HSE COMPLIANCE FORM

• Site conducted

  Select

• Prepared by

• Location
  Address

• Yes

  No

  N/A

WORK GROUNDS OR ENVIRONMENT

• Safety Talk done?

  Yes

  No

  N/A

• PPE Provided for the task?

  Yes

  No

  N/A

• Good Housekeeping done?

  Yes

  No

  N/A

• Oil spillages on the grounds

  Yes

  No

  N/A

• Work grounds in Good Condition?

  Yes

  No

  N/A

• Dangerous areas barricaded

  Yes

  No

  N/A

• Dust suppression done?

  Yes

  No

  N/A

• Illumination adequate

  Yes

  No

  N/A

• Ventilation adequate

  Yes

  No

  N/A

• Yes

  No

  N/A

Work At Heights

• Are there any works on heights?

  Yes

  No

  N/A

• Do the employees have safety harnesses?

  Yes

  No

  N/A

• Are the safety harnesses inspected and safe to use?

  Yes

  No

  N/A

• Who inspected them?

  Yes

  No

  N/A

• Are they working on a Scaffold?

  Yes

  No

  N/A

• Has it been Inspected?

  Yes

  No

  N/A

• By Who?

  Yes

  No

  N/A

• Are the working platforms safe to work on?

  Yes

  No

  N/A

• Has other task-specific PPE been provided?

  Yes

  No

  N/A

Welding And Grinding

• Are the welders competent for the task?

  Yes

  No

  N/A

• Are the shields provided?

  Yes

  No

  N/A

• Are the leather aprons, gloves and spats in place for the welders

  Yes

  No

  N/A

• Are the eye glasses for grinding provided?

  Yes

  No

  N/A

• Are the gas cylinders secured?

  Yes

  No

  N/A

• Are the welding machines earthed?

  Yes

  No

  N/A

• Has combustible materials been removed from the welding area?

  Yes

  No

  N/A

• Distribution Box earthed and locked?

  Yes

  No

  N/A

• Voltage controls and Pressure gauges functional?

  Yes

  No

  N/A

• Are cables well insulated?

  Yes

  No

  N/A

• Is the Fire Extinguisher available at the welding area?

  Yes

  No

  N/A

Workshop

• Is the workshop clean?

  Yes

  No

  N/A

• Housekeeping done?

  Yes

  No

  N/A

• Are walkways Clear and Safe

  Yes

  No

  N/A

• Are Fire Extinguishers provided and kept at a visible location?

  Yes

  No

  N/A

• Is there a First Aid Box?

  Yes

  No

  N/A

• Emergency Exits visible and clear?

  Yes

  No

  N/A

• Are all Electrical cables properly insulated?

  Yes

  No

  N/A

• Were all Tools checked for Usability before use?

  Yes

  No

  N/A

• Is there adequate ventilation?

  Yes

  No

  N/A

• Is there adequate illumination?

  Yes

  No

  N/A

• Are there any Oil, Fuel spillages on the floor?

  Yes

  No

  N/A

• Is the Storeroom kept orderly and safe?

  Yes

  No

  N/A

CONCLUSION

• General overview on Housekeeping out of scale of 10

  Good

  Fair

  Poor

  N/A

• General overview on PPE provision and usage

  Good

  Fair

  Poor

  N/A

• General overview on Safety Awareness and Compliance

  Good

  Fair

  Poor

  N/A