Professional Documents
Culture Documents
All ESH Form PDF
All ESH Form PDF
4.0 Safe & Unsafe Acts / Conditions (Tindakan / Keadaan Selamat & Tidak Selamat)
4.1 Sling / Lifting Operation (Kerja Pengangkatan) 4.8 Electrical (Letrik)
4.2 Earthworks / Excavation (Kerja Tanah / Pengorekan) 4.9 Plant /Equipment (Loji/Peralatan)
4.3 Scaffolding / Netting (Perancah / Jaring Keselamatan) 4.10 Welding (Kimpalan)
4.4 Machineries Guarding (Pengadang Mesin) 4.11 Confined space (R/Terkurung)
4.5 Housekeeping (Kekemasan) 4.12 Working Platform (Planta Kerja)
4.6 Working at height (Kerja Tempat Tinggi) 4.13 Access/Egress (Masuk /Keluar)
4.7 Demolition / Blasting (Meroboh / Peletupan) 4.14 Hacking Activities (Hentakan)
4.15 Launching work (Beam etc)
5.0 Environment (Alamsekitar)
5.1 Environmental Aspects & Impacts (Air, Water, Noise Pollution & Vibration)
5.2 Waste Control (Construction, Domestic, Scheduled Waste)
5.3 3R Practices (Reduce, Reuse & Recycle)
5.4 Conservation of Natural Resources / Energy Saving (Water, Electricity & Fuel)
Name Signature
SUBMISSION BY Designation
Contact No
Name Signature
ENDORSED BY (Project Manager or Safety
Designation
and Health Officer)
Contact No
WORK PERMIT COMPANY WORK PERMIT CIDB GREEN CARD
NO NAME NRIC / PASSPORT NO CIDB VALIDITY NATIONALITY
NAME VALIDITY NO
2
3
4
5
6
7
8
9
Conduct By : Varified By :
Name : Name :
Designation : Designation :
Date : Date :
Checked By : Varified By :
Name : Name :
Date : Date :
Doc. Ref. : TCS/PI/FAL Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
TCS CONSTRUCTION SDN BHD
INSPECTED BY
NAME SIGNATURE
DESIGNATION
COMPANY
DATE / TIME
ENDORSED BY
NAME SIGNATURE
DESIGNATION
COMPANY
DATE & TIME
Checked By : Varified By :
Name : Name :
Date : Date :
ESH WALKABOUT
Doc. Ref. : TCS/PI/ESHW Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
TCS CONSTRUCTION SDN BHD
Acceptability Remarks
(i.e. specify location, good practices,
No. Items to be checked problem observed, possible cause of non-
YES NO N/A conformance and/or proposed
corrective/preventative action)
1. SH Management
SH Policy displayed and disseminated
SH Manuals
SH Procedures
SH Instructions
Project ESH Plan
Work permit for dangerous work
SH Management Programme
SH Training / Awareness
SH Induction
Training for Competent Person
SH information dissemination
2. Site SH Committee
Organisation Chart
Chairman and secretary’s Appointment Letter
Committee Members’ Appointment Letter
Regular Meetings
Workplace Inspection by Committee
Sub Contractor and workers participation
Incident / accident investigation
Management cooperation
Action from report and suggestions
Action on the unsafe act
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 1 of 5
TCS CONSTRUCTION SDN BHD
Acceptability Remarks
No. Items to be checked (i.e. specify location, good practices, problem
YES NO N/A observed, possible cause of non-conformance
and/or proposed corrective/preventative action)
5. Scaffold
PE design drawing and calculation
Scheduled inspection
Maintenance
Stable foundation
Competent erector
Signage
7. Working at heights
Proper PPE
Safe working platform
OSH Instruction
Supervision
Training
Life line provided
8. Access / Egress
Safe access and egress
Overhead protection cover
Adequate lighting
Safe ladder
Inspection and maintenance
Traffic control
9. Public Safety
Warning signage
Hoarding
Security Officer at entrance
Traffic Control Officer
Traffic Control in the project site
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 2 of 5
TCS CONSTRUCTION SDN BHD
Acceptability Remarks
No. Items to be checked YES NO N/A (i.e. specify location, good practices, problem
observed, possible cause of non-conformance
and/or proposed corrective/preventative action)
13. Housekeeping
Housekeeping programme
Proper waste disposal
Material storage
Adequate access way
Inspection
Drainage condition at the surrounding area
Proper disposal area
Signages
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 3 of 5
TCS CONSTRUCTION SDN BHD
Acceptability Remarks
YES NO N/A (i.e. specify location, good practices,
