CP07-HO Daily Site HSE Inspection Report (Ver 1.2)

• Document No.

• Conducted on

  Date

• Prepared by

• Contractor

LIFE CRITICAL

1. Work Platform & Scaffolding

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

2. Electrical

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

3. Fire Prevention & Protection

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

4. Confined Spaces

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

5. Plant & Equipment

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

6. Working at Height

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

7. Lifting Operations

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

8. Excavations & Trenching

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

NON-LIFE CRITICAL

HEALTH & WELFARE

1. Work Area

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

2. Trash Containers / Disposal

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

3. Rest Areas

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

4. Drinking Water

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

5. Toilets / Washing Facilities

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

6. First Aiders / First Aid Kits

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

WORK ENVIRONMENT

1. Heat Stress

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

2. Noise

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

3. Illumination

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

4. Dust Suppression / Control

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

5. Object / Line of Fire Hazards

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

6. Access / Egress

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

7. Traffic Management / Barricades

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

8. Safety & Road Signage

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

9. Housekeeping

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

EQUIPMENT & PROCEDURES

1. Personal Protective Equipment - PPE

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

2. Hand & Power Tools

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

3. Management & Supervision

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

4. Control Of Substances Hazardous to Health - COSHH

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

5. People (Behaviors)

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

6. Method Statements / Risk Assessments

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

7. Permit To Work - PTW

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

8. Emergency Drills / Response

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

9. Gas Tanks

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

10. Ladders

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

11. Environmental

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

OTHER

Observation 01

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

Observation 02

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

Observation 03

• Safe

  At Risk

  N/A

• Has the issue been resolved immediately?

  Yes

  No

• ISSUE IS CLOSE

• Target date of closure

  Date

SIGN OFF

• I confirm that I am fully aware and understand every detail of the contents in this inspection report.

• Contractor Representative

  Sign

• Dorsch HSE Representative

  Sign

• Other Comments

VERIFICATION & CLOSEOUT

• Contractor Representative
  
  Signature
  
  Date
  
  Comments

• Dorsch HSE Representative
  
  Signature
  
  Date
  
  Comments