signals in working condition8 Any damage to wire ropes9 Operator registered with DOSH

10 Valid PMA11 Fire extinguisher available12 Load chart available13 Any welds/visible cracks on the boom14 Outriggers fully extended and pads available15 Noise/smoke level acceptable16 Extension jib safely secured17 Height limit alarm functioning18 Hoist brakes functioning19 View from operator cabin not restricted20 Boom angle indicator accurate21 Lifting blocks/hooks in good condition22 Safety latches in good condition23 Barricades and signs installed24 Taglines available25 Signalman available26 Operator/Signalman familiar with signals27 Crane crew safety briefed

Attached are true copies of:-

Valid PMA Load Chart

Operator’s Competency Cert. (DOSH/JPJ License) Road / Insurance Tag Reg.

Inspection Result : PASSED FAILED

ACCEPTED WITH COMMENT DATE LINE: …………

NAME & SIGNATURECRANE SUPPLIER

NAME & SIGNATURESAFETY OFFICER

NAME & SIGNATUREYARD MANGER

Fr ,Rev 0,01.02.2009


CRANE / SKY LIFT INSPECTION DAILY CHECKLIST Contractor Crane

OperatorInspection Date

Crane Type Crane No.

Rated Capacity

DOSH Reg. No.

PMA No PMA Expiry

S/No

Item Description Tick Remarks

Yes No1 Tires in good condition and inflated2 All wheels off the ground3 Oil leakages4 Lifting/Rigging equipments acceptable5 Horn/buzzer/hazard lights functional 6 Valid Road Tax/ Insurance7 Lights/signals in working condition8 Any damage to wire ropes9 Operator registered with DOSH10 Valid PMA11 Fire extinguisher available12 Load chart available13 Any visible cracks on the boom14 Outriggers fully extended and pads

available15 Noise/smoke level acceptable16 Extension jib safely secured17 Height limit alarm functioning18 Hoist brakes functioning19 View from operator cabin not restricted20 Boom angle indicator accurate21 Lifting blocks/hooks in good condition22 Safety latches in good condition23 Barricades and signs installed24 Taglines available25 Signalman available26 Operator/Signalman familiar with signals27 Crane crew safety briefed

Remark :

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT YNESB/OSHED/07 Date : ___________

DAILY WELDING & CUTING MACHINE CHECKLIST

NO DESCRIPTION YES NO N/A REMARKS

1 STARTER & WIRING SYSTEM IN GOOD CONDITION

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

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT YNESB/OSHEF/08 Date : ___________

QUARTERLY WELDING & CUTING MACHINE CHECKLIST

NO DESCRIPTION YES NO N/A REMARKS

1 STARTER & WIRING SYSTEM IN GOOD CONDITION

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

Area :

Responsible Person On site :

Checked by :

Name :

Signature :

Acknowledged By : _______________ _________________________ ___________ Name Signature Date

Fr ,Rev 0,01.02.2009


Date: ____________

QUARTERLY CHECKLIST FOR LIFTING SLING, CHAIN AND WIRE ROPE

Statutory and licensed equipment/machinery Non -statutory and licensed equipment/machinery

Location :Colour code:

Department/section

Inspected item Visual inspection Remarks

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

Area :


Checked by :

Name :

Signature :

Acknowledged By : _______________ _________________________ ___________ Name Signature Date

Fr ,Rev 0,01.02.2009


Date : ____________

DAILY CHECKLIST FOR LIFTING SLING, CHAIN AND WIRE ROPE

Statutory and licensed equipment/machinery

Non -statutory and licensed equipment/machinery

Location Department/section


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 daily checklist for 24 months

Checked By :

_____________________ ___________________ __________________ Name Signature Date

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 :

Area :


Checked by :

Name :

Signature :

Acknowledged By :

_____________ _________________ ___________ Name Signature Date


BARBENDING, ROLLING & CUTTING MACHINE DAILY INSPECTION CHECKLIST

Company : Type :

Fr ,Rev 0,01.02.2009

BARBENDING,ROLLING & CUTTING MACHINE QUARTERLY INSPECTION CHECKLIST

Company :

Supervisor :

Date :

Type :

Model :

Series No:

Inspection By :

Next Inspection :