No. Items to be checked problem observed, possible cause of
non-conformance and/or proposed
corrective/preventative action)
15. Formwork
PE drawing and calculation
Inspection
Designated person
17. Excavation
Excavation site with guarding of fences
Warning signages posted at exit and entrance
Warning light placed at night
Checked by designated person after rainstorm
Excavated material not placed at least 610mm
from edge
More than 1.2m provided with ladder
More than 4m in depth in accordance with
design and drawing by PE
Permit to work maintained for all works
18. Blasting
Blasting permit
Shot Firer’s license
Evacuation procedure
Warning Notice given to all residence in the
vicinity
Signages
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 4 of 5
TCS CONSTRUCTION SDN BHD
Acceptability Remarks
(i.e. specify location, good practices, problem
No. Items to be checked observed, possible cause of non-
YES NO N/A conformance and/or proposed corrective
/preventative action)
Inspected By :
Signature : ………………………. Date :
Name :
Verified By :
Signature : ………………………. Date :
Name :
Doc. Ref. : TCS/PI/SHIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 5 of 5
TCS CONSTRUCTION SDN BHD
6.
7.
Potential Hazards / Enviromental Impact
8.
Fall from heights, Falling objects, Slip and fall, Hit by
objects, Caught in between, Collapse of machinery 9.
Electricution, Fire, Chemical spillage,Noise,
Water pollution, Air pollution, Open burning 10.
11.
Control Measures
12.
Wear proper PPE, Use proper plugs / ear muff,
Permit to work, Use proper signages, Report unsafe 13.
acts and condition, HIRADC (Eliminate, Subtituation,
Engineering, Signages & Administrative and PPE ) 14.
Comply to FMA. Act 139, OSHA, Act 514,
EQA, Act 127, CIDB, Act 520, 15.
JKR Arahan Teknik (Jalan) 2C/85
16.
…………………………. ………………………….
ESH Officer/SHO/SSS Manager ESH/SH
(Name and Signature) (Name and Signature)
Note: Occupational Safety and Health Act 1994 (OSHA Act 1994), Part VI, Section 24 (1) (c) - to wear or use at all times any protective equipment
or clothing provided by the employer for the purpose of preventing risks to his safety and health.
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
1. Air Pollution Control
1.1. Are the construction sites watered to
minimize dust generated?
1.2. Are stockpiles of dusty materials
covered or watered?
1.3. Cement debagging process
undertaken in sheltered areas
1.4. Are all vehicles carrying dusty loads
covered/watered over prior to leaving
the site?
1.5. Are demolition work areas watered?
1.6. Are dusty roads paved and/or
sprayed with water?
1.7. Are dust controlled during percussive
drilling or rock breaking?
1.8. Are plant and equipment well
maintained? (any black smoke
observed, please indicate the
plant/equipment and location)
1.9. Is dark smoke controlled from plant?
1.10. Are there enclosures around the
main dust-generating activities?
(e.g. grout mixing)
1.11. Hoarding provided along boundaries
and properly maintained (any
damage / opening observed, please
indicate the location).
1.12. Are speed control measures applied?
(e.g. speed limit sign)
1.13. Others (please specify)
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 1 of 6
TCS CONSTRUCTION SDN BHD
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
2. Water Pollution Control
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 2 of 6
TCS CONSTRUCTION SDN BHD
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
3. Noise Control
3.1. Is the CNP (Construction Noise
Permit) valid for work during
restricted hours?
3.2. Are copies of the valid Construction
Noise Permits posted at site
entrance/exit?
3.3. Do air compressors and generators
operate with doors closed?
3.4. Is idle plant/equipment turned off or
throttled down?
3.5. Any noise mitigation measures
adopted (e.g. use noise barrier /
enclosure)?
3.6. Are silenced equipments utilized?
3.7. Others (please specify)
4. Waste Management
4.1. Is the site kept clean and tidy? (e.g.
litter free, good housekeeping)
4.2. Are separate chutes used for inert
and non-inert wastes?
