Title Page
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Name of HSE Coordinator
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Employee No.
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Vessel / Project
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Date
Stage 1: Safety equipment on board
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1.1) Fire Line Point onboard, are equipment in good condition?
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1.1.1) Quantity?
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1.1.2) Photo
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1.2) Fire Hydrants at Quay Side, are equipment in good condition?
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1.2.1) Quantity?
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1.2.2) Photo
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1.3) Fire Line Connection on Board (Leaking)? Are equipment in good condition?
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1.3.1) Quantity?
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1.3.2) Photo
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1.4) Fire line pressure on board, are, are equipment in good condition?
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1.4.1) Photo
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1.5) Gangways to vessel, are equipment in good condition?
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1.5.1) Quantity
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1.5.2) Photo
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1.6) Fire fighting equipment in fire boxes, are equipment in good condition?
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1.6.1) Quantity?
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1.6.2) Photo
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1.7) Fire alarm and fire point flags, are equipment in good condition?
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1.7.1) Quantity?
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1.7.2) Photo
Stage 2: Site Inspection / Enforcement
HIRA - Height Safety
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
HIRA - Confined Space
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
HIRA - Fire Safety
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
HIRA - Electrical Safety
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
HIRA - Lifting Safety
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
HIRA - Material Handling
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Job description.
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Location.
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Time of inspection.
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Control measures in place.
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Photo.
Stage 3
The above are the observations and findings during my shift work and i hereby handover the report to the vessel HSE lead and as well as the next shift HSE Coordinator.
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Name of HSE Coordination preparing report:
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Date and Time of report.
