Title of the Job/Project

Annual Rack Safety Inspection

Department/Location:
Job requested by :
Duration of the Job:
Person-in charge:/Contact Number:

Permit To Work in PAVCSG

S/N Safety Document Check

Yes

No

Remarks

Method Statement

Risk assessment

Safe Work Procedure

Toolbox meeting form

Declaration of chemical use

Declaration of equipment/tools used

Permit to work system for Work at height

Licence for Work at Height for supervisor, MEWP ,Fall Protection Plan.

Permit to work system for Hotwork

License worker for conducting welding.

Permit to work system for Crane / Hoisting

Licence for Crane operator,Lifting supervisor,signallar,rigger.Lifting

Plan.Certificate for crane and accessories used.

Provide SDS

10 Permit to work system for confined space

Confined space accessor,

11 Apply Lock out tag out procedure

LEW, Portable ELCB.

12 Legalize worker checked

13 Emergency Response Chart/ Org, Chart

Provide own 1st aid box and standby own fire extinguishers

14 PPE Provided
15 Licence workers/equipment.
Licence required :
Forklift

Checked by Process
Owner

Checked By
FSG

Approved By
WSHO/Management

Date
Note: Only with this approved document is allowed to work in PAVCSG.

List of items used (Facilities) in PAVCSG

Use of equipment/machines
1
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35
Signature

Remarks

List of items used (Chemicals) in PAVCSG

Use of chemicals
1
2
3
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Signature

SDS

Remarks