Title Page
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بسم الله الرحمن الرحيم. استعن بالله. هذا الإستبيان مهم جدا في رفع مستوى السلامة في الموقع. وهو ليس لتقييم الأشخاص. أجب بنعم أولا أوغير مطلوبThis questionnaire helps to increase the safety level in the site. It is not to blame someone
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PROJECT NAME إسم المشروع
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Site name اسم الموقع
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Area Name (Building name) إسم المنطقة أو المبنى
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Conducted on تم الفحص بتاريخ
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PERSONS TAKING INSPECTION الأشخاص الذين أجروا الفحص
1- JOBSITE INFORMATION معلومات عن موقع العمل
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1-Posting Safety Posters and Warning Signs نشر ملصقات السلامة والإشارات التحذيرية
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2-Safety Meetings يوجد اجتماعات سلامة في الموقع
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3-Safety Training يوجد دورات في السلامة والصحة المهنية
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4-Medical Facilities, First Aid Equipment, Ambulance يوجد معدات إسعافات أولية ،سيارة إسعاف، معدات طبية
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5-Injury Records Being Kept يتم الإحتفاظ بسجلات الإصابة
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6-Emergency Telephone Numbers Posted أرقام الطوارئ منشورة في الموقع
2-HOUSEKEEPING AND SANITATION النظافة والمرافق الصحية
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1- Tidiness and Neatness of Working Areas
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2- Regular Disposal of Waste & Trash
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3-Passageways and Walkways Clear
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4- Adequate Lighting
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5- Protruding Nails Removed or Bent
3- Fire Preventive الوقاية من الحرائق
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1- Fire Fighting Instructions to personnel
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2. Fire Extinguishers Checked
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3- Phone Number of fire Departmeat Posted
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4- Hydrants clear Access
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5- Good Housekeeping
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6- "NO smoking" Posted and Enforced where Needed نشر ملصق ممنوع التدخين و الاجبار عليها عند الحاجة
4-TEMPORARY ELECTRICAL INSTALLATION التمديدات الكهربائية المؤقتة
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1 - Adequate Wiring Well Insulated
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2- Fuses Provided/Control Panel
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3- Fire Hazard Checked
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4- Electrical Dangers Posted
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5- Proper Fire Extinguishers Provided تواجد طفايات الحريق المناسبة
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6- Proper Grounding
5- HAND TOOLS الأدوات اليدوية
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1- Proper Tool Being Used for Each Job
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2-Neat Storage
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3- Inspection and Maintenance
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4- Damaged Tools Repaired/Replaced Promptly إصلاح/إستبدال الأدوات فورا
6- Power Tools الأدوات الميكانيكية
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1-Good Housekeeping Where Tools are Used.
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2-Tools and Cords in Good Condition.
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3-Proper Grounding
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4-Proper Instruction In Use
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5-All Mechanical Safeguards In Use
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6-Tools Neatly Stored When in Use
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7-Right Tool Being Used for Job at Hand
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8-Wiring Properly Installed
7- POWER ACTUATED TOOLS أدوات تعمل بالطاقة
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1-Clint' Requirements Complied With
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2-All Operators Qualified
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3-Competent Instruction and Supervision
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4-Tools Checked and in Good Working Order
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5-Tools Used only on Recommended Materials.
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6-Face Shield
8- LADDERS السلالم
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1-Ladders Inspected and in Good Condition.
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2-Ladders Sliced مجمعة Properly.
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3-Properly Secured to Prevent Slipping, Sliding or Falling.
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4-Extended 3 Feet Above Top of Landing
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5- Ladders Constructed of Appropriate Materials
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6-Rungs not Over 12 Inches on Center
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7-Metal Ladders not Used Around Electrical Hazards
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8- Proper Maintenance and Storage.
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9- No Painted Ladder
9- SCAFFOLDING السقالات
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1-Erection Properly Supervise
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2- Structural Components Meet the Safety Factor.
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3- All Connection Secure.
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4- Scaffolds Tied into Structure مرتبطة بالمبنى
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5-Working Areas Free of Debris حطام
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6-Workers Protected From Falling Objects
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7- Scaffold Plumb and Square with Cross Bracing
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8- Guardrails, Intermediate Rails and Toe Boards in Place
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9- Scaffold Tags
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10- No Damage Components
10- HOISTS AND CRANES الروافع
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1- Good Cables and Sheaves بكرات
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2- Check Slings رافعات and Chains سلاسل , Hooksخطاف & Eyes
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3- Outrigger دعامات وطبليات Used if Needed
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4- Powered Lines Inactivated, Removed or At Safe Distance.
