SHELL PAKISTAN

Sr # Subject Control Number Remarks

CHECK LIST
1 Ambulance check list SPL-HSSE-CL-01
2 Cutting torch check list SPL-HSSE-CL-02
3 Dozer check list SPL-HSSE-CL-03
4 Electric cable & extention board check list SPL-HSSE-CL-04
5 Grader check list SPL-HSSE-CL-05
6 Excavator check list SPL-HSSE-CL-06
7 Crane check list SPL-HSSE-CL-07
8 Hand tools check list SPL-HSSE-CL-08
9 Power blower check list SPL-HSSE-CL-09
10 Drill machine check list SPL-HSSE-CL-10
11 Hilti machine check list SPL-HSSE-CL-11
12 Welding machine check list SPL-HSSE-CL-12
13 Light Vehicle check list SPL-HSSE-CL-13
14 PPE's check list SPL-HSSE-CL-14
15 Supervision controle check list SPL-HSSE-CL-15
16 Work at height check list SPL-HSSE-CL-16
17 Dumper Truck SPL-HSSE-CL-17
18 Baby Compactor SPL-HSSE-CL-18
19 MEWP- Cherry Picker SPL-HSSE-CL-19
20 Concrete Mixer, Lorry / Tractor Truck SPL-HSSE-CL-20
21 Mobile Crane Inspection Check list SPL-HSSE-CL-21
22 Genset Inspection Check list SPL-HSSE-CL-22
23 Portable Grinder SPL-HSSE-CL-23
24 Portable Electrical Tool SPL-HSSE-CL-24
25 Fire Extinguisher SPL-HSSE-CL-25
26 Portable Ladder SPL-HSSE-CL-26
27 Lifting Gear Equipment SPL-HSSE-CL-27
28 Full body Harness SPL-HSSE-CL-28
29 Hydraulic Jack SPL-HSSE-CL-29
30 Scaffolding Material SPL-HSSE-CL-30
31 Pneumatic Tools SPL-HSSE-CL-31
32 Confined Space work activity inspection SPL-HSSE-CL-32
33 Dropped Object SPL-HSSE-CL-33
34 Hot work Daily check list SPL-HSSE-CL-34
35 Tractor (Blade) check list SPL-HSSE-CL-35
36 Jumping compactor check list SPL-HSSE-CL-36
37 Plate compactor check list SPL-HSSE-CL-37
38 Back Hoe check list SPL-HSSE-CL-38
39 Drum Roller check list SPL-HSSE-CL-39
40 Front End Loader check list SPL-HSSE-CL-40
41 Skid Steer Loader check list SPL-HSSE-CL-41
42 Skylift inspection check list SPL-HSSE-CL-42
43 Air Compressor Inspection SPL-HSSE-CL-43
44 Confine Space Pre-entry Daily Inspection SPL-HSSE-CL-44
45 Control of Substance Hazardous to Health SPL-HSSE-CL-45
46 Lux Level Monitoring check list SPL-HSSE-CL-46
47 Anemometer Monitoring check list SPL-HSSE-CL-47
48 Gas Detector Log Sheet SPL-HSSE-CL-48
49 Boring machine checklist SPL-HSSE-CL-49
50 Contrete Vibrator checklist SPL-HSSE-CL-50
51 SCBA Daily Inspection checklist SPL-HSSE-CL-51
52 Forklift Inspection checklist SPL-HSSE-CL-52
AUDIT
1 1st Aid audit SPL-HSSE-AU-01
2 Audit formate SPL-HSSE-AU-02
3 House keeping audit SPL-HSSE-AU-03
4 PTW audit SPL-HSSE-AU-04
5 Site work location audit SPL-HSSE-AU-05
6 First aid box Item Inventory list SPL-HSSE-AU-06
RECORD
1 Site induction record SPL-HSSE-R-01
2 Training attendance record SPL-HSSE-R-02
3 Wind speed record SPL-HSSE-R-03
INSPECTION
1 Mobile scaffolding inspection SPL-HSSE-IR-02
2 Scaffolding inspection SPL-HSSE-IR-03
3 Waste management area inspection SPL-HSSE-IR-04
WASTE RECORD
1 Construction waste census SPL-HSSE-WR-01
 SPL-HSSE-CL-01

AMBULANCE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Type Modal
Reg/Serial No Make/ Brand
Date of Examination Inspection Status PASS Attention required

Sr. # Description Yes No Comments

1 Stretcher with lateral handles, short legs or wheel

2 Extra seat for paramedic & ease of access for strecher in/out
3 Hooks for drips & waste container
4 Cabinets for medical supplies/kits
5 Automated/manual suction pump portable/fixed
6 Safety belts for stretcher, attendant and driver
7 4X4 or 2x2 working properly
8 Oxygen cylinder with complete resuscitator
9 Rotating beacon and siren are in working condition
10 Ambulance signs, red cross or cresent signs
11 Emergency light available for escort staff
12 Are all the doors and window glasses are in good condition
13 Direct communication of driver with the medic
14 No fuel container or other material in patient compartment
15 Complete emergency kit with medic
16 Climate control system in good working condition
18 Is extra or second padded stretcher available in the ambulance
19 Is ambulance in good interior condition

20 Vehicle speed meter, temperature and fuel gauges are in working condition

Vehicle head lights, indicators, brake lights and reversing light & horn working
21 properly

22 Tires including spare are in good condition

23 Driver has valid license, defensive driving training and medically screened
Comments

Verify by:
Inspected by:
Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-02

GAS CUTTING TOOLS DAILY INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project Machine #
Location PTW No.

Day Mon Tue Wed Thur Fri Sat Sun Comments

Sr. # Description
Date
1 Cylinders used are in upright position and secured and placed on trolleys.
2 Cylinders protected from direct fire, sparks or excessive heat
3 Oxygen and Acetylene cylinders are kept safe distance free from obstacles
4 Cylinders are "soap solution" tested for leakage
5 Cylinders are kept away from live electrical cables or ground wires.
6 Empty and Full cylinders are properly separated and marked.
7 Regulators and torches are in sound working condition
8 All connections are "soap solution" tested to be leak free.
9 Hoses are free from tape or wrapping material.
10 Proper connections are used for fastening
11 All gas hoses are in good physical condition.
12 Any kinked or tangled hoses? If found shall be removed and replaced.
13 Hoses protected from mechanical damage
14 Flash-Back arrestor provided / in use-Cutting Torch & Regulator Side
15 Torch Free of Defects
16 Is there a hot work permit & JHA for the job?
17 Are all flammable / combustible materials remove from the hot work area?
Are the gas cylinder valve key readily available at the gas cylinder / trolley.
18 Cylinder shall be shut off after use.

19 Are the soap solution bottle at the cylinder for testing of any leakage
20 Fire Blanket or Shield In Use (If required)

Supervisor Name Sign

Verify by:
Inspected by:
Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-03

DOZER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Modal
Reg/Serial No Make/ Brand
Date of Examination Inspection Status PASS Attention required

Sr. # Description Yes No Comments

1 Operator Particulars
a Does operator possess a valid HTV license
b Is operator trained on IOGP-CSSS
c Driver license if required Operator Assessment certificate.
d Does operator have FtW and Police verification certificate
2 Static
a Track chain tightness & condition
b Tow hooks
c Reversing alarm (auto) / indication lights
d Rear view mirror
e Tire condition
f Tie rod
g Loose parts (secure)
h Spakr Arrestor or Exhaust Muffler
j Fire extinguisher
l Seat belts
m Bucket / blade & plough condition
n Battery condition
o Electrical wiring
p Any other hazards identified & evaluated
2 Runner
a Vibration
b Plunger box (stuffing box) leaks
c Abnormal sound
d Oil leakages

Comments

Inspected by: Verify by:

Name Name
Position Position

Company Company

Date Date
 SPL-HSSE-CL-04

ELECTRICAL CABLE & EXTENSIONS BOARD INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Equip / Serial # Color coding
Date of Examination Inspection Status PASS Attention required

Sr. # Description Good Not N/A Comments

Good
1 Are electrical cables & extension boards in good condition?

2 Are electrical cables & extension boards inspected & colour coded by
competent person?
3 Are electrical cables double insulated?

4 Power cords and extension cords are not run through doorways, windows,
or unprotected openings or holes in walls.

5 Electrical cables and extension cords are run so that they do

not create tripping hazards.

