Delta Company Ltd.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety Representatives Monthly Inspection Report

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

• Name of Inspector

  Select Aju Thomas Amal Muraly Sindarth Khrisnan Michael Dave Herrero Allan Rey Rizalde Ryan Cabarlo Bryle Cyril Besinga Charles Subong Archie Pulmano Darwin Llantada Charlie Villanueva Rainerio Bacon Bahar Ali Muhammad Jaafar Lagayan

  • Aju Thomas
  • Amal Muraly
  • Sindarth Khrisnan
  • Michael Dave Herrero
  • Allan Rey Rizalde
  • Ryan Cabarlo
  • Bryle Cyril Besinga
  • Charles Subong
  • Archie Pulmano
  • Darwin Llantada
  • Charlie Villanueva
  • Rainerio Bacon
  • Bahar Ali Muhammad
  • Jaafar Lagayan

• Select date

  Date

STANDARD

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

  Yes

  No

  Comments

  High Risk

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

  Yes

  No

  Comments

  High Risk

• 1.2 Good lighting, natural or artificial?

  Yes

  No

  Comments

  High Risk

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

  Yes

  No

  Comments

  High Risk

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

  Yes

  No

  N/A

• 1.5 Pollution of air, water and ground

  Yes

  No

  Comments

  High Risk

• 1.5 Hazardous waste disposal in responsible manner.

  Yes

  No

  N/A

• 1.6 Areas demarcated.

  Yes

  No

  Comments

  High Risk

• 1.7 Stacking-stable, neat and safe.

  Yes

  No

  Comments

  High Risk

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

  Yes

  No

  Comments

  High Risk

• 1.9 Scrap and refuse bins enough and correctly placed.

  Yes

  No

  Comments

  High Risk

• 1.10 Color coding of pipes and plant in order.

  Yes

  No

  Comments

  High Risk

• 2.1 Machine guards in place

  Yes

  No

  Comments

  High Risk

• 2.2 All equipment/ hazards areas can be isolated / locked out and procedure displayed where applicable.

  Yes

  No

  Comments

  High Risk

• 2.3 Switches, isolator and valves labeled, outlets marked.

  Yes

  No

  Comments

  High Risk

• 2.4 Ladders, scaffolds and hand rails in good condition.

  Yes

  No

  Comments

  High Risk

• 2.5 Lifting gear in good condition.

  Yes

  No

  Comments

  High Risk

• 2.6 Gas cylinders and pressure vessels in order.

  Yes

  No

  Comments

  High Risk

• 2.7 Hazardous substances handled / stored using correct procedures.

  Yes

  No

  Comments

  High Risk

• 2.10 Portable electric equipment in good condition. No cords over floor.

  Yes

  No

  Comments

  High Risk

• 2.12 General electrical installations / flameproof Equipment is safe.

  Yes

  No

  Comments

  High Risk

• 2.13 Hand tools in good condition and properly stored.

  Yes

  No

  Comments

  High Risk

• 2.14 Ergonomics: conditions safe and confortable.

  Yes

  No

  Comments

  High Risk

• 2.18 Appropriate protective clothing / equipment available, properly utilized and in good condition.

  Yes

  No

  Comments

  High Risk

• 2.24 Safety signs and notices in place.

  Yes

  No

  Comments

  High Risk

• 3.1 Fire extinguishing equipment maintained and inspected.

  Yes

  No

  Comments

  High Risk

• 3.2 Location of fire extinguishers clearly visible, demarcated and unobstructed.

  Yes

  No

  Comments

  High Risk

• 3.3 Fire extinguishers in position.

  Yes

  No

  Comments

  High Risk

• 3.4 Flammable materials stored correctly.

  Yes

  No

  Comments

  High Risk

• 3.5 Alarm system working, employees aware of system.

  Yes

  No

  Comments

  High Risk

• 3.8 Emergency plan available and understood by staff.

  Yes

  No

  Comments

  High Risk

• 4.2 Injuries/accidents which occurred since previous inspection.

  Yes

  No

  Comments

  High Risk

• 5.6 Name of First Aiders displayed.

  Yes

  No

  Comments

  High Risk

• 5.19 Safe Work Procedures available and used.

  Yes

  No

  Comments

  High Risk

General

Other Items not mentioned above:

• Other item

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

• Date

  Date