4.3. Are separated labelled containers /
areas provided for facilitating
recycling and waste segregation?
4.4. Are construction wastes / recyclable
wastes and general refuse removed
off site regularly?
4.5. Are construction wastes collected
and disposed of properly by licensed
collectors?
4.6. Are chemical wastes, if any, collected
and disposed of properly by licensed
collectors?
4.7. Does chemical waste producer
license covers all major chemical
wastes produced on site?
4.8. Are chemical wastes properly stored
and labelled?
4.9. Are oil drums and plants/equipments
provided with drip trays?
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 3 of 6
TCS CONSTRUCTION SDN BHD
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
4.10. Are drip trays free of oil and water?
4.11. Is there any oil spillage? Clean-up
the contaminated soil immediately?
4.12. Is litter, foam or other objectionable
matters in nearby water drain/sewer
cleaned?
4.13. Are asbestos wastes handled by
registered professionals?
4.14. Others (please specify)
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 4 of 6
TCS CONSTRUCTION SDN BHD
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
7. Resource Conservation
7.1. Is water recycled wherever
possible for dust suppression?
7.2. Is water pipe leakage and
wastage prevented?
7.3. Are diesel-powered plants and
equipments shut off while not in
use to reduce excessive use?
7.4. Are energy conservation
practices adopted?
7.5. Are metal or other alternatives
used to minimize the use of
timber?
7.6. Are materials stored in good
condition to prevent deterioration
and wastage (e.g. covered,
separated)?
7.7. Are pesticides used under the
requirement of Agriculture,
Fishers and Conservation
Department?
7.8. Others (please specify)
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 5 of 6
TCS CONSTRUCTION SDN BHD
Remarks
Acceptability
(i.e. specify location, good practices,
Inspection Items N/A problem observed, possible cause of non-
Yes No* conformance and/or proposed corrective/
preventative action)
Remarks : [ESH Officer / Supervisor]
Inspected By :
Signature : ………………………. Date :
Name :
Verified By :
Signature : ………………………. Date :
Name :
Doc. Ref. : TCS/PI/EIC Rev. No. : 0 Issue Date : 21 May 2018 Page: 6 of 6
TCS CONSTRUCTION SDN BHD
Signature :
Signature :
Page 3 of 3
NO DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
: APPROVED BY APPROVED BY :
: NAME NAME :
: DESIGNATION DESIGNATION :
6. General Notes
PART A (To be completed by Leader of Investigation Team and returned to Project Manager)
Report No:
Investigation team:
Name Designation
1. (Leader)
2.
3.
4.
5.
Category of incident:
Incident
(1) Accident
Injury Serious Bodily Injury
Ill Health Occupational Poisoning / Disease
Fatality Fatal Injury
(2) Near-miss Dangerous Occurrence
Enclosed Attachment #
Description of the incident:
Enclosed Attachment #
DOC. REF. : TCS/PI/IAIR REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 1 OF 3
TCS CONSTRUCTION SDN BHD
Enclosed Attachment #
How and why did the incident occur?
Enclosed Attachment #
Findings of the investigation:
(List out underlying ESH deficiencies and other factors that might be causing or contributing to the occurrence of incidents)
Enclosed Attachment #
Reported by / Submitted by:
DOC. REF. : TCS/PI/IAIR REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 2 OF 3
TCS CONSTRUCTION SDN BHD
Insurance claims:
The results of the investigation (especially lessons learnt) has been communicated to following personnel:
ESH Committee Chairman
Client / HOD / HOP
Staff / Representative
Sub-Con / Supplier
Other interested parties.
Signature: (Safety & Health Officer)
Name: Date:
DOC. REF. : TCS/PI/IAIR REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 3 OF 3
TCS CONSTRUCTION SDN BHD
Month : Year :
Project :
Frequency Rate
Severity Rate
Near-Miss
Lost Time Accident = For Injuries Resulting In > 4 Days Off Work
Prepared by : Verify by :
……........................................... ……...........................................