6 Are All electrical cable must be hanged properly and above the ground to
avoid trip hazards and electric shock from muddy/watery area.

Are Ground Fault Circuit Interrupters (GFCI)/ ELCB used

7 when workers are using any electrical equipment/cords, Does erthing
performed?
Any repairs to electrical cables & extension cords have been made by a
8 Competent person, and the repairs have the same or greater protective
qualities as the original cord or plug.

9 Has insulate, Elevate and Guard safety required for cables to avoid
damage.

10 Are damaged extension cords reported and removed from service? Does
the log maintained.

Comments

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-05

GRADER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand
Reg/Serial No Modal
Date of Examination Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

A Vehicle's Driver's Particular
1 Year of Manufacture
2 FTW & Police verification
3 Driver license if required Operator Assessment certificate. Validity:
4 Trained on relevant IOGP-CSSS Trainings. Validity:
B. Vehicle's Condition
5 Tires condition
6 Track condition
7 Door/Latches/Locks
8 Seat belts
9 Fire extinguisher
10 Mirror
11 Signal Lights (traficator, foot brake, hand brake)
12 Reverse Light with audio buzzer
13 Lamps (Dim Light, High Light)
14 Wind Screen
15 Wiper/ Washer
16 Horn
17 Exhaust Muffler / Spark Arrestor
18 Related Tools kit
19 Fuel & Oil Leakage
20 Untidy Wiring
21 Machine guard are in place and good condition
22 Foot/ Hand Brake
23 Fire Extinguisher
24 All moving parts are properly guarded?
25 Battery is properly secured
26 Operator cabin is it tidy?
27 Any trace of oil leak at the pistons?

Comments

Inspected by: Verified by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-05

EXCAVATOR INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand 3rd Party
Reg/Serial No Modal
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good good N/A Comments
1 Vehicle's Driver's Particular
2 Year of Manufacture
3 FTW & Police verification
4 Driver license if required Operator Assessment certificate.
5 Trained on relevant IOGP-CSSS Trainings.
6 Vehicle's Condition
7 Tires condition
8 Track condition
9 Door/Latches/Locks
10 Seat belts
11 Fire extinguisher
12 Mirror
13 Signal Lights (traficator, foot brake, hand brake)
14 Reverse Light with audio buzzer
15 Lamps (Dim Light, High Light)
16 Wind Screen
17 Wiper/ Washer
18 Horn
19 Exhaust System/ Flame Arrestor
20 Related Tools kit
21 Fuel & Oil Leakage
22 Untidy Wiring
23 Machine guard are in place and good condition
24 Foot/ Hand Brake
25 Fire Extinguisher
26 All moving parts are properly guarded?
27 Battery is properly secured
28 Operator cabin is it tidy?
29 Any lifting hook welded on the bucket?
30 Bucket locking pin in good condition
31 Any trace of oil leak at the pistons?
32 Condition of the seals?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-08

HAND & EQUIPMENT TOOL INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal

Project Inspection Status PASS Attention required

Loose
Sr. # Type of Tool Damage Bend Corrosive Gun/Handle Tag Comments

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Comments

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-09

POWER BLOWER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand 3rd Party
Reg/Serial No Color coding
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good Good N/A Comments

2 Cable Condition
3 Joint condition
4 Socket (receptacle type)
5 Plug (receptacle type)
6 Safe Guards
7 Abnormal Sound
8 On/off Switch
9 Motor condition (EX rated)
10 Fan Condition
11 Farthing Provided (Extended Pipe)

Comments

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-10

DRILL MACHINE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal

Project

Make/Brand 3rd Party

Reg/Serial No Color coding

Date of Examination Inspection Status PASS Attention required

Sr. # Description Good Not N/A Comments

Good

1 Cable Condition

2 Joint condition

3 Socket (receptacle type)

4 Plug (receptacle type)

5 Safe Guards

6 Abnormal Sound

7 On/off Switch

8 Visual Conditon

9 Spanner/Key

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-11

POWER HILTI MACHINE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand 3rd Party
Reg/Serial No Color coding
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good Good N/A Comments

2 Cable Condition

3 Joint condition

4 Socket (receptacle type)

5 On/Off Switch

6 Safe Guards

7 Abnormal Sound

8 Covered Amature

9 Earthing Provided

10 Overall condition

11 Excessive Vibaration

12 Other

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-12

WELDING MACHINE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand
Reg/Serial No Modal
Date of Examination Inspection Status PASS Attention required

Sr. # Description Not N/A

Good good Comments
A Equipment's Condition
1 Drip tray is provided or not?
2 Drip tray's condition
3 Polarity marked
4 All moving parts are properly guarded?
5 Welding cable’s condition
6 Welding holder
7 Earth rod’s condition
8 Earthing cable’s condition
9 Terminal’s condition
10 Any sign of Fuel & Oil Leakage?
11 Spark arrestor installed?
12 Battery is properly secured
13 Dynamo brushes cover fitted
14 Any abnormal sound?
15 Excessive vibration?
16 Body is free from any damages?
17 Towing frame
18 Are the terminals covered?
19 Electrical switch gear provided and functioned?
20 Machine guard are in place and good condition
21 Operating volts sockets are available (240 volts)
22 Industrial Power cable plug and socket
23 ELCB available in supply DB.
24 Trial run conducted?
25 Voltmeter/ Ammeter
26 Overall body condition

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-13

LIGHT VEHICLE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand
Reg/Serial No Model
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good good N/A Comments

1 Tires: Wear/Tear, Inflation, Cut etc.

3 FTW & Police verification
4 Driver license if required Operator Assessment certificate.
5 Trained on relevant IOGP-CSSS Trainings.
6 Head Lights
7 Turn Signals or Indicators
9 Hazards Lights/Reflectors
10 Door Locks
11 Speedo Meter, Fuel Indicator, Temperature Indicator
12 Air Ventilation System (Inside Vehicle)
13 Horn & Reverse Alarm
15 Seat Belts
16 Wind Screen, Wipers, Side Mirror, Back View Mirror
17 Air Filter, Tuning
18 Gears & Steering Controls
19 Breaks (Paddle & Hand)
21 Parking Lights
22 Paddles (Accelerator, Clutch)
23 Driving license/ Certificate
24 Hydraulic Oil/ Radiator Water/ Battery
25 General Tools Kit
27 Any other

Comments

Inspected by: Inspected by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-14

PPEs INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Area Supervisor Activity
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good good N/A Comments

1 Are the workers aware of minimum PPEs requirement?

2 Are the workers wearing all the mandatory PPEs?
3 Do the workers know about the use and benefit of PPEs?

4 Are the workers wearing other additional PPEs as per their job
requirement?
5 Are all the PPEs in good condition?
6 Are all the PPEs are Safe to use?
7 Are all the PPEs are of approved standard?
8 Are workers familiar with T&S PPEs policy?
9 Are workers using the PPEs in correct way?
10 Other

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-15

SUPERVISOR CONTROL CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Area Activity
Area Supervisor Inspection Status PASS Attention required

Sr. # Description Yes No Comments

1 Is the supervisor available at site (Actual job location) ?

2 Dose the crew member aware of their supervisor name?
3 Is the supervisor vs worker ratio is 1-15?
Does the crew member continued work without supervisor
4
(Actual, Potential or historically) ?
5 Is there a shell qualified PtW personal on site with supervisor?
6 Is supervisor familiar with Shell PTW?
7 Does the supervisor aware about Life saving Rules / Shell golden
8 Is there a separate Supervisor for every work group?
9 Is execution familiar with Shell ERP?
10 Is execution familiar with its Traffic layout plan?
11 Is supervisor familiar with worker welfare needs?
12 Is supervisor trained on Shell Stop work policy?
13 Do the supervisor understand the 3-strike card?
14 other

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-16

WORK AT HEIGHT INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Area Activity
Area Supervisor Inspection Status PASS Attention required

Sr. # Description Yes No Comments

1 Is work at heights properly planned and organized?
2 Are all the personnel selected medically fit?
3 Are all the personnel trained for working at height?
4 Has job safety analysis (JSA)/risk assessment (RA) been conducted?
5 Are the hazards and risk control measures communicated to all workers?

6 Every open side or opening into or through which a person may fall is covered
or guarded by an effective barrier to prevent falls.