Tag No :

Supervisor :

Date : Model :

Series No:


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






18. Material proper store

Checked By :

_____________________ ___________________ __________________ Name Signature Date


WRITTEN WARNING FOR SAFETY MISCONDUCT

REPORT NO : DATE :

Fr ,Rev 0,01.02.2009

NAME :

DESIGNATION:

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/14NOTIFICATION OF OVERTIME AND REST DAY/PUBLIC HOLIDAY WORK

CONTRACTOR: DATE:

Fr ,Rev 0,01.02.2009

Fill the appropriate row

Overtime Works On :

Rest Day Works On :

Public Holiday Works On :

_____/_______/_______

_____/_______/_______

_____/_______/_______

Time : From_________To_________

Time : From_________ To_________

Time : From _________To_________

Specific Location of Work Area : Supervisor in charge

Specific Work To Be Carried Out : No Of Persons

Contractor On Duty : ______________________ (Name)

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

Contractor’s Authorized Personnel : ______________________ (Name)

Signature ________________

________________

________________

Approved by(YNESB PERSONALS)

Production Manager : __________________________(Name)

Safety officer : __________________________(Name)

Signature

________________

________________

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


Date :

HEAVY LIFTING PERMIT

Fr ,Rev 0,01.02.2009

SECTION 1

DEPT/CONTRACTOR LOCATION DESCRIPTION OF WORK

SECTION 2

Item Description Purpose of Lift Special Work InstructionA. Normal lift <6 metric tonsB. Lifting between 6-12metric tonsC. Critical lift exceeding 12 metric tons (Attach sketch & capacity calculation)D. Multiple crane lifting (wt..................E. Use of overhead crane (wt.................F. Lifting over unprotected/live equipmentG. Removal or installation of equipmentH. Overhead lift (sling not made of wire rope)I. Using more than 4 legged slingJ. Lifting inside confined space

Originator/User...................................Designation..............................................Signature........................................

Name of crane operator Signalman........................................... Signature......................................SECTION 4 : WORKSITE PREPERATION

PRECAUTIONS Yes / No Initial by S’visor SLING SPECIFICATIONA. Valid PMA A. Sling test dateB. Crane inspected (safe for use) B. Sling Assy. SWLC. Competent crane Operator / Signalman C. Load wt. (mt)D. Rigging equipments in good condition D. Sling ID NoE. Load weight ascertained E. Size of wire ropeF. Ground condition firm and level (use steel plates if reqd)

G. Size of shackle

G. Pre-job meeting carried out H. Shackle SWLH. Overhead obstruction/ services checked I. No of shackle used

SECTION 5 : PERMIT VALIDATION

Approved By : Lift Permit No: Date Time

Name Position Signature

From To

SECTION 6 : WORK COMPLETION / SUSPENSIONThe work has been completed/suspended on..............................(date) at......................(hrs)Reason for suspension (if any)...............................................................................................................................................................................................................................................................................................................................................................


PERMIT TO WORK

Fr ,Rev 0,01.02.2009

Work Activity (delete as applicable)

Hot Work Lifting Work Repair/Maintenance Machine

Confined Space Entry

Blocking Access

OTHERS

A. Application ( to be completed by H.O.D, Contractor, )

Requesting Dept/Cont Request by Date

Plant Area Description of work (attach drawing / sketch as necessary)

Permit is required From: Time Date To Time Date

B. Precautions to be taken prior to commencement and during the work (delete/add as appropriate)

Hot WorkIs Approved Method Statement and Risk Assessment availableArea cleared of Flammable WasteFire Extinguisher availableOverhead work to have area below barricadedPipelines etc free of gas/liquidFire blanket provided to arrest spark / flameWelding screens in use to protect othersAppropriate PPE availableCylinders secured & flash-back arrestor fitted

Lifting WorkNo lifting machine shall be operated except by an authorized person. All lifting equipment must be examined by the supervisor and operator before use. Protect wire rope or chain sling from sharp edges and corner with padding. The centre of gravity for the load must be determined for proper balancing of the load. The chain opening angle shall not exceed 60%.Stay clear from any suspended load.

Repair/Maintenance Machine

Is Approved Method Statement & Risk Assessment available, PPE available. Log In and Log Out sign display.

