ALSTOM Grid EHS - HSV checklist and report 阿尔斯通电网事业部环境、健康、安全-领导层安全检查（检查表及检查报告）

• Prepared by 编制单位

HIERARCHICAL SAFETY VISIT

• Name of site 检查地点

• Type of site

  industrial

  Field / construction

  office
• Area visited
  Address

• Conducted on 检查日期及时间

  Date

• USE CHECKLIST? 是否使用本检查表

  Yes

  No

  N/A

GENERAL CONDITIONS 一般情况

• Is the site tidy and clean? 现场是否整洁干净？

  Yes

  No

  N/A

• Are material and scrap properly stored? 材料以及废料等是否妥善存放？

  Yes

  No

  N/A

• Is EHS information properly posted ? 是否张贴出EHS信息？

  Yes

  No

  N/A

• Have you done your EHS induction ? 是否做过EHS入职培训？

  Yes

  No

  N/A

• Explain why

PERSONAL PROTECTIVE EQUIPMENT 个人劳保用品（PPE）

• Safety boots? 是否穿了安全鞋？

  Safe

  At Risk

  N/A

• Safety hat? 是否带好安全帽

  Safe

  At Risk

  N/A

• Ear protection? 是否佩戴了耳塞等听力保护设备？

  Safe

  At Risk

  N/A

• High visibility vest or straps? 是否穿了高亮度反光背心或反光条？

  Safe

  At Risk

  N/A

• Safety glasses, face shield? 是否佩戴了安全眼镜，面罩？

  Safe

  At Risk

  N/A

• No gloves for rotating hand tools? 在使用手持式旋转工具时，是否未戴手套？

  Safe

  At Risk

  N/A

• Respiratory protection? 是否佩戴了口罩等呼吸保护装置？

  Safe

  At Risk

  N/A

• Fire resistant garments 是否穿戴了阻火服？

  Safe

  At Risk

  N/A

* CONFINED SPACES 受限空间

• Applicable ? 是否适用？

  Yes

  No

  N/A

• Are competency & training checked? 是否检查了资质能力及培训情况？

  Yes

  No

  N/A

• Air test done? 是否进行了气体监测？

  Yes

  No

  N/A

• Was the permit delivered? 是否办理了许可证？

  Yes

  No

  N/A

• Are confined spaces clearly identified? 现场受限空间警示标示是否清晰可认？

  Yes

  No

  N/A

• Is there a keeper dedicated to the confined space? 是否指派了专门的受限空间监护人？

  Yes

  No

  N/A

• Emergency Arrangements checked ? 是否检查了应急安排？

  Yes

  No

  N/A

* LOCK OUT TAG OUT 上锁挂牌

• Applicable? 是否适用？

  Yes

  No

  N/A

• LOTO procedure available? 上锁挂牌程序是否适用？

  Yes

  No

  N/A

• One lock̀, one key, one person? 是否执行了专人专锁专钥匙？

  Yes

  No

  N/A

• Are employees trained to LOTO? 员工是否经过上锁挂牌培训？

  Yes

  No

  N/A

• Absence of residual Energy is checked before work? 作业前是否验证已消除了残余能量？

  Yes

  No

  N/A

• Is LOTO done on all energized equipment? 所有带能设备是否均已上锁挂牌？

  Yes

  No

  N/A

* ELECTRICAL SAFETY 电气安全

• Applicable? 是否适用？

  Yes

  No

  N/A

• Are competency & training checked? 是否检查了资质能力及培训情况？

  Yes

  No

  N/A

• Is equipment dead prior to work? 作业前设备是否断电？

  Yes

  No

  N/A

• Are electrical panels tagged? 电气面板是否张贴标签？

  Yes

  No

  N/A

• Is there work live on Voltage? 带电作业是否禁止

  Yes

  No

  N/A

• Are appropriate tools available? 是否可获取适当的工具？

  Yes

  No

  N/A

• Are safe working distance respected? 是否遵守安全工作距离？

  Yes

  No

  N/A

• Are appropriate PPE available? 是否可获得适当的劳保用品？

  Yes

  No

  N/A

* MACHINE SAFETY 机械安全

• Applicable? 是否适用？

  Yes

  No

  N/A

• Are competency and training checked? 是否检查了资质能力及培训情况？

  Yes

  No

  N/A

• Are all guards in place & checked? 所有的安全防护装置是否完好并已经过检查确认？

  Yes

  No

  N/A

• Are electric tools inspected & conform? 电动工具是否检查且符合要求？

  Yes

  No

  N/A

• Are equipment unplugged when changing tools? 更换工具前是否拔掉了设备插头？

  Yes

  No

  N/A

• Are extension cords protected or suspended? 电缆软线是否得到了保护（不被碾压）或者悬挂架空？

  Yes

  No

  N/A

* WORKING AT HEIGHT 高处作业

• Applicable? 是否适用？

  Yes

  No

  N/A

• Are competency & training checked? 是否检查了资质能力及培训情况？

  Yes

  No

  N/A

• Fall arrest equipments inspected? 防坠落设备是否已经过检查？

  Yes

  No

  N/A

• Lifting equipments inspected? 吊装设备：吊索具是否检查合格

  Yes

  No

  N/A

• Scaffolds inspected and tagged? 脚手架是否已经检查并张贴了检查合格与否状态标签？

  Yes

  No

  N/A

• Temporary floor/roof openings protected? 是否对地面及屋顶的临时孔洞进行了防护？

  Yes

  No

  N/A