7 Where covers are used for openings, are these covers securely fixed to prevent
accidental displacement?

8 Have all the openings been covered with hole covers or guarded with top rail
& mid rails?

Full body harness with double lanyard and shock absorber with (SALA /
9 Suspension Trauma prevention Device) shall be used and attached to the
designated anchor point on the platform

10 Are the scaffolding used for working at height inspected as per tag system?
11 Are the full body harnesses used by workers inspected?
12 Is sufficient and secured anchorage provided and inspected?

13 Is the work area properly barricaded and warning signage displayed?

Where a ladder is used for access or as a working place, are adequate

14 handholds provided to a height of at least one meter above the place of
landing of the highest rung to be reached by the feet of any person on the
ladder?
15 Tool lanyard are used to avoid falling objects.
16 Toe boards are installed to avoid falling objects.
17 Has dropped object plan considered for work at height?
18 Any other

Comments

Inspected by: Verify by:

Name Name

Position Position
Company Company

Date Date
 SPL-HSSE-CL-17

DUMP TRUCK INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A
1 Vehicle’s & Driver’s Particular
2 Year of Manufacture
3 FTW & Police verification
4 Driver license if required Operator Assessment
certificate.
5 Trained on relevant IOGP-CSSS Trainings.
6 Vehicle’s Condition
7 Tires Condition
8 Tread Condition
9 Door/ Latches/ Locks
10 Seat/ Seat Belt
11 Mirror
12 Signal Lights (Traficator, Foot Brake, Hand Brake)
13 Reverse Light with audio buzzer
14 Lamps (Dim Light, High Light)
15 Wind Screen
16 Wiper / Washer
17 Horn
18 Exhaust System / Flame Arrestor
19 Foot / Hand Brake
20 Vehicle Handling (rooad test)
21 Spare tire & ralated tools
22 Body Panels / paint work
23 Fuel & Oil Leakage
24 Untidy Wiring
25 Machine Guard are in place ad good condition
26 Fire Extinguisher
27 Operator cabin is tidy
28 All moving parts are properly guarded?
29 Body is free from any damages?
30 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-18

BABY COMPACTOR INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not N/A Comments

Sr. # Description Good
Good
1 Vehicle’s & Driver’s Particular
2 FTW & Police verification
3 Driver license if required / Operator Assessment certificate.
4 Trained on relevant IOGP-CSSS Trainings.
5 Vehicle’s Condition
6 Tires Condition
7 Tread Condition
8 Door/ Latches/ Locks
9 Seat/ Seat Belt
10 Mirror
11 Signal Lights (Traficator, Foot Brake, Hand Brake)
12 Lamps (Dim Light, High Light)
13 Wind Screen
14 Wiper/ Washer
15 Horn
16 Exhaust System/ Flame Arrestor
17 Foot/ Hand Brake
18 Spare Tire & Related Tools
19 Body Panels/ Paint Work
20 Fuel & Oil Leakage
21 Untidy Wiring
22 Machine guard are in place and good condition
23 Fire Extinguisher
24 Operator cabin is it tidy?
25 All moving parts are properly guarded?
26 Body is free from any damages?
27 Battery is properly secured
28 Any other

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-19

MEWP-CHERRY PICKER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project Registration #
Location Activity
Date of Examination Inspection Status PASS Attention required

Sr. # Description Yes No N/A Comments

1 Has the operator been assessed by 3rd party?

2 The MEWP manufacturers’ operations manual is kept in MEWP cabin.

3 No sign of cracked welds on MEWP body parts, fuel & hydraulic leak and
damaged control cables.

4 Tire & wheels are in good working condition, with adequate air pressure
if pneumatic.

5 Operating & emergency controls including flashing beacon and howler

are in proper working condition?
6 Maintenance executed in time. No overdue tasks.

7 Slewing assembly of the plant, in particular its slewing bolts are in good
condition.
8 Reverse alarm is fitted and functionally tested

9 Manual emergency decent is clearly labeled and functionally tested.

10 Level indicator is fitted where outriggers are used.

11 Drive controls function properly & accurately labelled (up, down, right,
left, forward, back) and functionally tested.
12 Safety signage is in place and readable

13 Control panel is clean & all buttons/ switches are clearly visible (no paint
over spray, etc.)
14 Braking devise are working properly during the test.
15 Inspect the battery and hydraulic equipment.
16 Emergency lowering function operates properly.
17 All guardrails are sound and in place, including gate door.
Any Other:

Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-20

LORRY TRUCK, TRAILER, CONCRETE MIXER AND PICK UP TRUCK INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Reg / Serial # Inspection Status PASS Attention required

Not N/A Comments

Sr. # Description Good
Good
1 Vehicle’s & Driver’s Particular
2 Year of Manufacture
3 FTW & Police verification

4 Driver license if required Operator Assessment

certificate.
5 Trained on relevant IOGP-CSSS Trainings.
6 Vehicle’s Condition
7 Tires Condition
8 Track Condition
9 Door/ Latches/ Locks
10 Seat/ Seat Belt
11 Mirror
12 Exhaust System/ Flame Arrestor
13 Reverse Light with audio buzzer
14 Foot/ Hand Brake
15 Spare Tire & Related Tools kit
16 Body Panels/ Paint Work
17 Fuel & Oil Leakage
18 Untidy Wiring
19 Machine guard are in place and good condition
20 Fire Extinguisher
21 Operator cabin is it tidy?
22 All moving parts are properly guarded?
23 Body is free from any damages?
24 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-21

MOBILE CRANE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand Type
Reg/Serial No Modal
Date of Examination Inspection Status PASS Attention required

Sr. # Description Not N/A

Good good Comments
1 Vehicle's Driver's Particular
2 Year of Manufacture
3 FTW & Police verification
4 Driver license if required / Operator Assessment certificate.
5 Trained on relevant IOGP-CSSS Trainings.
6 Calibration Certificate for ASLI (Automatic Safe Load Indicator)
7 Crane’s operating manual, load chart
8 Crane operator assessment?
9 Vehicle's Condition
10 Spark arrestor installed
11 Batteries are covered
12 Fire extinguisher mounted on the crane
13 Horn are functional
14 Boom Structure and Connection
15 Safety pins in good condition
16 Hooks are installed with safety latch

17 Main and auxiliary wire ropes are well lubricated and that there are no
visible defects such as broken wires, kinks, excess wear, crushing etc.
18 Correct size of wire rope
19 Boom sections are free from cracks or dents
20 Winches, pulleys and wire ropes are in good working condition
21 Engines and Electrical Connection
22 Oil (Engine & transmission)
23 Water
24 Electrical wiring- No visual sign of damage
25 Safety and Operational Devices
26 Load radius indicator and warning alarm installed
27 An effective hoist and derricking braking mechanism are maintained
28 Boom angle indicator
29 Warning gauges and buzzer
30 A swing lock capable of preventing unintended rotation
31 Limit switch to prevent over hoisting of the hook is functional

Comments

Inspected by: Inspected by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-22

GENERATOR SET INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Reg / Serial # Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 Equipment's Condition
2 Drip tray / Secondary containment is provided or not?
3 Drip tray / Secondary containment condition
4 Earth rod’s condition
5 Earth cable’s condition
6 Terminal’s condition
7 Are the terminals covered?
8 Electrical switch gear provided and functioned?
9 All moving parts are properly guarded?
11 Any sign of Fuel & Oil Leakage?
12 Machine guard are in place and good condition
13 Body is free from any damages?
14 Battery is properly secured
15 Battery cable in good condition
17 220 / 440 volts socket
18 Industrial Power cable plug and socket
19 ELCB VAC supply
20 Trial run conducted?

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-23

POTABLE GRINDER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Reg / Serial # Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 Equipment's Condition
2 Machine RPM Rating
3 Voltage Rating
4 Wheel RPM Rating
5 Equipment body Condition
6 Double insulation body
7 Machine guarding/ Disc guard
8 Flanges/ Mounting screw
9 Industrial cable and socket
10 Power cord/ Cable condition
11 Wheel RPM (More than machine RPM)
12 Body and flange cleanliness
13 Designated operator

Operator’s Name:

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-24

PORTABLE ELECTRICAL TOOL INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Model
Reg / Serial # Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 Equipment's Condition
2 Tool is double insulated
3 Tool housing is not damaged
4 Deadman switch available

5 All shields, guards or attachments required by OSHA or

manufacturer are present.

6 Rotating or moving parts or tool are guarded to

prevent physical contact

7 Blades or bits are not damaged, cracked, excessively

worn, etc.
8 Tool appears to be in generally good condition
9 Switches are working
10 Electrical cable is Properly connected
11 Double insulated type of cable (Good condition, no
exposed wire & waterproof)
12 No splice
13 Properly sized
14 Industrial type socket/ plug used
15 Safety accessories provided (Guards, handles etc.)
16 Proper PPE is available

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-25

PORTABLE FIRE EXTINGUISHER INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal
Project Date and Time
Date of Examination Inspection Status PASS Attention required

Sr. # Equipment No. Location Type Capacity Loose Type of

Gun/Handle Inspection/Test Result Comments

10

11

12

13

Comments

Inspection by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-26

PORTABLE LADDER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Project
Contractor Make / Brand
Length Color Code
Date of Exam Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 Are all rungs, cleats, or steps in good condition?

2 Ladder stored safely and separately from other

materials?

3 Are the side rails intact without any cracks, bends, or

breaks?

4 Do the rungs, cleats, or steps fit snuggly into the side

rails?
5 Is the ladder free of corrosion?
6 Are the side rails and steps free of oil or grease?

7 Are the ladder's hardware and fittings secure and

undamaged?

8 Do moveable parts operate freely without binding or

excessive play?
9 Are tie-off ropes attached to straight, extension and
step ladders?

10 Are the ropes on extension ladders intact without

fraying or excessive wear?

11 Does the ladder have rigid footrests?

12 Is pulley correctly fixed and its motion is consistent?

13 Is the ladder free of dents or bends?

14 Safety feet condition?

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-27

LIFTING EQUIPMENT INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Capacity 3rd Party
Reg / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

Is there a register of lifting equipment recording the following

1 data for each piece of lifting equipment?

b Identification number
c Safe working load limit (SWL)
f Certificates of test, inspections, and examinations.
Due dates for previous and next periodic inspection or
g periodicity of inspections
h Maintenance log
Are daily or pre shift visual inspections conducted on all pre
2 slung or general lift wire rope slings being utilized?

Are annual inspections conducted, documented and current on

3 pre-slung wire rope sling assemblies?

Are annual inspections conducted, documented and current on

4 general lifting wire rope slings?

Are all pre slung wire rope sling assemblies equipped with a
5 certification tag containing:

b Safe working load limit?

d Sling length and diameter?
e A valid annual certification date?
Rated load for the type of hitch(es) and the angle upon which it
f is based?
Are all general lifting wire rope slings equipped with a
6 certification tag containing:

a Sling manufacturer?
b Safe working load limit?
c Proof test certification number?
d Sling length and diameter?
Rated load for the type of hitch(es) and the angle upon which it
e is based?

f A valid annual certification date?

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-28

FULL BODY HARNESS INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Project
Brand / Make Capacity 3rd Party
Reg / Serial # Inspection Status PASS Attention required

Comments
Sr. # Description Good Not Good N/A

1 1. Inspect the harness webbing (straps):

a Webbing (strap)
b Stitching for cuts & pulled or broken threads
c Excessive wear & abrasions
d Altered or missing straps
e Burns or heat & chemical exposures
2 Inspect all metallic parts (D-ring, Oval rings, Buckle & Adjusters)
a Deformation
b Cracks or Fractures
c Corrosion
d Sharp edges and cuts
e Missing or loose parts
f Improper function
g Evidence of burns & excessive heat & chemical exposure
3 Inspect all plastic parts D-Ring Locator, Strap Collar, Labels, Tool Belt Clips (If any)
a Cuts or broken
b Excessive worn
c Missing & loose parts
d Evidence of burns & excessive heat & chemical exposure
4 Inspect the lanyard
a Snaps

I. Inspect closely for hooks & distortions, cracks & corrosion

II. The latch should seat into the nose w/o binding & should not be
distorted or obstructed
III. Keeper/Latch must prevent from opening when closed
b Thimbles
I. Must be seated firmly in the eye of the Splice
II. Splice should have no loose or cut strands
III. Edges must be free of sharp edges, distortion or cracks
c Shock Absorber Pack
I. Outer portion of the pack should be examined for burn holes & tears
II. Stitching on areas where pack is sewn to D-rings, or lanyards should be
examined for loose strands, rips & deterioration
Are Sala Devices available and correctly attached to harness?
Are Sala Devices 3rd party certified?
Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-30

HYDRAULIC JACK INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Brand / Make Capacity 3rd Party
Reg / Serial # Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 Shell Plate
a Are welded lugs on shell plate suitable for securing jacking equipment?
b Is jack post vertical after installation?
c Is adequate supports in-place to prevent the shell from toppling?

d Is there possibility of uncontrolled/unexpected movement of shell plate?

e Is there possibility of contact with sharp objects from the shell plate?
2 Jacking Equipment
a Are the equipment (LG) been inspected with valid certification?
b Is the equipment a restricted use/operate item?

c Any possible entanglement (e.g. hair, clothing, gloves or other materials)?

d Are the bolt and nuts serviced/fastened to prevent oil leak during
operation?
e Will anyone come into contact with hydraulic oil when equipment is under
pressure or due to equipment failure or misuse?
Are adequate measures taken to prevent equipment falling-off from its
f
housing during installation?
3 Power Pack- Electrical

a Will anyone using the equipment suffer injury due to exposure to noise?

b Will anyone using the equipment suffer ill-health from exposure to

vibration?
c Does the equipment have emergency stop button?
d Are all the controls on the machine labelled and legible?
Are all guards and safety devices in the right places and are they in good
e
working order?
f Is there a drip tray provided to prevent oil leak to the ground?
4 Hoses & Connections

a
Are hoses and connections been fitted properly and are they
protected against damage?
Are the hose and connections tested/inspected
b
for oil leak?

Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-30

SCAFFOLDING MATERIAL INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal Project
Location
Type Inspection Status PASS Attention required

Sr. # Description Quantity Good Not Good N/A Comments

1 Sole boards
2 Base plates
3 Base Jacks
4 Standards
5 Ledgers
6 Transoms
7 Intermediate transoms
8 Right angle couplers
9 Swivel couplers
10 Sleeve couplers
11 Scaffold tube
12 Decking/Scaffolding boards
13 Diagonal Brace
14 Access stairs / Ladders
15 Contilever /Stage brackets
16 Bridging ledgers
17 Anchorage / Ties
18 Brick Guards
19 Sheeting / Netting
20 Erection & use instructions
21 Scaffolding signs & tags
22 Other component

Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-31

PNEUMATIC TOOL AND EQUIPMENT INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal
Project 3rd Party
Make / Brand Serial #
Capacity Inspection Status PASS Attention required

Sr. # Description Good Not Good N/A Comments

1 General condition of unit- clean, free of grit, free from damage and
defects.
2 Are all required guards fitted, secure and undamaged?
3 Rotating bits securely fastened and in safe condition.

4 Do the bearings rotate smoothly on the tool without catching or making

a screeching noise?

5 Tools governed not to over speed- check tool RPM

versus working RPM.

6 Is the tool’s body and handle in good condition with no cracks, damage
or wear?
7 Is the tool being oiled daily?

8 Is the air hose in good condition with no cracks, damage or wear? or

evidence of leaking air?

9 Hose and hose fittings shall have pressure ratings not less than the
supply source.
Hose connections shall have a positive-locking action or the connecting
10 sections shall have a safety whip to restrain any whipping action if the
sections become disconnected.
11 Hose connection to tool in good condition- proper hose clamps used
(not wire)
12 Hose joints properly connected- proper hose clamps used (not wire)

13 An air supply line shall be regulated to maintain the pressure at not

more than the pneumatic tool rating.
14 Safety devices and operating controls shall not be made inoperative.

Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-32

CONFINE SPACE WORK ACTIVITY INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal

Project

Location Activity

Date of Examination Inspection Status PASS Attention required

Sr. # Description Yes No N/A Comments

A. Pre-Entry Planning
1 All entries into confined spaces are controlled with a Confined Space CS Entry permit through the Permit to Work (PTW) system.
2 Each permit (PTW) applies to a single confined space entry only.
3 Is there adequate warning signage, label, ERP flow passage and escape arrow to exhibit the direction to safe assembly area?
4 Has simultaneous operations relating to the CS entry identified and addressed?
5 Isolation requirements are verified through Permit to Work and Lock-out Tag-out procedures.

6 Line walk conducted to confirm the CS is under positive isolation, double block & blind, de-energization, lock-out and isolation of all other energy
sources which may be external to but still capable of affecting the confined space.

