Delta Company Ltd.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Managers/Supervisors-Building and Floors Monthly Inspection

Location

• Location

  Select Al Maather Al Hazem Al Waha Hindawiah Khuzam 69 KV Dammam Al Khatam Al Lith Bawat Murjan Taima Tabuk

  • Al Maather
  • Al Hazem
  • Al Waha
  • Hindawiah
  • Khuzam
  • 69 KV Dammam
  • Al Khatam
  • Al Lith
  • Bawat
  • Murjan
  • Taima Tabuk

• Select date

  Date

STANDARD

• 1.1 Structure, furniture, and equipment, in good condition and safe condition

  Yes

  No

  Comments

  Major Threat

• 1.1 Floors- clean and free of dirt or other dangers

  Yes

  No

  Comments

  Major Threat

• 1.2 Good lighting, natural or artificial?

  Yes

  No

  Comments

  Major Threat

• 1.4 Rest room facilities-toilet,wash basins, clean and hygienic

  Yes

  No

  Comments

  Major Threat

• 1.4 Kitchen lunchroom clean. No food in unauthorized areas.

  Yes

  No

  Comments

  Major Threat

• 1.5 Pollution of air, water and ground

  Yes

  No

  Comments

  Major Threat

• 1.5 Hazardous waste disposal in responsible manner.

  Yes

  No

  Comments

  Major Threat

• 1.6 Areas demarcated.

  Yes

  No

  Comments

  Major Threat

• 1.7 Stacking-stable, neat and safe.

  Yes

  No

  Comments

  Major Threat

• 1.8 Areas inside and outside of building are neat and tidy. General housekeeping.

  Yes

  No

  Comments

  Major Threat

• 1.9 Scrap and refuse bins enough and correctly placed.

  Yes

  No

  Comments

  Major Threat

• 1.10 Color coding of pipes and plant in order.

  Yes

  No

  Comments

  Major Threat

General

Other Items not mentioned above:

• Other items

Report by Inspector:

• Does the report contain any major threat to the safety of any Employee?

  Yes

  No

  N/A

• If yes, complete the following:

Report by Inspector

• The matter was reported as soon as practical?

  Select In Writing Verbally

  • In Writing
  • Verbally

• Signature of Inspector:

  Sign

• To

  Select Manager of the Area Site Engineer Project Manager

  • Manager of the Area
  • Site Engineer
  • Project Manager

• Date Reported:

  Date

• This Safety Information Report must be discussed with Manager/Supervisor as soon as possible.
  I have reviewed the inspection report and have been taken action on correcting the deviations noted.

• Signature of Supervisor/Manager:

  Sign

• Select date

  Date