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    She Inspection Report Template

    Uploaded by

    Ad Gautama

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    She Inspection Report Template

    Uploaded by

    Ad Gautama
    9 views2 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    9 views2 pages

    She Inspection Report Template

    Uploaded by

    Ad Gautama

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Date : date_header_id

    Location : location_header_id
    Inspector : inspector_header_id
    Area Owner/Supervisor : area_header_id
    PTFI Health & Safety Standards are available on PTFI Web Safety Page or Area Safety Office
    Rating Rating
    Potential Potential
    Checklist Need PTFI Std Checklist Need PTFI Std
    Risk Good N/A Risk Good N/A
    Works Works
    1. Work Area & Housekeeping 1.00 6. Fire Safety 3.00
    Buildings, Floors and Mining pr_1 nw_1 g_1 na1 1.11 Nearest fire extinguisher pr_32 nw_32 g_32 na32 3.01
    Stacking & Storage pr_2 nw_2 g_2 na2 1.22 Color coding & demarcation pr_33 nw_33 g_33 na33 1.21/3.02
    Work set up (ergonomics) pr_3 nw_3 g_3 na3 2.31 Sufficient number & type pr_34 nw_34 g_34 na34 3.01
    Walkways pr_4 nw_4 g_4 na4 1.21 Visible & accessible pr_35 nw_35 g_35 na35 3.01
    General cleanlinnes pr_5 nw_5 g_5 na5 1.23 ERG Inspection tag pr_36 nw_36 g_36 na36 3.01
    Ground Support Conditions pr_6 nw_6 g_6 na6 1.11

    2. Structures & Floors 1.00


    Color coding & demarcation pr_7 nw_7 g_7 na7 1.25 7. First Aid 5.15
    Windows & screens pr_8 nw_8 g_8 na8 1.23 First aid Kit pr_37 nw_37 g_37 na37
    Drainase pr_9 nw_9 g_9 na9 1.23 Eyewash station pr_38 nw_38 g_38 na38
    Water Lines & valves pr_10 nw_10 g_10 na10 1.25 Stretcher pr_39 nw_39 g_39 na39
    Sanitary facilities (wc) pr_11 nw_11 g_11 na11 1.14

    3. Machinery & Tools


    Stationary Equipment 2.11
    Guards in place pr_12 nw_12 g_12 na12 8. Environmental
    Servicable Guards pr_13 nw_13 g_13 na13 Lighting pr_40 nw_40 g_40 na40 1.12
    Pinch points pr_14 nw_14 g_14 na14 Ventilation pr_41 nw_41 g_41 na41 1.13
    Hand Tools 2.30 Noise pr_42 nw_42 g_42 na42 2.48
    Correct for the job pr_15 nw_15 g_15 na15 HazMat pr_43 nw_43 g_43 na43 2.17
    Good condition pr_16 nw_16 g_16 na16
    Mobile Equipment 2.18 9. Communications
    Pre-go checklist pr_17 nw_17 g_17 na17 Telephone / Radio pr_44 nw_44 g_44 na44
    Licenses & permits pr_18 nw_18 g_18 na18 Signs & Notices 2.50
    Emergency Procedure pr_45 nw_45 g_45 na45 3.09
    4. Electrical 2.00 Personal protective eqt pr_46 nw_46 g_46 na46 2.40
    Power & extension cables pr_19 nw_19 g_19 na19 2.21 No smoking pr_47 nw_47 g_47 na47 1.13
    Panels, switches, plugs & outlets pr_20 nw_20 g_20 na20 2.21 JSA/SOP posted pr_48 nw_48 g_48 na48 5.14
    Equipment cables pr_21 nw_21 g_21 na21 2.21 Emergency exit pr_49 nw_49 g_49 na49
    Labeling pr_22 nw_22 g_22 na22 2.13 Other pr_50 nw_50 g_50 na50
    Color coding & demarcation pr_23 nw_23 g_23 na23 1.25
    10. Fall Protection 2.40
    5. Personel Ladders pr_51 nw_51 g_51 na51
    Correct PPE in use pr_24 nw_24 g_24 na24 2.30 Scafolds pr_52 nw_52 g_52 na52
    Work activities pr_25 nw_25 g_25 na25 Stairways & ramos pr_53 nw_53 g_53 na53
    Supervisor daily check pr_26 nw_26 g_26 na26 Lanyards pr_54 nw_54 g_54 na54
    Special safety instructions pr_27 nw_27 g_27 na27 4 point harness / safety belt pr_55 nw_55 g_55 na55
    Licenses & permits pr_28 nw_28 g_28 na28 5.52 Safety block pr_56 nw_56 g_56 na56
    Correct lifting & handling pr_29 nw_29 g_29 na29 2.31
    JSA/SOP Available pr_30 nw_30 g_30 na30 5.50 10/20
    Gas Detector pr_31 nw_31 g_31 na31

    version_id device_id
    Corrective Action Potential Responsible Date
    Finding Photo
    Required / Comments Risk Person Complete

    Signature / Acknowledgment Emp # Date


    Site Supervisor employee_id_1 date_id_1
    Department Manager employee_id_2 date_id_2
    Area Safety Dept. employee_id_3 date_id_3

    version_id device_id

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