7 When atmospheric oxygen content differs from normal (20%-21.5%) the risks properly assessed and necessary measures is addressed with adequate
control.

8 Ventilation and air extraction system (forced ventilation) are used when natural
ventilation is not adequate, i.e. storage tanks, vessels, oil interceptors, excavation pit, trench etc.
9 A ventilation plan is prepared and is available at site e.g. for storage tank internal activity.
10 The ventilation set-up, air extraction arrangement complies with the ventilation plan
11 Low voltage 110V /or ground fault protected equipment are used for work inside the CS?
12 Is lighting adequate to cater for all work area visibility inside the CS?
13 The equipment and tools to be used are checked prior to use. (check record displayed, tags)
Pre-entry meetings, attended by all personnel involved in confined space entries, are held in order to review the Job Hazard Analysis and the confined
14 space entry permit to ensure that all measures are implemented, isolation points in place and gas detection done prior to authorizing the work to start
and entry.
15 All required supporting documents i.e. TBT form, HITS card, CS checklist are filled up and attached with PTW.
B. Roles & Responsibility & Competence Check

14 Is there Entry Supervisor assigned for the CS work? Who?

15 In case Entry Supervisor need to leave site, is there equivalent competent replacement assigned during his absence? Who?
Note: CS work must stop if NO Entry Supervisor present at CS site.
16 Is there Site Safety Supervisor assigned for the CS activity? Who?

17 All personnel with roles and responsibilities in the planning, approval, execution, and monitoring of entry into confined spaces are trained in a language
they understand. If there is foreign workers involved, a translator can be used.
18 All Entrants have attended NIOSH approved AESP training. Pre-entry competence checked and verified the following personnel (per item 21 below).

a. Entry Supervisors

b. Replacement Entry Supervisor

c. Authorized Entrants (All)

d. Standby Person/ Watchman

19 Check AESP Card Validity for all CS personnel.
e. Authorized Gas Tester (AGT)

f. First Aider

g. Fire Watcher

h. Emergency / Rescue Team

20 Has CS personnel signed their Health Declaration form every day during the CS
activity?

21 Is there a copy of valid Fitness To Work (FTW) at site for Entry Supervisor,
Authorized Entrants, Standby Person, First Aider, AGT, Fire Watcher & ER Team & relevant Entrants?
C. Hazard & Risk Control

22 Carrying out work activities in CS entry is avoided wherever possible.

23 If CS work becomes absolutely necessary, all the potential hazards and acceptable entry criteria have been identified and recorded on the pre-entry
plan, Job Method Statement, Job Hazard Analysis and permit and the controls to safely enter and exit CS are in place.

24 Risk analysis and necessary measures taken when atmospheric oxygen content
differs from normal (20%- 21.5%)
Hazardous atmosphere, dust, fume, gas, vapor.

Release of hazardous energy.

Migration of hazardous products.

Snags, entanglement.

Congestion.

Slip, Trip, Falls.

Emergency access obstruction.

Check the CS has any of the following residual Fatigue/ Ergonomic.
25 hazard? If any of these hazard exist during
work activity, revisit RA/ JHA and discuss their
additional controls with all the CS personnel. Temperature, heat or cold extreme.
Sparks, fire or explosion source.

Drop Object for WAH in tank.

Wall collapse (for excavation)

Physical hazard.

Chemical & biological hazard.

Electrical hazard.
Line of Fire hazard.
26 Is there a clear segregation between simultaneous activity-SIMOP?(if any)

27 Are hoses & cables lined-up into CS via separate entry from the Entry/Exit point?

D. Gas Testing & Air Quality Verification Control

Entry criteria for gas level are met

Gases Type Without With Respiratory Inert Entry

Respiratory Protection Protection
28 Oxygen % 20 to max. 21.5 >16 to max. 21.5 <4

Toxics < ½ OEL < IDLH Not applicable

Flammable % of Not detectable (<1) <10 for hot work- <10
LFL not detectable
29 Gas/atmospheric testing and its frequency determined in PTW?

30 Pre-entry gas test conducted by Authorized Gas Tester and recorded?

(Note: entry into CS shall not lapse 30 minutes after the gas test)

Gas monitoring/atmospheric testing is in place during work activities in accordance with the Job Hazard Analysis and at least after every break, after
31 lunch and at the beginning of a new work shift, or if the atmosphere inside the confined space is expected to change during work activities (e.g. during
welding operations)

32 During Painting & Blasting, is the supplied air from internal combustion engine has CO gas detector provided to the air supply filter system?

33 Is the CO detector located near and visible to the Standby Person/ Watchman?

34 Is Personal Gas Detector adequate and worn by Entrant?

35 Is portable Area-Gas-Detector provided for the CS entry activity?

36 Is location of breathing air sources identified?

37 Is location of generators/ equipment with engine exhaust not facing air intake of CS?

38 Safe location of inert/ hazardous gas sources (bottles/ packs) determined, if they are used.

39 The location of inert or hazardous gas sources (bottles or packs) away from CS air intake.

40 The location of generators or equipment with engine exhaust away from CS air intake.

41 Has proper control provided to extract and collect airborne dust from blasting activity?

42 Has proper control provided to contain airborne midst in case of spray painting for tank external?

43 Has proper control provided to extract welding fumes such as localized exhaust vent from accumulating inside CS?

44 Entry Activity & Access Control

The CS is attended by a trained and competent Standby Person/ Watchman with no other duties, typically one per entry point.
45 (Note: One Standby Person/ Watchman on two or more confined spaces is possible if all confined space entry points they are responsible for are visible
from one standing point of the watchman, and the watchman is able to perform their
responsibilities for all confined spaces they are responsible for.)

46 All CS personnel signed off a health declaration form daily prior to entry into CS.

47 Is there a “display board” for hanging Entry/Exit tags?

48 Is lighting adequate to cater for all work area visibility inside the CS?

49 Is there a warning sign posted at the entry/exit point which specify “Danger!” “Confine Space” “Enter By Permit Only”?

50 The equipment and tools to be used are checked prior to use. (check record displayed, tags)

51 Is there physical barrier at point of entry to prevent unauthorized entry during work break or at the end of each shift?

E. Emergency Response Preparedness

52 Adequate walkie talkie provided.

53 Emergency response/ escape plan prepared and copy of the ERP attached to PTW.

54 Is the ERP/ escape plan understood by all CS personnel?

55 Has ERP drill conducted to verify the plan is adequate for the entry activity?

56 Are all the ERP equipment properly kept, protected, the breathing apparatus not contaminated and ready in case of

First Aid Box c/w adequate supply

SCBA (pressure > 200 barG)

Escape set for SCBA

57 Check ERP equipment is in place at the work Stretcher

site.
Fire Extinguishers

Search torch light (Ex proof type)

Rescue Rope

58 Is First Aider available and on standby at site during the CS activity?

59 Is the First Aider competence valid?

60 The Emergency team trained, equipped and available for rescue and First Aid assistance?

61 The required firefighting equipment adequate, readily and in good working condition?

62 Is there clear communications (established/agreed/understood) and tested between workers and the Standby Person/ Watchman. e.g. voice, radio,
pre- agreed signals and whistles?
63 Communications walkie talkie adequate and tested between Entrants, Entry Supervisor, Standby Person/ Watchman and on-duty TOS?

64 Personal Protective Equipment Requirement

65 Is Personal Protective Equipment evaluation and its use relevant for the work being done?

66 If respirator mask is required, have fit-test been done for users?

67 Is there protective clothes e.g. disposable tyvex for irritant, dust, or product contaminant?

68 Is hearing protection worn when work generates noise above regulatory action level?

69 Is there a proper PPE control/ record and safekeeping system in place?

70 Is there SDS available at site for reference to substance in use for PPE requirement?

71 Is PPE adequate/ suitable for hazardous atmosphere, fume, dust, vapor?

 H. Work Completion

72 Housekeeping is done before PTW suspension or at the end of each work shift?

73 Standby Person/ Watchman and Entry Supervisor check headcount prior to closing CS.

74 Utility lines (e.g. oxygen and gas hoses) are disconnected or removed when not in use – this is verified by Entry Supervisor and double checked by the
Standby Person/ Watchman.
75 Is lighting adequate to cater for all work area visibility inside the CS?

76 Reinstate manhole cover for physical barrier to prevent unauthorized entry into CS.

77 The equipment and tools to be used are checked prior to use. (check record displayed, tags)
Note: If the answer is No, please provide action taken to rectify this issue at action column.