Name : ……………………… Name : ………………………
Position : ……………………… Position : ………………………
Date : ……………………… Date : ………………………
Doc. Ref. : TCS/PI/MSA Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 1
TCS CONSTRUCTION SDN BHD
……………………………………………………………………………
Starting Time
Completion Time
Number of participants
(name list attached)
Participation Rate
Name of Officer
(conducted the drill)
Suggestion Items
Action Plan
Signature: Date:
ISSUED BY
Name: ………………………………………………
Safety and Health Officer
PERMIT TO WORK
2. Name of Supervisor In Charge: …………………………………… Tel No: …………………………………… Signature: ……………………………… ……………………………………………………………………..
3. Name of Designated Person: ……………………………………… Tel No: …………………………………… Signature: ……………………………… ………………………………………………………………………
Permit Close-Out
i. Permit Applicant ii. Authorized Personnel
The work activity is complete, all persons accounted for, and the work site has been left in safe All works associated to this Permit To Work has been completed and the related documentation has
condition. The related documentation has been submitted to TCS Authorized Personnel. been submitted to me. I hereby confirm the closed-out status of this Permit To Work.
Signature:……...................... Name :……………………… Position:………………. ……. Date: ………………… Signature:……...................... Name :……………………… Position:………………. ……. Date: …………………
CONTRACTOR DURATION
DOCUMENTATION REQUIRED
RFI MSDS / CSDS
Doc. Ref. : TCS/PI/PTWCSP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 2
TCS CONSTRUCTION SDN BHD
ISSUANCE AUTHORITY
In the event of non-compliance, this permit is automatically invalid and TCS reserves the right to stop work. TCS HSE
Department will not be responsible for any inconvenience caused by the stop work order.
ISSUED BY SIGNATURE
APPROVED BY SIGNATURE
PERMIT EXTENSION
PERMIT CLOSURE
Remarks on site condition:
Doc. Ref. : TCS/PI/PTWCSP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 2 of 2
TCS CONSTRUCTION SDN BHD
CONTRACTOR DURATION
WORKER(S)
NAME
DOCUMENTATION REQUIRED
RFI Gas monitoring record
Doc. Ref. : TCS/PI/PTWCSWP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 2
TCS CONSTRUCTION SDN BHD
ISSUANCE AUTHORITY
In the event of non-compliance, this permit is automatically invalid and TCS reserves the right to stop work. TCS HSE
Department will not be responsible for any inconvenience caused by the stop work order.
ISSUED BY SIGNATURE
APPROVED BY SIGNATURE
PERMIT CLOSURE
Remarks on site condition:
Doc. Ref. : TCS/PI/PTWCSWP Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 2 of 2
TCS CONSTRUCTION SDN BHD
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………...
Time : ………………………………………………………………………………………………………….
Inspected By : ………………………………………………………………………………………………………….
Comments : ……………………………………………………………………………………………………….
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………....
………………………………………………………………………………………………………
Doc. Ref. : TCS/PI/SIC Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 1 of 3
TCS CONSTRUCTION SDN BHD
Acceptability
No Items To be Checked Remark
Yes No
1. Is scaffold erected on firm ground?
12. Are scaffold erected one lift above top most construction level?
Doc. Ref. : TCS/PI/SIC Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 2 of 3
TCS CONSTRUCTION SDN BHD
Acceptability
No Items To be Checked Remark
Yes No
15. Tube and fitting:
a) Is ledger connected to the standard with right
angle coupler?
b) Is transom connected to the standard with right
angle coupler?
c) Is bracing for tube and modular scaffold provided?
Re-Inspection : Remarks :
Doc. Ref. : TCS/PI/SIC Rev. No. : 0 Issue Date : 21 MAY 2018 Page : 3 of 3
TCS CONSTRUCTION SDN BHD
Acceptability
No Items To be Checked Remark
Yes No
s
1. Passenger Hoist Identification No (PMA) is
conspicuously displayed & valid till
2. Hoist max loading capacity notice is conspicuously
displayed
3. 2 X 9 kg portable fire extinguishers (type ABC dry
powder) are in good working condition
4. Electrical main switch box is securely locked and the
key is kept by the hoist operator
5. Housekeeping in and around the cage is satisfactory
6. Outer cage sliding / bi-parting doors are working
satisfactorily
7. Inner cage sliding / bi-parting doors are working
satisfactorily
8. Emergency stop button is working effectively
9. Top and bottom limit switches are working effectively
10. Roof and floor of cage is in good condition
11. The bracket and mask section is tightened firmly
12. The tooth tracks are in good condition
13. Last maintenance date
Re-Inspection : Remarks :
……........................................... ……...........................................
