Doc.

No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

Report No: DOR / SM / 0019 Date: 14/07/2019 Page No. 01 / 05

Name of the

SECTION A: Project HSSE Lead

Avg. No of man No. of Hospital
_ No. of LTI _ No. of Man days lost _ _
days worked Ref. cases
No. of HSSE
No. of First No. of Near Miss
Man-hours _
Aid cases
_
Incidents reported
_ Meeting _
worked conducted
SECTION B: Project HSSE Officer/Engineer
Danger Remedial Action Proposed/ Additional
Sl. Data Equipment/ Danger Action By with Action
Observations Hazard / Risk Level control measure / Applicable Legal Target date
No. type Doc Ref. code Staff No& Name. taken on
(LXMXH) requirement to comply

It has been observed that 
plumbing material  Don’t stack or store any 
 Slip, Trip and  Firefighting 
stacking yard access has  materials obstructing to other 
Falls  Department
1.  UC    blocked due to  M  B  storage materials access. All the  15/07/2019   
Personal Injury  Eng.: 
Firefighting team  materials shall be stack/store in 
  Manjith 
materials.   designated storage places. 
 

It has been observed that  Ensure to arrange all the 
HVAC upper level  materials in store rack by 
Falls from  HVAC 
storage container was  categorization with index 
UA/ height.  Department
2.    opened without proper  H  A  number. All the heavy  14/07/2019   
UC  Personal Injury  Eng.: 
access and the door kept  materials shall be kept outside 
  Bishoy 
to open unattended.  rack provided from the main 
  contractor. 

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

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Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

All the storage containers  Ensure to provide minimum 
Fire 
at site without adequate  one number of DCP fire  All 
Personal Injury 
3.  UC    firefighting ang fire  H  A  extinguishers and two numbers  Department  Immediate   
Property 
prevention system  of battery‐operated smoke  stores. 
Damage 
(Inside the container)  detectors to each store. 

Scaffold 
It has been observed that,  collapse  All the scaffold erector must be 
incompetent operator has  Falls from  trained and certified from 
UA/ All 
4    engaged the erection and  height  H  A  approved third party trainer to  Immediate   
UC  department. 
dismantling of  Personal Injury  carryout scaffolding erection 
scaffolding at site.  Accident/Incide and dismantling at site. 
nt 

Personal Injury  All the materials shall be 
HVAC 
HVAC duct stored at site  Property  stored/stacked with 
UA/ Department
05    without adequate  Damage  M  B  demarcation and warning  15/07/2019   
UC  Eng.: 
barrication & Signages.  Accident/Incide signages with adequate 
Bishoy 
nt  covering of the materials. 

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

   Doc. No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

   Doc. No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

   Doc. No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

   Doc. No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

Guidelines for filling the report:

Section A:

This section is applicable for project HSE in charge only, (HSSE Head need to identify the Project HSSE Lead if project has more than one safety officer)

Section B:

This section is applicable for project HSSE representative; If only one person is in the project then he has to fill Section A & B.

Description of entries in the fields:

1. Only abbreviation as shown below needs to be filled under the ‘data type’. (For example, if the entry is about equipment inspection conducted simple state ‘EI’ under “Data Type”).
2. Data Type: Unsafe Condition (UC)/Unsafe Act (UA)/Equipment inspection outcomes (EI)/NCR from Audit (NCR)/NCR from incident Investigation (NCR-I)/points agreed in HSSE
Meeting(HSSEM)/Client Observation (CO)/Camp observation (CAMP)/Employee Health observation (OH)/ Penalties (PEN)/First Aid cases (FAC)
3. Equipment/Doc No.
4. Observation – It can be anything as detailed under Sl. No. 2
5. Danger Level – As per the OHSEMS guidelines
6. Danger Code : O – activity shall proceed with necessary supervision; A – activity to proceed only after rectification; B – action to be effected in same shift; C – action to be effected in 24h; D –
action to be effected in 48h
7. Remedial Action – Proposed and agreed corrective and/ or preventive action
8. Action by – Details of the responsible staff who needs to execute the remedial action
9. Target Date – As per the Danger Code (Sl. No. 6) and communicated to the concerned personnel

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No:

   Doc. No

Revision No: 01
Store Inspection Report
Issue Date: 06.10.16

10. Action Taken Date – Observation closure date when the remedial action is complete

Prepared by: Anil Kumar Submitted to: Mr. Nadir, Hany, Mohamed & Rajabteen

Name/ Staff No/ Designation: HSEO Name/ Staff No: