Information
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检查員Inspect Name
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員工號碼staff number
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日期 Date:
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檢查内容Inspection (圈出選擇項 circle the choice)
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Maintenance order/Contractor name
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檢查地點Inspection Location
Personal Protective Equipment & Work Behaviors 個人保護裝置及工作行為
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1.1 Wearing appropriate Personal Protective Equipment (PPE) 配戴合適之個人保護装備
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1.2 Strictly follow the safety warning signage 嚴格遵守安全警告標誌
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1.3 Wearing high visibility reflective jackets while working on road 路邊工作需穿著反光衣
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1.4 Safety harness being used property when working at a level from a height of 2 meters or above 當工作高度等於或高過2米時，有適當地使用安全防墮裝置。
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1.5 Proper loading / placement/ lifting 正確的装载/放置/提舉
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1.6 No drug or alcohol in work 工作中没有服用藥物和饮酒
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1.7 Using the safety devices 使用合適安全装置
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1.8 Proper work technique, e.g.: equipment to be fixed properly before drilling or cutting 正確的工作技巧, 例如鑽孔或切割時有固定好機器
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1.9 Smoking at the designated smoking area 在指定吸煙區吸煙
Environment 環境
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2.1 Area is good condition (light, electric and ventilation function normally) 工作環境良好(照明, 電源及通风正常)
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2.2 Exits and walkways are clear of obstructions 出入口及走道沒有放置障礙物
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2.3 Floor areas are clean, dry, and free from slip/trip hazards 地板乾淨, 乾燥, 並沒有滑倒或絆倒的危險
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2.4 Standard working platform in use while working at a level liable falling from a height of 2 meters or above 在易於下堕之工作環境(高度等於或高於2米), 使用合格之工作平台
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2.5 Protective fencing and toe-board provided at open edge 在邊緣缺口位置, 有使用保護圍欄及踏腳板装置
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2.6 Isolate the worksite by barriers 使用鐵馬隔離施工工地
Emergency Response 緊急措施
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3.1 Fire extinguisher is accessible and valid 易取得滅火器及其仍有效
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3.2 Eye-wash is functional 沖眼器運作正常
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3.3 Exit signs are in place and functional 出口指示牌清晰, 並操作正常
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3.4 Fire door kept closed 防煙門常關
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3.5 Evacuation route available 現場備有逃生路線圖
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3.6 Emergency number kept updated and available 設有緊急聯絡電話並保持最新
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3.7 Names and contacts of first aiders available 設有急救員名單及其聯絡方式
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3.8 First aid boxes available 現場設有急救箱
Hazard Material 危害物質
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4.1 All containers/Gas cylinders are clearly labeled with contents, hazards warnings and the precautions to be taken 所有容器/氣樽清楚標明内容物, 危害標誌及預防措施
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4.2 All chemical containers capped and sealed 所有化學品容器均密封
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4.3 Gas cylinder valve closed when cylinder not in use 當不使用時, 氣樽的閥門保持常關
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4.4 Gas cylinders secured to wall, trolley or other permanent fixture in an upright position by bracket or chain 使用架或鐵鏈把氣樽直立地稳固於牆或推車上
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4.5 Hazard material stored in compatible containers at the designed area 有害之物料需储存於合適之容器, 並存放於指定區域
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4.6 Fuel cylinders separated from oxidizing cylinders 内含可燃物之氣樽需與氧氣樽分別存放
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4.7 Empty cylinders separated from full ones and clearly identified 空樽與满樽分開擺放, 並標識清楚
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4.8 Cylinders stored at a minimun of three meters from the ignition source. 氣樽的儲放至少要離開可燃物3米
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4.9 Flash Back Arrestor in place on oxy-acetylene cylinders or the regulator functioning properly. 氧乙炔(風煤樽)有安装防止回火裝置, 或該等装置操作正常
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4.10 Spill kits are available and maintained 設有洩漏控制及狀況良好
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4.11 MSDS available for all chemicals 所有化學品均設有MSDS
Machinery and equipment 機械設備
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5.1 Equipment in good condition, without any oil/ water leakage or spillage 設備儀器狀況良好, 沒有油/水的洩漏
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5.2 Equipment in good condition, without any damage or broken parts. 設備儀器狀況良好, 沒有任何損壞的部件
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5.3 Equipment under maintenance identified clearly (contractor information or working permit) and protected by appropriate safety measure 維修中的設備有標示清楚(如承建商資料或工作許可證) 及使用合適之安全保護措施
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5.4 Information on Lockout/Tagout label (LOTO) available and clear LOTO的標籤資料内容清晰可讀
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5.5 Compliance with the LOTO procedure 符合LOTO的程序
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5.6 Equipment is good condition, not rusted seriously and not in imminent danger 設備儀器狀況良好, 沒有嚴重鏽, 不存在即時危險
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5.7 Socket in good condition and not overloaded 插座狀況良好, 並沒有超出负荷
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5.8 Standard electric appliance in use or installation, following items not in use non-weather proof plug and socket, non-industrial wire, non-insulated transformer, wire connection and without earthing 使用合格之電氣裝置，沒有使用以下不合格裝置, 包括：非防水之插座插頭、非工業級別之電線、非絕緣之變壓器/電線之接駁以及沒有接地。
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5.9 Proper fall arrestor devices provided for lifting operations at open edge 在起重操作過程中, 於邊缘缺口位置, 有提供防墮装置
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5.10 Load not beyond the crane's safe working load 吊物沒有超過起重機負荷
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5.11 Safety latch fixed on hook of crane.<br>15. 起重機之吊鉤有安裝安全彈簧鎖。
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5.12 The crane securely anchored on the ground 起重機必須安全地鞏固於地面
Road works 路邊工程
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6.1 Safe passage for pedestrians and vehicles ensured 確保行人及車輛安全通行
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6.2 Safety control by cones, flashlights, barriers and warning signals 使用雪糕筒、閃燈、圍欄及警告標誌
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6.3 When excavation, proper supports should be used to prevent the collapse od mud 在進行挖掘時, 需使用適合的支撐架以防止塌泥
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6.4 Providing proper and safe acess and egress 提供適合當之安全進出口
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Other findings (please specify) 其他發現(請具體註明)：
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Sign by inspectors 檢查人員簽名：