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5- Proper Loading for Capacity at Lifting Radius
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6- All Equipments Properly Lubricated and Maintained
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7- Signalman Avaliable where Needed
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8- Signals Understood and Observed
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9- Inspections and Maintenance Logs سجل Maintained
11- HEAVY EQUIPMENT & MOTOR VEHICLE
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1- Regular Inspection and Maintenance
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2- Lubrication and Repair of Moving Parts
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3- Light, Brakes, Warning Devices Operated
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4- Weels Checked When Necessary
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5- Competence of Operation & Equipment شهادات المعدة والمشغل
11- WELFARE FACILITIES (TOILETS, EATING AREAS, MASJID, Etc.) AND WATER TANKS أماكن الراحة (حمامات. أماكن تناول الطعام. مسجد إلخ))وبيانات ماء
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a- Toilets in Good condition and maintained الحمامات في وضع جيد وتحت الصيانة
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b- water tanks filled up and in Good condition خزانات الماء مليئة وفي حالة جيدة
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c- Maintained good Housekeeping (Eating areas, Toilets, MASJID) المحافظة على نظافة جيدة لأماكن تناول الطعام والحمامات والمسجد
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d- Stangnant water لا يوجد ماء راكد
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e- regularly removed trash or garbage إزالة المخلفات أو المهملات دوريا
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f- pest control applications تطبيقات لأفضل تحكم
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g- Toilets Septic tanks emptied regularly نزح مياه الصرف الصحي دوريا
12- MOTOR VEHICLES المركبات والسيارت
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1- Regular Inspection and Maintenance
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2- Drivers Lincesed
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3- Local and National Transportation Laws and Regulations Observed التأمين والفحص الحكومي
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4- Brakes, Light, Warning Signal Operative
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5- Personnel Carried in a Safe Manner قيادة آمنة
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6- All Glass in Good Condition مرايات وزجاج
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7- Back-up Signals Provided
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7- Fire Extinguishers Installed
13- GARAGES AND REPAIR SHOP
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1- Dispensing of Fuels and Lubricants
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2- Good Housekeeping
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3- Adequate Lighting
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4- Fire Fighting Equipment
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5-Proper Ventilation
14- BARRICADES
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1- Floor Openings Planked Over a Barricaded
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2- Adequate Lighting Provided
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3- Open Sides Adequately Protected
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4- Traffic Controlled
15-HANDLING AND STORAGE OF MATERIALS
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1- Materials Properly Stored of Stacked عليها كرت للوصف
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2- Passageways Clear
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3- Stacks on Firm Footings, Not Too High الحمامات صلبة وغير عالية
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4- Materials Protected from Weather Condition
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5- Fire Protection
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6- Traffic Controlled in the Storage Area
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7- MADS
16- EXCAVATION AND SHORING
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1- Adjacent Structure Properly Shored تدعيم مناسب
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2- Roads and Sidewalks Supported and Protected
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3- Materials Stored Not Close to Excavation
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4- Excavation Barricaded and Lighting Provided
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5- Access Ladders Provided
17- FLAMMABLE GASSES AND LIQUIDS
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1- Containers Clearly Identified حاويات
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2- Proper Storage Practices Observed
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3- Fire and Electrical Hazards Checked
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4- Barricaded and Lighting
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5- Access Ladder Provided
18- WELDING AND CUTTING
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1- Operators Qualified
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2- Completely Prescribed Personal Protective Equipment
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3- Equipment in Safe Operating Condition
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4- Electrical Equipment Grounded
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5- Cables Protected and in Good Repair
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6- Proper Fire Extinguishers Readily Available
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7- Inspection for Fire Hazard
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8- Gas Cylinders Chained Upright
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9- Gas Hoses Protected & in Good Condition
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10- Cylinder Caps in Used
19- STEEL ERECTION
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1- Floors Planked الأدوار ميقفة
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2- Prescribed Personal Protective equipment Used
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3- Tools فحص الأدوات جيدا
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4- Fire Hazards at Welding / Cutting Operation
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5- Floor Opening Barricaded
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6- Access Ladders / Stairs Provided
20- CONCRETE CONSTRUCTION
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1- Forms Properly Installed and Braced الشدات مدعمة جيدا
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2- Adequate Shoring, Plumbed & Cross Braced الدعائم والمقصات والشدات للشد
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3- Shoring Remains in Place Until Strength Is Attained
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4- Excavation Barricaded and Lighting Provided
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5- Mixing and Transport Equipment Supported and Traffic Planned
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6- Adequate Runways
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7- Protection from Cement Dust
21- MASONRY أعمال البناء
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1- Proper Scaffold
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2- Masonry Saw Properly Equipped, Dust Protection Provided
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3- Site Hoisting Equipment معدات الرفع والتحميل
22- ROAD WAYS OR HIGHWAY CROSSING عبور الطريق أو الطرق السريع
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1- Laws and Ordinance التشريعات Observed
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2- Flagmen Posted and Properly Dressed
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3- Adequate Warning Signs and Markers
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4- Equipment Not Blocking Right-of-Way
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5- Traffic Control through Costruction Site
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6- Maintenance Detours صيانة التحويلات
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7- Adequate Lighting
23- PERSONAL PROTECTIVE EQUIPMENT
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1- Eye Protection
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2- Face Shields
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3- Respiratory and Mask
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3- Hard Hats
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4- Safety Shoes
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5- Welding Masks and Goggles
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6- Welding and Working Gloves
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7- Rubber Boots, Apronsمرايل, Sleevesأكمام, Legging غطاء الأرجل
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8- Ear Protection