Title Page

  • Site conducted

  • Prepared by

  • Location
  • Date and Time

Evaluation guideline: in each item if no any finding --> good, 1 finding--> fair, >1 finding--> bad.

Check List

PPE-Write Observations

  • Are employees wearing safety glasses/ear plugs<br>0 violation--> good<br>1 violation--> fair<br>>1 violation--> bad

  • - Were workers follow regulation for PPE?

  • - Are PPEs is good condition?

  • -Are clothes or gloves suitable for the work?

5S-Write Observations

  • - Shop floor clean or dirty? Any thing blocked walkway? Workplace had been cleaned or not?

  • - Was garbage collected and put into garbage tank? Is garbage tank overfilled? Was garbage inside classified or not (ex: oil rag, paper, wire, flux, grinding disc… was mix up with normal waste…)

  • - Other issue included arrangement/ storage at workshop for machine, tool, wip, consumption/ material and cleanliness of workshop (wall, ceiling, rest place, smoking place, toilet…)

  • Is area Sorting/Set in Order/Shining<br>- Any unnecessary things are put in work<br> place?<br> - Everything's orderly?<br> - Shop floor clean?

Fire Safety-Write Observations

  • - Any leak at valves, connection parts for gas/ oxygen pipe or hose. Are valves closed or can be closed when not working (any rust or broken)? Is hose in good or bad condition, any thing run through the hose? Is area using gas/ oxygen well-ventilated or not? Gas cabinet is suitable to use or not? Any label for indication or not, is label right for type of gas (LPG/ Oxygen/ CO2)?

  • - Fence/ warning sign in good condition or not? Door closed or not? How is inside cleanliness?

  • - Any cigarrete end at workplace (other than smoking area)? Is the smoking area suitable? Any other issue at smoking area?

  • - Is fire fighting equipment in good condition? When was it last check (within 1 month from patrol date)? Is there any equipment used for other purpose?

Electrical safety-Write Observations

  • - Check isolation cover, connecting part, cleanliness. Condition of using area (wet floor/ water…); Is the cable/ plug in danger of overload, any cover for switcher/ plug?

  • - Cabinet door close or not, anything strange inside? Cabinet have inside cover or not, inside is dirty or clean.

  • - Outside: fence, door condition, door locked or not; Inside: any garbage inside or issue for tree/ grass.

  • - Machine is grounded or not, in good or bad condition, connecting method is right or not (wrong connection include connect with workshop column, crane rail, gas pipe)

  • - Any machine running without operator? Any issue with lighting system

Machine/Equipment-Write Observations

  • - Check identify/ calibration card if possible. Any issue with date?

  • 'Lifting equipment (jig, chain, cable, shackle) should have have identify and alow to use tag. Are they in good condition or not, any strange sign?

  • - Is rotation part covered or not?<br>- Safeguard part of machine is working or not? Any machine part is unstable or ready to fall out (machine cover/ body/ handle, chair, moving part, additional part…)<br>- Machine condition: dirty or clean, any missing part, any oil leak or strange attachment, condition of remote or control board<br>- Work platform/ ladder is good or not, suitable or not (too high, too narrow, too far...)

  • - Check for valve's indicator (working or not, good or bad condition)

  • - Any rust or contorted part? Any strange thing? Condition of surround area: put on steel floor/ easy being run over or knock by other equipment, have electric cable running over…

  • - Area has people working on high (repair crane…) or repair electric should have warning sign.

  • Any strange issue detected: strange noise/ smell/ smoke, machine tilt over, worker's working position or working pose

Chemical Control-Write Observations

  • All flammable chemicals located inside flammable cabinets and labeled correctly.

  • Are all not-in-use chemicals stored appropriately and labeled accordingly.

  • No unlabeled chemicals allowed. All flammable chemicals in flammable cabinets.

Other Items-Write Observations

  • Workshop condition (door, wall, floor, ceiling)- Broken door/ wall/ ceiling; rain water coming inside workshop; too hot, too windy, lack of light…

  • Road, yard condition- Cleanliness, flooded, sink or sag down, indication line on road

  • Detected human behavior - Any strange behavior, was the worker assigned for the work (especially for crane/ forklif operator), any sign of ill health or lack of concentration <br>

  • Sub-contractor, delivery man- Any issue with delivery man? Sub-contractors have safety card/ work permit or not, are they in the right workplace <br>

  • Other issue- <br>Issue with stopper/ support leg, wood for product storing in yard<br>- Issue with wip at workshop (store on shop floor or on working line)<br>- Violation for safety regulation.


  • Any improvement idea and suggetion for safety?

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