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-33

DROP OBJECT CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Project
Location Activity
Date of Examination Inspection Status PASS Attention required

Sr. # Description Yes No N/A Comments

1 Working on Temporary Platform (Scaffolding)

Are materials properly stacked, stored and secured at elevated work

a areas i.e. Scaffolding tubes, clamps, wooden plank, aluminum deck,
ladder)?
(Stacking materials higher than toe guard shall be secured)

Are all scaffolding decks inspected to ensure there are no gaps/spaces in

b decking surface and that toe boards are installed around entire
perimeter of scaffold deck as well as any openings /penetrations in
decking?

c Are all tools utilized at height secured and/or placed in rated bags to
prevent accidental falling from height?

d Are all small materials and/or items (bolts, nuts, gasket, etc.) placed at
secured locations or adequately contained?

e Are loose hand tools (ratchet, spanner, cutter etc.) secured with safety
lanyard?
2 Working on Permanent Platform (i.e. Gratings, checkered plates, etc.)

Check grating is securely fastened and in an acceptable condition (i.e.

a will maintain its integrity, free from serious corrosion, physical damage,
loose clips, etc.)

Is the grating platform checked for openings: between toe plate and
b decking; pipe penetrations provided with collar/sleeves; and floor
openings adequately covered or protected?

Are the storage areas, waste disposal facilities and maintenance stations
c located on grating are boarded or sheeted appropriately to prevent
small/thin items falling through grating?

d Are the storage bins full/ overfilled? Where the material or waste can
potentially become drop object.
Are all tools that are small enough to pass through grating are tethered,
e including small materials contained or secured to prevent from
penetrating through small openings?

f Is periodic housekeeping performed and rubbish, off-cut materials and

scrap contained and prevented from falling from height?

Comments:

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-34

HOT WORK DAILY INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Machine 3rd Party Location
No.
Reg/Serial No Activity
Date of Examination Inspection Status PASS Attention required

Day Mon Tue Wed Thus Fri Sat Sun Comments

Sr. # Description
1 Hot work to be conducted at safe area i.e. workshop if possible
2 Hot work location to be kept free from combustible materials
3 Suitable fire extinguishers are readily available at hot work location
Fire extinguishers are provided at machinery location i.e. Welding machine,
4 portable compressor, portable
generator.
5 Adequate
Shield.
fire blanket and canvas is placed around the hot work location as

6 Trained fire watchmen with vest is present at the hot work location at all
time during hot work activity.
7 Gas test is conducted by Terminal Authorized Gas Tester/ Gas Tester before star
8 Personal gas detector and/or area gas detector is being used at hot work
Location
9 Appropriate personal protective equipment provided and used
10 Hot work equipment is in good working condition
11 Ensure welding cables are layout properly to prevent slip, trip and fall.
12 Good housekeeping is maintained at work area.
Supervisor Name and Sign

Comments

Verify by:
Inspected by:
Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-35

Tractor (Blade) INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal
Project
Make/Brand
Reg/Serial No Modal
Date of Examination Inspection Status PASS Attention required

Sr. # Description Good Not

good N/A Comments
1 Vehicle's Driver's Particular
2 Year of Manufacture
3 FTW & Police verification
4 Driver license if required Operator Assessment
5 Trained on relevant IOGP-CSSS Trainings.
6 Vehicle's Condition
7 Tires condition
8 Reversse Horn
9 Operator over head guard
10 Seat belts
11 Mirror
12 Signal Lights (traficator, foot brake, hand brake)
13 Lamps (Dim Light, High Light)
14 Exhaust System/ Flame Arrestor
15 Fuel & Oil Leakage
16 Untidy Wiring
17 Machine guard are in place and good condition
18 Foot/ Hand Brake
19 Is Push / Pull to operate mechanism functioning smoothly?
20 All moving parts are properly guarded?
21 Battery is properly secured
22 Is blade free from any crack and bends?
23 Is blade firmly intact with front holders and has a lock pin in place?

Attachable Trolley Checklist

1 Is 3rd party inspection certificate for trolley is valid and available?

2 Are the tyres free from wear, tear and worn out tread?
3 Is there correct pressure in tyres?
4 Is adjustable metal post (support) attached with functioning locking
mehcanism?
5 Are stoppers / locks attached at back foldable metal flap of trolley?
6 Do lockable bolts have carter pins?
7 Is main attachable metal support of trolley free from cracks?
8 All lugs and nuts are tight.

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-36

JUMPING COMPACTOR INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A
A Compactor Operator Particular
1 Trained on relevant IOGP-CSSS Trainings.
B Compactor Condition
1 Properly Lubricated and no signs of leakage
Window at rear end of the foot for oil check is clear
2 and visible.
Is vicinity of recoil starter and foot free from dirt and
3 dust?
4 Fuel shut off valve is functioning properly
5 Engine On/ Off switch is functional
Recoil starter handle is free from damage and is not
6 loose
7 Manual choke is available and functional
8 Jack foot is supported by plate for compaction
9 Is throttle lever free from damage
Does opertor know emergency shutdown of
10 compactor by immediately idleing the throttle?
11 Is ramming show hardware properly tightned?
12 Are engine cooling fins cleaned?
13 Clean engine muffler and exhaust port?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-37

PLATE COMPACTOR INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Sr. # Description Good Not GoodN/A Comments

A Compactor Operator Particular
1 Trained on relevant IOGP-CSSS Trainings.
B Compactor Condition
1 Properly Lubricated and no signs of leakage
2 Check oil levels
3 Fuel level and condition of fuel lines.
4 Operator foldable handle condition
Recoil starter handle is free from damage and is not
5 loose
6 Is vicinity of recoil starter free from dirt and dust?
7 Fuel shut off valve is functioning properly
8 Check all the bolts, nuts and belts.
9 Manual choke is available and functional
Plate of compactor is free from damage / cracks and
10 bends and firmly fastned to the base frame?
11 Is throttle lever free from damage
Does opertor know emergency shutdown of
12 compactor by immediately idleing the throttle?
13 Are rotary parts guarded?
14 Are engine cooling fins cleaned?
15 Clean engine muffler and exhaust port?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-38

BACK HOE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A. Vehicle’s & Driver’s Particular

1 Year of Manufacture
2 FTW & Police verification
3 Driver license if required Operator Assessment
4 Trained on relevant IOGP-CSSS Trainings.
B. Vehicle's condition
6 Tires Condition
7 Tread condition
8 Door/ Latches / Locks
9 Seat / Seat belt
10 Mirror
11 Signal Lights (Traficator, Foot Brake, Hand Brake)
12 Reverse Light with audio buzzer
13 Lamps (Dim Light, High Light)
14 Wind Screen
15 Wiper/ Washer
16 Horn
17 Exhaust System/ Flame Arrestor
18 Foot/ Hand Brake
19 Spare Tire & Related Tools
20 Body Panels/ Paint Work
21 Fuel & Oil Leakage
22 Untidy Wiring
23 Machine guard are in place and good condition
24 Fire Extinguisher
25 Operator cabin is it tidy?
26 All moving parts are properly guarded?
27 Body is free from any damages?
28 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-39

DRUM ROLLER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A Vehicle's Driver's Particular

1 Year of Manufacture
2 FTW & Police verification
3
Driver license if required Operator Assessment
certificate.
4 Trained on relevant IOGP-CSSS Trainings.
B Vehicle condition
5 Tires Condition
6 Track condition
7 Door/ Latches / Locks
8 Seat / Seat belt
9 Mirror
10 Signal Lights (Traficator, Foot Brake, Hand Brake)
11 Reverse Light with audio buzzer
12 Lamps (Dim Light, High Light)
13 Wind Screen
14 Wiper/ Washer
15 Horn
16 Exhaust System/ Flame Arrestor
17 Foot/ Hand Brake
18 Spare Tire & Related Tools
19 Body Panels/ Paint Work
20 Fuel & Oil Leakage
21 Untidy Wiring
22 Machine guard are in place and good condition
23 Fire Extinguisher
24 Operator cabin is it tidy?
25 All moving parts are properly guarded?
26 Body is free from any damages?
27 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-40

FRONT END LOADER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A Vehicle's Driver's Particular