C. REQUEST (PRODUCTION TEAM)

Permission is given for the work to proceed subject to the conditions specified above

Signed ( PermitController)

Sign Print Date Time Company

D. Performing Authority Acceptance (SAFETY PERSONAL)

I certify that I have read and understood this permit and that the work will be carried out in accordance with the requirements

Signed : Sign Print Date Time Company

E. Completion of work (PRODUCTION TEAM)

I hereby declare that all work for which this permit was issued has been complete, all personnel under my control have been withdrawn and the work area and all associated equipment has been left in a safe condition.


F. Cancellation (SAFETY PERSONAL)

This permit is cancelled



ELECTRICAL TOOLS / EQUIPMENT QUATERLY INSPECTION CHECKLISTCompany : Type :

Fr ,Rev 0,01.02.2009

Supervisor :

Date :

Model :

Series No:

Inspection By :

Next Inspection :

Tag No :


BO

DY

PA

RT

1. Casing – damage / crack

2. Handle – installed securely

3. Handle – damage / crack

4. Switch – damage / no function

5. Trigger lock – faulty / damage

6. Main dead switch – faulty / damage

7.Power cord defect – cracking / frying

8. On / Off switch – faulty / damage

9. Guardrail / shield / hazard part protection provided

CA

BLE

/ W

IRE

/ P

LUG

10. Damages of wire

11. Proper Connection

12. Earth, properly grounded

13. Plug – crack, loose, missing

14. Use 3 prong plug (faulty prongs)

15. Check earth leakage

16. Broken wire insulated

17. Wire cable / quality

OT

HE

RS






23. Proper store

NAME & SIGNATUREMAINTENANCE/ FACILITY DEPT.

NAME & SIGNATURESAFETY PERSONAL

NAME & SIGNATURESTOR SUPERVISOR


ELECTRICAL TOOLS / EQUIPMENT DAILY INSPECTION CHECKLISTCompany :

Supervisor :

Type :

Model :

Fr ,Rev 0,01.02.2009

Date : Series No:

Inspection By :

Next Inspection :

Tag No :


BO

DY

PA

RT

1. Casing – damage / crack

2. Handle – installed securely

3. Handle – damage / crack

4. Switch – damage / no function

5. Trigger lock – faulty / damage

6. Main dead switch – faulty / damage

7.Power cord defect – cracking / frying

8. On / Off switch – faulty / damage

9. Guardrail / shield / hazard part protection provided

CA

BLE

/ W

IRE

/ P

LUG

10. Damages of wire

11. Proper Connection

12. Earth, properly grounded

13. Plug – crack, loose, missing

14. Use 3 prong plug (faulty prongs)

15. Check earth leakage

16. Broken wire insulated

17. Wire cable / quality

OT

HE

RS






23. Proper store

Checked By :

_______________________________ Name/ Signature/ Date

( GENERATOR, WELDING MACHINE, AIR COMPRESSOR, ETC)

Company : Type of Inspection : INITIAL / QUARTERLY / RENEWAL

Fr ,Rev 0,01.02.2009


GROUND EQUIPMENT INSPECTION CHECKLIST(INITIAL/ QUARTERLY)

Type of Equipment :

Serial / Equipment No :

PMT No.(air compressor) :

Expiry Date :

Inspection Certificate No.:

Expiry Date :


A. Is wiring in good condition

B. Is insulation in good condition

C. Is information plate visible

D. Is ELCB in good condition

E. Is safety guard in place

F. Is radiator cap fired

G. Is fuel cap fitted

H. Is exhaust spark arrestor fitted

I. Is air induction control valve fitted

J. Is drive belt cover fitted

K. Is there any evidence of fuel leakage

L. Are pressure regulators in good condition

M. Are gauges in good condition

N. Are the leads and hoses in good condition

P. Is Emergency Stop button available and clearly marked

Q. Is earthling system available

R. Is equipment fitted with fire extinguisher

S. Is copy of PMT displayed on the equipment

GROUND EQUIPMENT DAILY INSPECTION CHECKLIST

Company : Type of Equipment :

Serial / Equipment No : Inspection Certificate No.:

