SH EMEA FBA BEL QT - PM (2018/03)

• Conducted on

  Date

• Prepared by

• Location
  Address

• This inspection is to enhance safety awareness amongst the employees and must be conducted in a dialogue with the affected employees, thus to drive continuous improvement by active leadership in EHS.

• Site Name:
  Address

• Please mention as Site Name: City - Hospital / Customer name - Project

• Description of the works - intervention:

• Present subcontractor(s); company name(s): (enter "None" if no subcontractors are present)

• In case questions can't be verified or checked; than please answer N/A

1. Organization, environment and execution of the works

• 1.1. Is our safety plan available and followed through?

  Yes

  No

  N/A

• 1.2. Is our risk-assessment (incl. risk-assessment for subcontractors) available and followed through?

  Yes

  No

  N/A

• 1.3. Has a safety toolbox meeting been organized with the customer (and subcontractors) prior commencing the works?

  Yes

  No

  N/A

• 1.4. Is a work permit for hazardous activities (i.e. work at heights) and/or a hot work permit available and followed through?

  Yes

  No

  N/A

• 1.5. Is the work area properly demarcated and/or indicated with safety signage?

  Yes

  No

  N/A

• 1.6. Are the vehicles for loading and unloading properly parked?

  Yes

  No

  N/A

• 1.7. Are the works conducted safely?

  Yes

  No

  N/A

• 1.10. Is the work area arranged neatly and in order?

  Yes

  No

  N/A

• 1.11. Is generated waste removed and properly segregated?

  Yes

  No

  N/A

2. Protective equipment

• 2.1. Is a fire extinguisher available and accessible?

  Yes

  No

  N/A

• 2.3. Have the workers a high visibility vest and do they wear it when required?

  Yes

  No

  N/A

• 2.4. Have the workers safety shoes and do they wear them when required?

  Yes

  No

  N/A

• 2.5. Have the workers a safety helmet and do they wear it when required?

  Yes

  No

  N/A

• 2.7. Have the workers a dosimeter and do they use it correctly when required?

  Yes

  No

  N/A

3. Work tools

• 3.1. Is the scaffold properly set up (wheels locked), inspected (label) and suitable for the job?

  Yes

  No

  N/A

• 3.2. Is the (step)ladder properly set up, inspected (label) and suitable for the job?

  Yes

  No

  N/A

• 3.3. Are the used lifting devices and lifting equipment (i.e. pallet/material lifts, hoists, slings) properly set up, inspected (label) and suitable for the job (not exceeding their maximum load capacity)?

  Yes

  No

  N/A

• A hoist is a device used for lifting or lowering a load. Our hoists are manually operated and use chain as its lifting medium. The hoists couple to their loads using a lifting hook.

• A sling is a flexible strap or belt used in the form of a loop to support or raise a hanging weight, it is used in a rigging system for lifting. Our slings are made of synthetic fiber.

4. Knowledge and qualification

• 4.1. Do the workers understand the risks they are exposed to and the risks they are generating by their tasks?

  Yes

  No

  N/A

• 4.2. Do the workers know the assembly point in case of evacuation or can they show where to find this information quickly?

  Yes

  No

  N/A

• 4.3. Do the workers know the emergency number(s) or can they show where to find this information quickly?

  Yes

  No

  N/A

• 4.4. Do the workers know what to do when they are involved in a work-related accident or incident?

  Yes

  No

  N/A

• 4.7. Do the employees know the principle of LMRA (Last minute risk-assessment)?

  Yes

  No

  N/A

• 4.8. Are the workers that work with electricity certified for the job?

  Yes

  No

  N/A

• 4.9. Do the workers know who is responsible for the execution of the works from the Siemens side?

  Yes

  No

  N/A

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