Name : ……………………… Name : ………………………
Position : ……………………… Position : ………………………
Date : ……………………… Date : ………………………
Project Code :
Project Name :
Location :
Operator's Name : Date :
JKKP Registration No : Crane PMA No :
…………………………. ………………………….
Site Safety Supervisor Safety and Health Officer
(Name and Signature) (Name and Signature)
This Checklist shall be done by the Site Safety Supervisor (SSS) and submitted to Safety and Health Officer (SHO).
Project Date
Model Registration
Owner Location
PMA No Validity
Acceptability
No Items to be checked Remarks
Yes No
1. Base (Dates Checked - every 3 months)
a) Bolts checked for torque
b) Grillage steelwork welding checked for distress
DOC. REF. : TCS/PI/MTCC REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 1 OF 2
TCS CONSTRUCTION SDN BHD
Acceptability
No Items to be checked Remarks
Yes No
10. Safety Devices ( Dates Checked - Daily)
a) Overload device tested
b) Slew alarm, anti-collision device tested
(where fitted)
c) Load radius charts in operator cab
d) Out of service free slew operating
e) Maintenance slew lock functional and disengaged
f) Windows are clean
11. Motor
a) Electric checked for safety
b) All cables securely clamped supported
c) Diesel motor serviced, no fuel leaks etc
d) Hydraulic hoses checked. No oil leaks reservoir
checked
e) Meter speed / power within normal limits
12. Configuration
a) Changes since initial installation
b) Re-overload test applied
The above checks where applicable, have been carried out as indicated. The crane manufacturer’s / supplier’s own
schedule of routine checks and inspections have also been fully complied with and recorded.
Non-Conformance : Action / Correction :
Re-Inspection : Remarks :
DOC. REF. : TCS/PI/MTCC REV. NO. : 0 ISSUE DATE : 21 MAY 2018 PAGE : 2 OF 2
TCS CONSTRUCTION SDN BHD
Project Date
Model Registration
Owner Location
PMA No Validity
Acceptability
No Items To be Checked Remarks
Yes No
1. Operator Competency Certificate issued by JKKP
(validity)
2. Slewing Alarm
3. Reversing Alarm Complete with Flashing Light
4. Boom Angle Indicator
5. Load Chart and Load Indicator
6. Over Hoist on Main and Auxiliary Hoist Alarm / out off
7. Over Boom Cut Out
8. Fire Extinguisher in Cab
9. Crane Hook with Safety Latch
10. Ropes Sleeves Condition
11. Out riggers (Mobile Crane)
12. Tires / Track Condition (Mobile / Crawler Crane)
13. Slings Condition
14. Warning Horn in Cab
Re-Inspection : Remarks :
Re-Inspection : Remarks :
Re-Inspection : Remarks :
Condition
Fire Extinguisher Type of Size /
Serial Number Location Date of Refill Date of Expiry Remarks
Number Extinguisher weight A NR D NM
10
11
12
General Remarks:
Key: A = Acceptable at time of inspection NR = Needs re-filling / re-charging
D = Damaged – Must be removed from site NM = Needs maintenance
Checked By: ______________________________ Position : __________________________ Signature: _________________________
Inspected By : _____________________ Condition Key: Marking Status Key: (ID, SWL, Colour
Position : _____________________ A = Acceptable at time of inspection Code)
AM = Acceptable at time of inspection
Signature : _____________________ B = In poor condition BM = Poor marking status
Date : _____________________ CM = To be re-tested / marked
C = Damaged – to be removed from site
Saya juga bersedia mematuhi peraturan-peraturan yang telah ditetapkan sebagaimana di bawah;
I agree to comply to all regulations as below;
Disaksikan oleh
Tandatangan / Tandatangan /
: :
Signature Signature
Nama Ketua /
Nama / Name : :
Leader’s Name
Tarikh / Date : No. k/p / i/c No. :
Tarikh / Date :
ITEM DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Engine Oil Level
2 Check Cooling System (Water)
3 Check Fan Belt Tension
4 Check Air Filter
5 Check Hydraulic Oil Level
6 Check Battery Water Level
7 Check Fuel Line For Leaks (Diesel)
8 Check Brake Fluid Level
9 Check Automatic Transmission Oil Level
10 Check Under Carriage For Any Oil
11 Check Tyre, Bolts & Nuts Condition
12 Check All Meter At Panel
13 Check Handbrake Operation
14 Check Steering Wheel Play
15 Check Rear Axle
16 Check Back Rest
17 Check Mast Assembly and Fork Condition
18 Check Overhead Guard
19 Warm-Up The Engine For 5 Minuts
20 Check Smoke Colour
21 Check operation Hydraulic, Lifting
22 Check Lifting Chain Tension
23 Others
NOTE: PLEASE WEAR SAFETY HELMET, BOOTS AND GLOVES (COTTON) BEFORE OPERATING THE FORKLIFT.