• Ladders attached and secured? 便携式直梯是否搭靠牢固？

  Yes

  No

  N/A

• Full body harness & chinstrap worn? 是否穿戴好全身型安全带，系好下颌带？

  Yes

  No

  N/A

• Fall arrest equipments listed on a register? 防坠落设备是否列清单登记记录？

  Yes

  No

  N/A

• Was the permit delivered? 是否办理了许可证？

  Yes

  No

  N/A

* EXCAVATION AND TRENCHES 基坑与壕沟

• Applicable? 是否适用

  Yes

  No

  N/A

• Permit delivered for excavation > or = 1,2 meters? 深度大于或等于1-2米的挖掘作业是否办理了许可证？

  Yes

  No

  N/A

• Are all excavations inspected daily? 是否每天检查所有的挖掘作业？

  Yes

  No

  N/A

• Rigid barriers less than 1,5 from edges for excavation > or = 1,2 meters? 深度大于或等于1-2米的挖掘作业在距其边缘1.5米范围内是否设立了刚性栅栏？

  Yes

  No

  N/A

• Slopes according to construction code? 是否按施工规范进行了放坡？

  Yes

  No

  N/A

• Trenches identified and protected? 壕沟是否有警示标志并有防坠落的保护措施？

  Yes

  No

  N/A

• Vehicle parking 3 meters from hedge 车辆停放在距基坑壕沟临边3m外？

  Yes

  No

  N/A

• Protective system against fall of the excavation? 基坑壕沟是否有放坠落保护系统？

  Yes

  No

  N/A

• Excavated material > or = 1 meter from hedge? 挖掘材料/弃土是否堆放在离临边1m以外？

  Yes

  No

  N/A

• Ladders or exits every 15 meters? 每15米是否有梯子或出口？

  Yes

  No

  N/A

* LIFTING OPERATIONS 吊装

• Applicable? 是否适用？

  Yes

  No

  N/A

• Lifting permit to work issued? 是否发布了吊装许可？

  Yes

  No

  N/A

• Lifting plan available? 吊装计划是否可行？

  Yes

  No

  N/A

• Are competency and training checked ? Respected? 是否检查了资质能力及培训情况？是否得到遵守？

  Yes

  No

  N/A

• Are lifting equipment in register? 吊装设备是否进行了登记记录？

  Yes

  No

  N/A

• Safety zone established under the lifting area? 吊装区域内是否设立了安全区？

  Yes

  No

  N/A

• Are lifting equipment inspected and conform? 吊装设备是否经过检查且符合要求？

  Yes

  No

  N/A

* VEHICULE MOVEMENTS 车辆移动

• Applicable? 是否适用？

  Yes

  No

  N/A

• Are vehicules tidy and clean? 车辆是否干净整洁？

  Yes

  No

  N/A

• Is traffic signing properly installed? 是否设立了适当的交通标志？

  Yes

  No

  N/A

• Parking Area & rules established? 是否确立了停车区及规则？

  Yes

  No

  N/A

• Are competency and training checked ? Respected? 是否检查了资质能力及培训？是否遵守？

  Yes

  No

  N/A

• Forklifts with fork lowered, boom tilted back and seat belt fastened? 叉车的叉齿是否放低，门架是否后倾，安全带是否系紧？

  Yes

  No

  N/A

• Circulation of mobile equipment and pedestrians seperated and clearly signalized? 移动设备及行人是否实现了人车分流并有醒目标志？

  Yes

  No

  N/A

• Is a safe distance of 2 meters respected between pedestrians and vehicles? 行人与车辆间是否保持了2m的安全距离？

  Yes

  No

  N/A

ENVIRONMENT 环境

• Applicable? 是否适用？

  Yes

  No

  N/A

• Are MSDS available? 是否可获取化学品安全说明书？

  Yes

  No

  N/A

• Are flammable segregated from oxidizing material? 易燃品与氧化剂是否隔离存放？

  Yes

  No

  N/A

• Are compressed gases secured? 压缩气瓶是否存放牢固？

  Yes

  No

  N/A

• Are compressed gases stored in designated area? 压缩气体是否存放在指定区域？

  Yes

  No

  N/A

• Is oil store in designated area? 油料是否存放在指定区域？

  Yes

  No

  N/A

FIRST AID, EMERGENCY AND ENVIRONMENT PREPAREDNESS 急救，紧急及环境准备

• First aid kit available and inspected? 急救箱是否易获取且已检查过？

  Yes

  No

  N/A

• Is evacuation plan & gathering point communicated ? 是否疏散计划及紧急集合点是否已沟通过？

  Yes

  No

  N/A

• Is First aiders list posted ? 是否张贴了救援人员清单？

  Yes

  No

  N/A

• As there and inspected fire extinguisher? 是否配有灭火器且经过检查？

  Yes

  No

  N/A

• Are spill kits available and inspected? 是否有化学品溢漏应急箱且经过检查？

  Yes

  No

  N/A

SAFETY OBSERVATION REPORT 安全观察报告总结

• Positive observations 好的方面

• Add media

  Media

• Aspects to improve or Deviations 待改善/偏差方面

• Add media

  Media

• Action and person in charge 行动项、责任人

• Date of completion 完成日期

  Date

• Satisfaction level of the visit (very poor; 10 excellent)

• Signature 签名

  Sign