Title Page

  • Report No.

  • Person In Charge

  • Client / Site

  • Conducted on

  • Prepared by

  • Location


  • Definition-
    High: High risk/priority which requires immediate action to solve the issue.
    Moderate: Moderate risk/priority which requires a planned approach to solve the issue.
    Safe: Safe and maintain the good practices.
    None: Not Applicable or Not Available during the inspection.


  • 1.1 Are the forklifts/reach trucks in good working condition (i.e. tyre, lamp, horn, chain, fork, reverse buzzer, signal light, seat, etc.)?

  • 1.2 Is daily inspection for the forklift/reach truck carried out and inspection records available?

  • 1.3 Is the goods lift possessed valid PMA license and PMA number displayed clearly at the goods lift?

  • 1.4 Is the periodical maintenance to the equipment (forklift/reach truck, goods lift) being carried out and maintenance records documented?

  • 1.5 Are the electrical panel & electrical room closed from unauthorized access and the clearance maintained?

  • 1.6 Are all the electrical appliances safe and free of frayed cable, broken socket & plugs?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 2.1 Is the provision of ladders (step stool, stepladder, ladder trolley, etc.) and trolleys sufficient and the equipment are in good working condition (step, frame, stability, platform, handle, wheels, wheel lock, overall condition, etc.)?

  • 2.2 Is the pallet jack in good working condition (forks, wheels, hydraulic jack cylinder, handle, overall condition, etc.)?

  • 2.3 Is the strapping machine in good working condition (electrical cable, plug, control panel, table top, overall condition, etc.)?

  • 2.4 Is the provision of hand tools (knife, scissors, wire cutter, stapler, wrapping tool, hammer, etc.) sufficient and in good condition?

  • 2.5 Are the grinder(s), cutter(s) and driller(s) maintained in good working condition, and rotating parts properly guarded? (For maintenance department)<br>

  • 2.6 Are the drum lifter maintained in good working condition?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 3.1 Does the staff stand/walk away from moving vehicle/forklift/reach truck?

  • 3.2 Does the forklift/reach truck driver drive in a safe manner (low speed, horn, no lifting people, lifting load in stable arrangement, park and positioned forks properly when not in use, etc.)?

  • 3.3 Has the forklift/reach truck driver been trained?

  • 3.4 Are the staffs driving delivery vehicles possessed valid driving license?

  • 3.5 Does the staff lift the heavy parts in correct method (within lifting capacity, with equipment, correct posture, etc.) ?

  • 3.6 Does the staff access to height using proper equipment (ladder, step stool, etc.) and correct method (3 points of contact, etc.)?

  • 3.7 Is safety harness available and worn by staff when working at height and near opening?

  • 3.8 Is the opening at height properly guarded (gate closed/locked) when not in use?

  • 3.9 Is the goods lift only used to carry goods/parts (no carrying people)?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 4.1 Is the chemical storage area identified and isolated from ignition sources?<br>

  • 4.2 Is the chemical storage area clean, well ventilated and protected from weather?<br>

  • 4.3 Is the combustible/flammable items stored distance away from heat/ignition source?

  • 4.4 Is the half-used chemical (battery acid, solvent, paint, etc.) being closed and kept on spill containment tray?

  • 4.5 Is the warehouse (passageway, staircase, storage, etc.) clean and free of trip and fall hazard?

  • 4.6 Are the stored items arranged/stacked in safe manner?<br>

  • 4.7 Are all the racks, pallets in good working condition and not overloaded?

  • 4.8 Is the spill kit available at warehouse to contain the spilled chemical?

  • 4.9 Are the stored materials being kept away from lights and fire detectors?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 5.1 Is the office clean, organized and free of trip and fall hazard?

  • 5.2 Are the stored materials arranged/stacked in safe manner?

  • 5.3 Are the stored materials being kept away from lights and fire detectors?

  • 5.4 Are all the racks and storage cabinet in good condition and not overloaded?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 6.1 Is the provision of fire extinguisher sufficient and ready for use?

  • 6.2 Are all the fire extinguishers visible, accessible and free from obstacles?

  • 6.3 Is the fire extinguisher inspected according to schedule (quarterly) and inspection tag available at fire extinguisher?

  • 6.4 Are the firefighting system well maintained and periodic maintenance records are available?

  • 6.5 Are the first aid supplies sufficient, clean and free of edible medicine?

  • 6.6 Is the first aid inspection record available?

  • 6.7 Are the emergency light and exits sign lit properly?

  • 6.8 Are the emergency exit doors and escape route accessible and free from obstacles?

  • 6.9 Are the evacuation plan and emergency contact number updated and displayed at office, warehouse, security area, etc.?

  • 6.10 Are the Emergency Response Team (ERT) established at warehouse and well communicated?

  • 6.11 Are the ERT members training record kept properly?

  • 6.12 Is the security personnel briefed on the emergency procedure (emergency contact, fire extinguisher, fire alarm system, etc.)?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 7.1 Is the appropriate foot protection (safety shoes or rubber boots) provided and worn by the workers (warehouse staff and cleaner) at all time in the workplace?

  • 7.2 Is the safety goggle provided and worn when handling/transferring the chemicals (battery acid, etc.)?

  • 7.3 Is appropriate hand protection glove provided and worn for task exposed to sharp edges?

  • 7.4 Is the chemical hand glove provided and worn when handling the chemicals?

  • 7.5 Is the safety glass provided and worn during grinding, drilling, knocking, cutting, preparing or other hazardous activities? (For maintenance department)

  • 7.6 Is the appropriate respirator (OV or N95 mask) provided and worn when exposed to dust particles and chemicals vapor (paint)? (For maintenance department)

  • 7.7 Is the earplug provided and worn when worker exposed to noise (i.e. grinding, knocking, etc.)? (For maintenance department)

  • 7.8 Is the surgical mask provided and ready for sick person?

  • 7.9 Are all the provided PPE clean and well maintained (i.e. sharing of PPE is not allowed)?

  • 7.10 Is the PPE issuance record available?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 8.1 Is the smoking area available, provided with ashtray and away from non-smoker?

  • 8.2 Is inside of warehouse free of food and drink?

  • 8.3 Are the Rest Area, Surau, Washroom, Meeting Room and Pantry clean and organized?

  • 8.4 Is the water dispenser provided and well maintained?

  • 8.5 Are all the floors, passageways and staircase free of slips, trips and falls hazard?

  • 8.6 Is the roof/ceiling free of leaking and falling object (e.g. frayed ceiling, frame for lighting, etc.)?

  • 8.7 Is the lighting sufficient at all the places?

  • 8.8 Is the temperature at workplace suitable?

  • 8.9 Is the workplace free of opening/unguarded floor or falling from height hazard?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 9.1 Is the SAFETY FIRST signage displayed visibly at warehouse?

  • 9.2 Is the NO SMOKING signage displayed visibly at warehouse?

  • 9.3 Is the PPE signage displayed visibly at warehouse?

  • 9.4 Is the CHEMICAL SAFETY signage displayed visibly at chemical storage area (battery acid, other chemicals)?

  • 9.5 Is the SMOKING AREA signage displayed visibly at smoking area for customer and staffs?

  • 9.6 Is the VISITOR SAFETY signage displayed visibly at entrance of warehouse?

  • 9.7 Is the ASSEMBLY POINT signage displayed visibly at designated assembly area?

  • 9.8 Is the FIRST AID signage displayed visibly to indicate the location of first aid kit?

  • 9.9 Is the FIRE EXTINGUISHER signage displayed visibly at all the fire extinguisher?

  • 9.10 Is the HIGH VOLTAGE signage displayed visibly at electrical panel?

  • 9.11 Is the PUSH & PULL signage displayed visibly at glass door?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • 10.1 Is the updated EHS policy displayed clearly?

  • 10.2 Is the weekly tool-box briefing conducted and briefing records kept in good manner?

  • 10.3 Is the safety briefing/training conducted to discuss EHS policy, emergency response procedure, safety alert, and spill control, manual handling and 5S?

  • 10.4 Is the fire drill conducted and fire drill report kept in good manner?

  • 10.5 Are the incident notification records (internal notification forms, JKKP 6, 7 & 8) and incident investigation report available and kept in proper manner?

  • 10.6 Is the JKKP log book available?

  • 10.7 Are the updated Chemical Register and Safety Data Sheet (SDS) available?

  • 10.8 Is the EHS committee implement its function according to the requirement and the records of meeting minutes, inspection records, appointment letters, EHS Chart, etc. well maintained?

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of report)


  • Is there any other non-conformance observed?

  • Photo (Non-conformance)

  • Updates (Corrective Action)

  • Photo (Corrective Action)

  • Comment (* filled up by EHS upon the review of repot)


Conclusion/ Recommendation

  • Compliance (%)

  • Very poor EHS MS implementation. Immediate action is required to avoid the disciplinary action taken by the authority.

  • Poor EHS MS implementation. Need to work harder on legal compliance first before move to next level requirements.

  • Moderate EHS MS implementation. A lot of corrective action required.

  • Good EHS MS implementation. Several corrective action required.

  • Excellent EHS MS implementation. Few corrective action required and ready for EHS MS level enhancement.

  • Deadline


  • Signature

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