1 Year of Manufacture
2 FTW & Police verification
3
Driver license if required Operator Assessment
certificate.
4 Trained on relevant IOGP-CSSS Trainings.
B Vehicle condition
5 Tires Condition
6 Track condition
7 Door/ Latches / Locks
8 Seat / Seat belt
9 Mirror
10 Signal Lights (Traficator, Foot Brake, Hand Brake)
11 Reverse Light with audio buzzer
12 Lamps (Dim Light, High Light)
13 Wind Screen
14 Wiper/ Washer
15 Horn
16 Exhaust System/ Flame Arrestor
17 Foot/ Hand Brake
18 Spare Tire & Related Tools
19 Body Panels/ Paint Work
20 Fuel & Oil Leakage
21 Untidy Wiring
22 Machine guard are in place and good condition
23 Fire Extinguisher
24 Operator cabin is it tidy?
25 All moving parts are properly guarded?
26 Body is free from any damages?
27 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-41

SKID STEER LOADER INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A Vehicle's Driver's Particular

1 Year of Manufacture
2 FTW & Police verification
3
Driver license if required Operator Assessment
certificate.
4 Trained on relevant IOGP-CSSS Trainings.
B Vehicle condition
5 Tires Condition
6 Track condition
7 Door/ Latches / Locks
8 Seat / Seat belt
9 Mirror
10 Signal Lights (Traficator, Foot Brake, Hand Brake)
11 Reverse Light with audio buzzer
12 Lamps (Dim Light, High Light)
13 Wind Screen
14 Wiper/ Washer
15 Horn
16 Exhaust System/ Flame Arrestor
17 Foot/ Hand Brake
18 Spare Tire & Related Tools
19 Body Panels/ Paint Work
20 Fuel & Oil Leakage
21 Untidy Wiring
22 Machine guard are in place and good condition
23 Fire Extinguisher
24 Operator cabin is it tidy?
25 All moving parts are properly guarded?
26 Body is free from any damages?
27 Battery is properly secured

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-42

SKYLIFT INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A Vehicle's Driver's Particular

1 Year of Manufacture
2 FTW & Police verification
3
Driver license if required / Operator Assessment
certificate.
4 Trained on relevant IOGP-CSSS Trainings.
B Vehicle condition
5 Tires Condition
6 Track condition
7 Door/ Latches / Locks
8 Seat / Seat belt
9 Mirror
10 Signal Lights (Traficator, Foot Brake, Hand Brake)
11 Reverse Light with audio buzzer
12 Lamps (Dim Light, High Light)
13 Wind Screen
14 Wiper/ Washer
15 Horn
16 Exhaust System/ Flame Arrestor
17 Foot/ Hand Brake
18 Spare Tire & Related Tools
19 Body Panels/ Paint Work
20 Fuel & Oil Leakage
21 Untidy Wiring
22 Machine guard are in place and good condition
23 Fire Extinguisher
24 Operator cabin is it tidy?
25 All moving parts are properly guarded?
26 Body is free from any damages?
27 Battery is properly secured
28 Emergency Stop Device is functioning well?
29 Emergency lowering function operates properly?
30 Control panel is clean & all buttons/ switches are
31 clearly visible
All switch and(No paint over
mechanical sprayare
guards etc.)
in good
condition and
32 Guardrails andproperly installed
anchor points are in place and
33 good
Work condition
platform is clean, dry and clear of debris
34 Inspect for defects such as cracked welds, fuel leaks,
35 Outriggersleaks,
hydraulic damaged
in place control cables
or functioning. or
Associated
alarms are working.
36 Any loose or missing parts?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-43

AIR COMPRESSOR INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Brand / Make Model
Registration / Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

Equipment Condition

1
Are compressor equipped with pressure gauges
and spring-loaded safety valves?
2
Are compressor provided with a drain valve and
removal or accumulated oil and water?
3
Observed that the receiver is cutting out at the
correct maximum pressure?
4
Is there any external signs or damage to the
receiver or component parts?

5
Are safety devices on compressor air system
check frequently?

6
Check for leaks on receiver, fittings, delivery lines
and coupling?
7 Are air filter installed on the compressor intake?
8 Are all pulley guards in place and secure?
9 Is the motor pulley and flywheel in line?
10 Check crankcase oil and top up if required?
11 Hoses and fittings have no cracks
12 Hose whip arrestor and safety clip installed
13 Drip tray is provided or not?
14 Drip tray’s condition
15 Earth rod’s condition
16 Earthing cable’s condition
17 Terminal’s condition
18 Are the terminals covered?
19 Electrical switch gear provided and functioned?
20 All moving parts are properly guarded?
21 Spark arrestor installed?
22 Any sign of Fuel & Oil Leakage?
23 Machine guard are in place and good condition
24 Battery is properly secured
25 Battery cable in good condition
26 Dynamo brushes cover fitted
27 240 volts socket
28 Industrial Power cable plug and socket
29 ELCB for 240 VAC supply
30 Trial run conducted?
Comments

Inspected by: Verify by:

Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-44

CONFINE SPACE PRE-ENTRY DAILY INSPECTION REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project
Location Activity
Date of Examination Inspection Status PASS Attention required

Day Mon Tue Wed Thus Fri Sat Sun Comments

Sr. # Description
Date

1 Has Permit Applicant raises an entry permit and submitted to Permit Issuer/
Lead Permit Issuer for approval?

2 Permit Applicant and Supervisor has inspected the work-site before

commencing work?
Standby Person (SP) is on-site and equipped with reflector vest, walkie-talkie,
3 whistle.
(i) SP’s Name……………….......................
(ii) SP’s Name…………………………………

4 Emergency Rescue Procedures in place, designated person, BA equipment, and

people trained on standby.

5 Emergency equipment provided on site (i.e. First aid box, eye wash station)

6 Trained fire watchmen with vest is present at the hot work location at all
time during hot work activity.
Workers understand emergency procedures and are provided with appropriate
7 means of communication. Main and alternative muster points are identified
and briefed.

8 Materials,
use.
equipment using in the confined space checked and verified safe to

9 Are all Confined Space work activity have been followed according to ICOP /
Confined Space Procedure?

10 Confined space properly ventilated and adequate lighting should be provided at

all time. (Min 50 lux)
11 Signal Lights (Traficator, Foot Brake, Hand Brake)
12 Personnel gas detector and area gas detector are provided for use on site.
 A Atmospheric gas checked and verified safe prior to entry / works (oxygen rich or deficient & other contaminants listed below)
1 (OXYGEN)-------------------------
2 (LEL) ------------------------------
3 (H2S) ------------------------------
4 (CO2) -----------------------------
5 Free from toxic gas
6 Free from explosive vapours
B. All appropriate PPEs have been checked and made available
1 Safety harness, safety line or lifeline / rescue line

2 Mandatory PPE are used (Clear safety glasses, respiratory protection, ear plug/
muff for high noise area)
3 Air purifying respiratory protective device or Supplied-air respirators.
4 Others as required by Shell:---------------------------
C The below have been checked & isolated where required:
1 Pipelines (water, steam, gas, fuel, etc.)
2 Electrical services identified, isolated and danger tagged. Apply LOTO.
3 Harmful materials (dusts / fumes / gases / chemicals)
4 Isolation / warning & danger sign / lock-out tags in place on any plant
Supervisor Name and Sign

Comments

Verify by:
Inspected by:
Name Name
Position Position
Company Company
Date Date
 SPL-HSSE-CL-45

CONTROL OF SUBSTANCE HAZARDOUS TO HEALTH CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Contractor
Project Location
Date Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A

A Prior to the usage of hazardous substances

Is the suitable personal protective gear issued to workers
1 exposed to hazardous substances?

Has the supervisor briefed the workers on the potential

hazard and the precautions as provided in the SDS? Attach
2 Training
Records
Is there a relevant safety signboard displayed at the location
3 of usage?

B Handling and storage of hazardous substance including training

Are the containers containing the substance properly
1 labeled?
Are the containers properly stored away from flammable
2 source?
Is the hazardous substance under the control of competent
person? If yes indicate name of competent
3
person……………………………………………………………

Are there records of hazardous substance kept for receipt.

Transportation movement or use by employee / worker?
4

Are the employee/ workers trained in safe handling and

5 storage of hazardous substance?
Is there any hazardous substance register established,
6 maintained and updated?
Are the containers of hazardous substance in good
7 condition such as leakage puncture or improperly capped?