Fr ,Rev 0,01.02.2009

NAME & SIGNATUREMAINTENANCE SUPERVISOR

NAME & SIGNATURESAFETY PERSONAL

NAME &SIGNATURESTOR SUPERVISOR

PMT No.(air compressor) :

Expiry Date : Expiry Date :


A. Is wiring in good condition

B. Is insulation in good condition

C. Is information plate visible

D. Is ELCB in good condition

E. Is safety guard in place

F. Is radiator cap fired

G. Is fuel cap fitted

H. Is exhaust spark arrestor fitted

I. Is air induction control valve fitted

J. Is drive belt cover fitted

K. Is there any evidence of fuel leakage

L. Are pressure regulators in good condition

M. Are gauges in good condition

N. Are the leads and hoses in good condition

P. Is Emergency Stop button available and clearly marked

Q. Is earthling system available

R. Is equipment fitted with fire extinguisher

S. Is copy of PMT displayed on the equipment

( GENERATOR, WELDING MACHINE, AIR COMPRESSOR, ETC)

NAME POSITION SIGNATURE / DATE




Fr ,Rev 0,01.02.2009


MONTHLY CHECKLIST - FIRE EXTINGUISHERS

Inspected item

Visual inspection and functional test Remarks

Yes No N.A

Is fire extinguisher conspicuously located?

.Is there any proper space demarcation for fire extinguisher.

Is trigger pin intact?

Is wire seal of fire extinguisher unbroken?

Is standard operating procedure for using fire extinguisher displayed?

Is there clear access to fire extinguisher?

Is discharge hose and horn in good working condition and free from cracks and surface grazing?

Is pressure indication gauge within the green zone?

Is the body of fire extinguisher free from corrosion?

Is the fire extinguisher close to hazard area (i.e 1.5 m apart at high fire hazard area)

Is the fire extinguisher affixed with approved labels?

Is the fire extinguisher inspected by licensed fire extinguisher contractor annually?

Is the fire extinguisher appropriate for the area served?

Note :

Responsible persons must record and maintain the monthly checklist for 36 months

Inspected By :



QUATERLY CHECKLIST - EXIT LIGHTS

Statutory and licensed equipment/machinery Non -statutory and licensed equipment/machinery


Inspected by Date of inspection

Fr ,Rev 0,01.02.2009

Area manager in-charge Reviewed by and date

Inspected itemVisual inspection and

functional test Remarks

Yes No N.A

a. Batteries of exit lights properly charged

b. Exit lights are ‘No’ when conducting inspection.

c. Light bulbs are intact and working order.

d. Supplementary electricity supply to exit lights is intact and normal.

e. Any signs of missing or damaged hardware, such as, wires, screws and lamps.

f. Any sign of obstruction to lamps.

g. Any signs of worn or frayed cables.

h. Any sign of improper support to exit lights

i. Any inventory of all exit lights in the facility.

j. Any obstruction to gain access to exits?

Note :

Responsible persons must record and maintain the quarterly checklist for 36 months

Inspected By :



QUATERLY CHECKLIST - FIRE DOORS





Yes No N.A

a. Are fire doors conspicuously located?

Fr ,Rev 0,01.02.2009

b. Is there any proper space demarcation for fire doors?

c. Are rivets, bolts or screw intact?

d. Are wires (Connected to counter weights)disconnected or broken?

e. Are warning sign “Not to damage fire door “ printed on fire doors?

f. Are fusible links intact?

g. Is there any signs of cracks or dents on fire doors?

h. Is there any “ fire rating” sign on fire doors?

i. Are fire doors free from oil and grease?

j. Is any standard operating procedure on operating fire door displayed near the affected area?

k. Is there an inventory of all fire doors?

l. Are fire doors free from obstruction?

m. Is fire door/fire shutter closed completely during functional testing?

n. Is there any warning signal or audio alarm associated with fire door/fire shutter when there is an activation?

Note :Responsible persons must record and maintain the monthly checklist for 24 months

Inspected By :



QUARTERLY CHECKLIST - MAIN SPRINKLER CONTROL AND HYDRANT





Yes No N.A

Fr ,Rev 0,01.02.2009

Are fire sprinkler control valve/hydrant isolation valves conspicuously located?