Inspected By : Verified By :
EQUIPMENT
MODEL NUMBER
CONTRACTOR
PROJECT
DATE OF INSPECTION
NEXT INSPECTION
Inspected by
Signature
(Name)
Witnessed by
Signature
(Name)
Company Name Date
Doc. Ref. : TCS/PI/BRDC Rev. No. : 0 Issue Date : 21 MAY 2018 Page 1 of 2
TCS CONSTRUCTION SDN BHD
Grease
1
Check fixing pins are tights and secure
ROPE SWIVEL
Test swivel rotates freely
2
Inspect for wear and damage
KELLEY BAR
Inspect for excessive wear broken wires or other
3 damage
CROWD ROPE Check fix points are secure
OR
Check cylinder are leak free
CROWD CYLINDER Check fixing pins are secure
Clean piston rods
Clean the tool
4
Inspect teeth, chisel and auger for wear,
DRILLING TOOL
Replace with new or rebuild by welding as required
Doc. Ref. : TCS/PI/BRDC Rev. No. : 0 Issue Date : 21 MAY 2018 Page 2 of 2
TCS CONSTRUCTION SDN BHD
LOCATION : EQUIPMENT:
INDO: REGISTERED:
YEAR OF MGG PMA NO.
ENGINE NO. SERIAL NO.
HOUR METER OPERATOR
HOUR
ITEM DESCRIPTIONS REMARK
10 50 250 1000 2000
1 Bucket & Link Pins Check/Grease
2 Bucket Teeth for Wear and Looseness Check/Replace
3 Coolant Water Check/Top Up
4 Fuel Tank Sump Drain
5 Fuel Hose Leaks & Cracks Check/ Replace
6 Hydraulic hoses & lines for leak Check/ Replace
7 Hydraulic oil level Check/Top up
8 Oil Level Check/Top up
9 Window & wind screen Clean
10 Battery Check/Top up
11 Fan belt tension Check/Replace/Adjust
12 Track sag Check/Adjust
13 Water separator Check/Replace
14 Front joint pins & link pins Check/Grease
15 Air cleaner element Check/Replace
16 Hydraulic Oil Tank Sump Drain
17 Swing Reduction Gear Oil Level Check/Top up
18 Transmission Pump Oil Level Check/Top up
19 Travel Reduction Gear Oil Level Check/Top up
20 Engine oil bypass filter Change
21 Engine oil bypass filter Change
22 Engine oil main filter Change
23 Fuel filter Change
24 Hydraulic Tank Oil Filter Change
25 Swing Bearing Check/Grease
26 Swing Internal Gear Check/Grease
27 Radiator & Oil Cooler Core Clean
28 Engine Valve Clearance Check/Adjust
29 Feed Pump Strainer Clean
30 Pilot Oil Filter Change
31 Pump Transmission Oil Change
32 Swing Reduction Oil Change
33 Hydraulic Oil Change
34 Hydraulic Oil Filter Change
PROJECT : DATE:
LOCATION : EQUIPMENT:
INDO: REGISTERED:
YEAR OF MGG PMA NO.
ENGINE NO. SERIAL NO.