Have you maintained good housekeeping at all time at the

8 storage area?
C Disposal of hazardous substance
Is the waste generated being properly disposed of in
1 accordance to local laws?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company
Date Date
 SPL-HSSE-CL-46

LUX LEVEL MONITORING CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Project
Location 3rd Party
Machine # Activity

Sr # Description 1st Time Result 2nd Time Result 3rd Time Result4th Time Result5th Time Result6th Time Result7th Time Result8th Time Result9th Time Result 10th Time Result

1 Monitoring Location
2 Date of Monitoring
3 Lux meter Make/model, Serial No.
4 Time of Monitoring
Weather conditions e.g (clear, hazy, overcast, partly overcast, with sun,
5 etc.)

6 Measure illuminance e.g (electric light or daylight)

7 Illuminance level in monitoring
8 Major illuminace source during monitoring
9 Other illuminance Source

Comments

Record by: Verify By

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-47
ANEMOMETER MONITORING CHECKLIST REVISION: 1
Dated: 09-APR-2020

Terminal Project
Location 3rd Party
Machine # Activity

Sr # Description 1st Time Result 2nd Time Result 3rd Time Result4th Time Result5th Time Result6th Time Result7th Time Result8th Time Result9th Time Result 10th Time Result

1 Monitoring Location
2 Date of Monitoring
3 Anemometer meter Make/model, Serial No.
4 Time of Monitoring

5 Height above ground

6 Measure the wind pressure

7 Measure the flow of the wind
Weather conditions e.g (clear, hazy, overcast, partly overcast, with sun,
8
etc.)
9 Other Source

Comments

Record by: Verify By

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-48
GAS DETECTOR LOG SHEET REVISION: 1
Dated: 09-APR-2020

Terminal Serial #
Project 3rd Party
Location Activity

Sr # CONDUCT BY O2 CO2 LEL H2S DATE TIME SIGN

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
Comments
 HSE-CHECKLIST-49

BORING MACHINE INSPECTION CHECKLIST REVISION: 1

DATED: 17-APR-2020

Terminal Project

Contractor Location Machine #

Sr.# Description Good Not N/A Comments

Good

A. Equipment and Operator

1 Is operator asssessed from SPL and trained on IOGP CSSS.

2 Boring work to be performed under the supervision ?

3 Is Boring equipment 3rd party certified ?

4 Are all the rotating parts of boring machine guarded / covered.

Check condition and operation of associated valves and flexible

5
connection ?
Proper greasing performed for pulleys, Rollers, Bearings and all
6
other rotary parts.
7 Any crack and deformation

Wire rope with valid color code and no sign

8
of defects (Bent, Twist, Bird cage, Broken wire)

9 Are operators / boring workers trained on manual handling.

10 Are all te sharp edges protected / guarded?

B. Electrical water pump and supply connection

1 Electrical cable and DB in good conditon and properly earthed.

2 Are industrial plugs and sockets used.

3 Is GFCI/ELCB is installed and in good condtion

4 Ensure pump protection on rotating parts

Check condition and operation of pump especially for signs of
5
wear, corrosion or demage ?
Adequeat watar supply and check condition/operation of
6
connection between water pump and boring motor.
 7 Check and clean exposed surface, sump and pump hosing.

8 Installed pipe and hose properly tie off

9 Are all te sharp edges protected / guarded?

10 Are there any signs of wear and tear on wheels?

11 Ensure the workers/staff wearing mandatory PPEs

12 Have boring pipes locking threads in good condition.

13 Is there a key to lock pipes tightly?

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
Comments
y:
 SPL-HSSE-CL-50

CONCRETE VIBRATOR INSPECTION CHECKLIST REVISION: 0

Dated: 28-APR-2020

Terminal Project
Contractor Location
3rd Party Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A
A Vibrator Operator Particular
1 Trained on relevant IOGP-CSSS Trainings.
2 Is operator asssessed from SPL ?
3 Does opertor know emergency shutdown of vibrator by
immediately idleing the throttle?
B Diesel Engine Condition
1 Any sign of Fuel & Oil Leakage?
2 Are all the rotating parts of vibrator machine guarded /
covered.
3 Body is free from any damages?
4 Clean engine muffler and exhaust port?
5 Earth cable’s condition
C Concrete Vibrator Condition
1 Is concrete vibrator equipment 3rd party certified ?
2 Concrete vibrator work to be performed under the
supervision ?
3 Are all the hot surface are properly covered on vibrator?
4 Engine On/ Off switch is functional
5 Recoil starter handle is free from damage and is not loose
6 Manual choke is available and functional
7 Is throttle lever free from damage
8 Place the main body on flat surface
9 Any crack and deformation
D Head Cap / pokerhead and Hose Condition
1 Vibrator head with valid color code and no sign
of defects (Bent, corrosion, crack)
2 Do not lubricate the pokerhead
3 Is pokerhead clean and free from dirt ?
4 Is center hose joint and shaft jointnd properly fixed with
machine?
5 Trial run conducted?

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 SPL-HSSE-CL-57

AUTOMATIC WELDING MACHINE INSPECTION CHECKLIST REVISION: 1

Dated: 09-APR-2020

Terminal Project
Make/Brand Modal
Reg/Serial No 3rd party
Date of Examination Inspection Status PASS Attention required

Not
Sr. # Description Good good N/A Comments
A Equipment's Condition
1 Drip tray is provided or not?
2 Drip tray's condition
3 Polarity marked
4 All moving parts are properly guarded?
5 Welding cable’s condition
6 Welding holder
7 Earth rod’s condition
8 Earthing cable’s condition
9 Terminal’s condition
10 Any sign of Fuel & Oil Leakage?
11 Spark arrestor installed?
12 Battery is properly secured
13 Dynamo brushes cover fitted
14 Any abnormal sound?
15 Excessive vibration?
16 Body is free from any damages?
17 Towing frame
18 Are the terminals covered?
19 Electrical switch gear provided and functioned?
20 Machine guard are in place and good condition
21 Operating volts sockets are available (240 volts)
22 Industrial Power cable plug and socket
23 ELCB available in supply DB.
24 Trial run conducted?
25 Voltmeter/ Ammeter
26 Overall body condition

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
 HSE-CHECKLIST-51

SCBA INSPECTION CHECKLIST REVISION: 0

DATED: 28-APR-2020

Terminal Project

Contractor Make/Model 3rd party

Sr.# Description Good Not N/A Comments

Good

A. Facepiece

1 Overall assembly: free from deterioration, dirt and damage

2 O ring is properly install and free from dirt.

3 Regulator connection properly function and free from demage

Rubber Components: free from deformation, wear, damage, and

4
cracks
Lens Frame Retainer: present, correctly installed and good
5
condition
B. Backplate and Harness Assembly
Harness and Backframe assemblies: free from cuts, tears and
1
damage.
2 Fastening assemblies: operate properly.

3 Cylinder Retention System: functional and undamaged.

4 Straps: extend fully.

C. Cylinder

1 Guage not damaged

2 Cylinder is fully charged

3 Cylinder: cracks, dents, or damage

4 Composite cylinder: cuts, gouges, or damage

5 Valve hand wheel properly working

D. Hoses
 1 Free of cuts, abrasion, or damage

2 External fittings: functional and undamaged

3 Demand valve and their controll button in good condition

4 Fittings are tight and are not leakage

5 Coupling nipple seal; present and undamaged

Comments:

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date
HSE-CHECKLIST-51

REVISION: 0

DATED: 28-APR-2020

3rd party

Comments
erify by:
 SPL-HSSE-CL-52

FORKLIFT INSPECTION CHECKLIST REVISION: 0

Dated: 28-APR-2020

Terminal Project
Contractor 3rd Party
Make/Serial # Inspection Status PASS Attention required

Not Comments
Sr. # Description Good Good N/A
Fluid level, leaks, (engine, hydraulic, transmission, coolant,
1 battery, fuel)
Air Cleaner
2 - Check when is the last change of air filter
Seat Belt
3 - In good condition
Light, Horn and Revolving warning light
4 - Tested before use
Brake (Travel, Parking)
5 - Tested before use
Capacity for labels and function
6 - SWL is labelled
Warning label
7 - Reverse alarm
Tire-condition, pressure, lug nut
8 - Tire in good condition
-Fork Crack
Hydraulic pressure
10 - No sign of visible crack, bent or twisted at tip point
Overhead Protection Guard
11 - Installed
Fire Extinguisher
12 - Provided and in good condition

Comments

Inspected by: Verify by:

Name Name

Position Position

Company Company

Date Date