Is there any proper space demarcation by hydrant isolation valve?

Is there a proper means of securing the main fire sprinkler control valves?(i.e straps & locks)

Are straps and locks of sprinkler control valve intact.

Is wire seal if hydrant isolation valve unbroken?

Is there any standard operating procedure and drawing of operating sprinkler control valve intact.

Is there clear access to sprinkler control valves.

Are local alarms /bells of deluge control valve of sprinkler system in good working condition order and free from cracks of surface glazing

Are pressure indication gauges and in good working conditions?

Is there any ‘open or shut’ indicator for hydrant isolation valve?

Is the body of sprinkler control valve or deluge valve free from corrosion?

Are fastening bolts, nuts or gaskets for sprinkler control valve or deluge valve intact and in good working conditions?

Are there signs of leaks of sprinkler valves/deluge valve/hydrant isolation valves?

Is there an inventory of sprinkler control valves deluge valves/hydrant isolation valves?

Note :Responsible persons must record and maintain the monthly checklist for 24 months Inspected By :


Rules and Regulations

1. I have been instructed and understood the OSHE rules and regulations and agree to abide by them.

Fr ,Rev 0,01.02.2009


2. I have been instructed and understood that if I have any questions or concerns then I should consult with my immediate supervisor. If he is unable to give a solution then I have a right to seek higher assistance from the Safety Personals.

Name of employee : ______________________________________________

Designation: ______________________________________________

Project badge no.: ______________________________________________

NRIC/Passport No. ______________________________________________

Employee signature:_____________________________________________

Date inducted: _____________________________________________

Company :________________________________________

Date :________________________________________

Post :________________________________________

Name Of Employee :________________________________________

I/C No. :________________________________________

Fr ,Rev 0,01.02.2009

SAFETY DEPARTMENT YNESB/OSHEF/26WORKER PARTICULAR

(To be contacted during emergency)

Next Of Kin :___________________________________________

Address :___________________________________________ ____________________________________________

Tel No. : ____________________________________________

H/P No. :_____________________________________________

I have been given the following P.P.E.

Safety Helmet

Safety Shoe

Safety Goggles

Gloves

Dust Mask

Welding Shield

Grinding shiled

Incase any accident happen and being traced me not wearing the above P.P.EProvided to me than I shall not to blame the company as it will be considered as my own carelessness.

Employee Signature

* I/C or Passport photocopy attached________________________

MEDICAL HISTORY

_________________________________ __________________ NAME IC/Passport No.

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__________________________ _______________ MALE / FEMALE D.O.B AGE

EMERGENCY CONTACT : ___________________________________________________ NAME PHONE#

ALLERGIES: ___________________________________________________________________________

________________________________________________________________________________________

PAST MEDICAL HISTORY (ie,HEART,LUNG,LIVER , ETC.:APPENDECTOMY,TONSILECTOMY, HYSTERECTOMY, ETC. )

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MEDICATIONS TAKEN________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

IF NOT TAKING ANY MEDICATION OR DO NOT HAVE A PAST MEDICAL HISTORY NOT ALLERGIES, PLEASE WRITE IN N/A.

ALL MEDICAL INFORMATION WILL BE CONFIDENTIAL.

THIS IS TO BENEFIT YOU IN CASE OF AN EMERGENCY INJURY OR ILLNESS.

Contractor Name : ___________________Induction Date Booked : ___________________ Time Booked : __________________

S/N Name Passport/IC No. DesignationRemarks

Absent Present

1

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SAFETY DEPARTMENT YNESB/OSHEF/28BOOKING LIST FOR OSHE INDUCTION

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Verified By Submitted By Received By

Name / Signature / Date Name / Signature / Date Name / Signature / Date

SAFETY DEPARTMENT YNESB/OSHEF/29 WARNING FOR SAFETY VOILENCE

NAME : _______________________________________

CONTRACTOR: _______________________________________

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1ST WARNING2ND WARNING3RD WARNING

PLACE: _____________ DATE: _____________ TIME: _____________

VOILENCE : ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

FEATHER ACTION : ______________________________________________________________TAKEN ______________________________________________________________ DEMIRIT POINTS:

ACCUMULETE DEMIT POINTS: GIVEN BY:- NAMA :____________________________________________

SIGNATURE:_____________________________________________

RECEVED BY:-

NAME : ___________________________________________________

EMP. NO : ___________________________________________________

DESIGNATION: _______________________________________________ SIGNATURE: _____________________________

DATE : _____________________________ Cc: Mr. M.S.Han – Senior Manager Mr. Yusufirashim - Admin& HR Manager Mr. Samuel Wong –Yard Manager Sub- Contactor

Picture as attached

SYSTEM DEMERIT The demerit system provides penalties and disqualification for staff and

workers who contravene safety rules within a three (3) month period.

1. PERSONAL PROTECTIVE EQUIPMENT

1.1 Working without safety helmet 101.2 Working without safety shoe 101.3 Working without eye protection 101.4 Working without ear protection 10

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1.5 Working without hand protection 101.6 Working without dust mask 101.7 Working without safety harness above 3 meters 30

2. UNSAFE ACTS AND CONDITION

2.1 Off all electrical equipment when not using 102.2 Absent from Tool Box Meeting 102.3 Close all gases valve when not using 102.4 Working without proper access 102.5 Poor house keeping 202.6 Eating / sleeping during working hours at workshop 202.7 Blocking emergency access or fire fighting equipments 202.8 Dumping of waste or scrap at unauthorized areas 202.9 Failure to report accidents, near misses and incident 202.10 Smoking inside plant 202.11 Throwing of tools 202.12 Using matches or lighter to light cutting torch 202.13 Unauthorized person doing heavy lifting 202.14 Violating gas cylinder procedures and incorrect storage 202.15 Using foul language against superior 202.16 Horseplay 252.17 Misuse of fire fighting equipment 252.18 Under influence of drug or alcohol, gambling, fighting, stealing, vandalism, illegal

workers.50

3. TRAFFIC

3.1 Riding motorcycle to around workshop area without approval 203.2 Speeding or dangerous driving around workshop area 203.3 Parking unauthorized area 20

PENALTY

30 Points Suspension for 3 days40 Points Suspension for 7 days50 points above Dismissal and bar from entering factory

Value of every one demerit point equal to RM 1.00. Penalty will be double for above foreman level.

Prepared By:- S.ESWARAN - Safety Officer

Approved By:

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______________________ ______________________ Mr. S.K. SIAU MR.SADIR MOHAMMEDExecutive Director Director

Effective Date: September 2008

C.C. Mr K. C. Seow – General Manager Mr M.S.Han – Senior Manager Mr. Yusufirashim - Admin& Safety Manager Mr. Samuel Wong –Plant Manager Mr. They.H.S- Production Manager Mr. Mandy Lua – Account Manager All Dept. Heads and Sub- Contractors.

SAFETY DEPARTMENT YNESB/OSHEF/03Block : Work Shop : DAILY PLANT SAFETY INSPECTION CHECKLISTS.No Description Yes No N.A

01 Foremen on job area02 All employees wearing proper eye/head protection?03 All wearing hearing protection where necessary?04 All wearing protective clothing where necessary.05 All wearing respiratory protection where necessary? 06 All wearing adequate safety shoes/gloves?07 All overhead workers using safety belts? Line? If required?08 Equipment properly locked out /tagged out?09 Electrical connections/cords, proper twist lock connections?10 Welding machines earth properly connected?

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11 Extension cables is properly lay. 12 Gas hoses in good condition? 13 Flash back arrestor installed?14 Gas hoses properly installed and properly lay. 15 Firefighting equipment in place and good condition. 16 Roads properly blocked if necessary?17 Any obstruction on the access way? 18 Scaffolding properly installed? Properly tagging? 19 Ladders properly used?20 Hand tools properly used?21 Proper lifting method safe material handling?22 Over head crane in good condition?23 Lifting sling in good condition? Inspected? 24 During lifting, padding in use cover the Sharpe edges? 25 Rubbish and scrap bins in place? 26 Good house keeping27 Special warning posted if necessary

Remark:

Supervisor : _________________ Safety Officer : _________________

Name : _________________ Name : _________________

Date : _________________ Date : _________________

Signature : _________________ Signature : _________________

Fr ,Rev 0,01.02.2009

Documents

Safety Department checklist format