HOUR METER OPERATOR
HOUR
ITEM DESCRIPTIONS REMARK
10 50 250 1000 2000
1 Alarm Test/Replace
2 Brake Test/Adjust
3 Engine oil level Check/Adjust/Replace
4 Fuel Refill
5 Fan belt condition Check/Adjust/Replace
6 Hydraulic Check/Top up
7 Radiator coolant level Check/Top up
8 Scraper setting Check/Top up
9 Air cleaning element Check/Replace
10 Battery Check/Top up
11 Drum Oil level Check/Top up
12 Hydraulic Hoses & Lines Check/Replace
13 Rubber Element & Fastening Check/Replace
14 Steering Joints Lubricate
15 Steering cylinder bracket Lubricate
16 Tyre pressure Check
17 Wheel nut Tighten
18 Control & moving joints Lubricate
19 Engine oil Change
20 Engine oil filter Change
21 Hydraulic oil cooler Clean
22 Hydraulic oil level Change
23 Rear axle planetary gear oil level Check/Top up
24 Transfer gearbox oil level Check/Top up
25 Torque Hub Oil Level Check/Top up
26 Engine Valve Clearance Check/Adjust
27 Fuel filter Change
28 Fuel tank condensed water Drain
29 Hydraulic Tank Venting Filter Drain
30 Supply Pump Strainer Change
31 Drum Oil Clean
32 Hydraulic Tank Change
33 Hydraulic Oil Clean
34 Pump Drive Oil Change
35 Rear Axle Planetary Gear Oil Level Change
DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water
level
Fan belt condition
Alternator belt
condition
Main hoist wire
rope
Boom hoist wire
rope
working light
Swing/propel
alarm
Boom structure
Instrument gauge
Hydraulic system
Guards
Electric wiring
Electrical
connection
Operator initial
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Engine oil level
Fuel level
Radiator coolant
Power shift oil
Battery water level
Fan belt condition
Alternator belt
condition
Gear oil level
Head light
Rear light
Signal light
Swing/propel alarm
Horn
Instrument gauge
Wiper blade
Tyre
Brake system
Hydraulic system
Guards
Pneumatic hoses
Safety relieve valve
Electric wiring
Electrical
connection
Operator initial
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Engine oil level
Fuel level
Track system
Radiator coolant
Power shift oil
Battery water
level
Fan belt
condition
Alternator belt
condition
Gear oil level
Working light
Swing/ propel
alarm
Instrument
gauges
Brake system
Hydraulic
system
Guards
Electric wiring
Electrical
connection
Operator initial
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
Inspected by : Verify by :
……....................................................... …….......................................................
Name : ………………………............ Name : ……………………............…
Position : ………………………............ Position : ……………………............…
Date : ………………………............ Date : ………………………............
DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Engine oil level
Fuel level
Radiator
coolant
Battery water
level
Fan belt
condition
Alternator belt
condition
Gear oil level
Working light
Swing/ propel
alarm
Horn
Instrument
gauges
Wiper blade
Load indicator
Boom angle
device
Hydraulic
system
Guards
Electric wiring
Electrical
connection
Operator
initial
Ref. No.:
Project Name:
Month:
Company:
CHECKLIST ITEMS
DATE / EVERY THURSDAY
NO CHECKLIST ITEMS Week 1 Week 2 Week 3 Week 4 REMARKS
1 Engine Condition
2 Diesel Level
3 Engine Oil Level
4 Water Level
5 Cabin
6 Hydraulic Condition
7 Contril Level
8 Bucket
9 Tires
10 Exhaust
11 Headlight
12 Reverse Light
13 Siren
OTHERS REMARKS
Subcontractor/Supplier Maincontractor/Client
INSPECTED BY APPROVED BY (PM) ACKNOWLEDGE BY
Name: Name: Name:
Position: Position: Position:
* This form must submitted to maincontractor/client Safety & Health Department on the fourth week
* Please keep this inspection list in proper storage
Company:
Model:
Capacity:
Manufacturer:
Date of Inspection:
Date of Deployment:
RESULT
NO ITEMS INSPECTED REMARKS
PASS FAIL
1 Tire Condition
2 Condition of Exhaust System
3 Condition of Electrical Control Panel
4 Drip Receiving Pan Provided
5 Condition of Machine Lifting Eye
6 Condition of Tower Bar
7 Battery Condition
8 Condition of Engine Cooling System
9 Engine Oil Level
10 Engine Oil Leakage
11 Grounding System Condition
12 Charges Fire Extinguisher Provided
13 Condition of Boom Hoisr Cable / Winch / Pulley
14 Condition Of Lamp / Lenses / Reflector Units
15 Out Rigger Condition (If Applicable)
16 Power Cable Condition (Damage / Joints)
17 ELCB Unit Provided
OTHERS REMARKS
Subcontractor/Supplier Maincontractor/Client
INSPECTED BY APPROVED BY (PM) ACKNOWLEDGE BY
Signature : Signature : Signature :
Company:
Model:
Capacity:
Manufactor:
Date of Inspection:
Date of Deployment:
