Delta Company Ltd.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Main Contractor should Provide

• Do you have an Approved Loss Prevention Program

  Yes

  No

• Do you have an Approved Safety Representative by NG?

  Yes

  No

• Does the Site has a Safety Policy?

  Yes

  No

• Does Safety Representative does possess?

  Select NEBOSH IGC Risk Assessment Training No Training

  • NEBOSH IGC
  • Risk Assessment Training
  • No Training

• Does Engineers and Foreman have SEC Badge

  Yes

  No

• Does the Project Site conduct the following?

  Select Risk Assessment Procedure Method Statement

  • Risk Assessment
  • Procedure
  • Method Statement

• Safe Work Procedures

  Yes

  No

• Safety Induction

  Yes

  No

• Daily Good Housekeeping

  Yes

  No

• Medical Surveillance

  Yes

  No

• Work Permit issuer/receiver trained?

  Yes

  No

• LOTO Supervisor certified

  Yes

  No

• Daily Safety Inspection report to send for NG

  Yes

  No

• Weekly and Monthly Statistics Report

  Yes

  No

• Emergency Plan and Fire Evacuation Drill

  Yes

  No

• 5% First Aiders and Facilities

  Yes

  No

• 5% of Firefighting training or Training conducted?

  Yes

  No

• Toolbox talks/Poster Program/HSE communication

  Yes

  No

• Internal Audits

  Yes

  No

• Certified scaffolder inspector

  Yes

  No

• Trained Storekeeper

  Yes

  No

• Safety Committees

  Yes

  No

Signature of Safety Representative

• Safety officer Signature

  Sign

• Date:

  Date