RESULT
NO ITEMS INSPECTED REMARKS
PASS FAIL
1 Condition of Exhaust System
2 Condition of Electrical Control Panel
3 drip Receiving Pan Provided
4 Battery Condition
5 Start / Stop Mechanism (Ignition Switch etc.)
6 Over-all Machine Condition
7 Engine Oil Level
8 Engine Oil Leakage
9 Grounding System Condition
10 Charged Fire Extinguisher Provided
11 Pulley Guard in Position
OTHERS REMARKS
Subcontractor/Supplier Maincontractor/Client
INSPECTED BY APPROVED BY (PM) ACKNOWLEDGE BY
Signature : Signature : Signature :
Company:
Model:
Capacity:
Manufactor:
Operator Name:
NRIC No.:
License Type/Validity:
Date of Inspection:
Date of Deployment:
RESULT
NO CHECKLIST ITEMS REMARKS
PASS FAIL
1 Forklift body and Overhead Guard Condition.
2 Battery Cables / Clamps.
3 Head Light / Turn Indicator / Break Light Function.
4 Rotating Beacon light Function.
5 Mirror Condition.
6 Preventive Maintenance Records.
7 Ignition switch / Engine stop mechanism.
8 Drive Belts Condition.
9 Government / 3rd Party Certification provided (if required)
10 Fire Extinguisher Fitted and Charged.
11 Engine / Radiator Coolant / Break Oil Level.
12 Seat Belt Condition.
13 Hydraulic Oil Level.
14 Hydraulic RAM / Hoses / Fittings Leakage.
15 Load Chain / Anchor / Mast Assembly.
16 Tire Condition (Worn / Damage / Inflated).
17 Backup Alarm / Horn Function.
18 Fork Condition / Load Chart.
19 Hydraulic Control Levers / Steering Wheel.
20 Parking Brake / Foot Brake / Inching Brake.
21 Gauges / Indicators / Switches and Controls Conditions.
22 Hydraulic / Transmission Oil Leakage.
OTHERS REMARKS
Subcontractor/Supplier Maincontractor/Client
INSPECTED BY APPROVED BY (PM) ACKNOWLEDGE BY
Signature : Signature : Signature :
NOTIFICATION OF PENALTY
Project :
TO
You are hereby notified that you / your worker (s) have committed the following breach / non-compliance on QESH RULES
Description of Non-Compliance /
PHOTOGRAPH / SKETCH
Offence
In accordance with the TCS Construction HSE Management System, we are imposing a fine as specified below and will be
deducted from the progress payment / salary due to you.
Project Director
DISTRIBUTION LIST
Quantity Surveyor
Finance
Status :
i. EXECUTIVE SUMMARY 1 of 12
1. MONTH 1 of 12
2. Workplace Description 1 of 12
4. SHO Report 1 of 12
‘We have achieved above xxxx million safe man hours without lost time injury’
The ‘xxxx’ project has achieved Approx. xxx million cumulative man-hours worked up to (insert date)
The project has accomplished Zero LTI free man-hours worked since last LTI on (insert date last
incident)
X No. First Aid cases occurred during the month of (insert current month)
Total xxx nos of Construction Vehicles (please give example) were inspected and stick green
sticker after inspection during the month of (insert current month).
Total xx nos of Safety trainings conducted at site and achieved xxxx man months during the
month of (insert current month).
Total xxxx man-hour achieved from tool box briefings such as incident alerts, hazard & fire safety
to site etc. conducted at site.
Xx Persons safety Induction conducted during the month of (insert current month).
Total xx nos Housekeeping Inspection conducted at site during the month of (insert current
month).
Xx nos Work Permit has been issued for (insert work activity) during the month of (insert current
month).
Issued mandatory PPE to the workers and ensure its proper use at site and PPEs stock list has
been attached with the monthly report as Appendix 1
No Description Details
2.1 Project Name
2.2 Project Target (Man-hours Worked without LTI)
2.3 Man-hours Worked without LTI
2.4 Total Man-hours Worked (With or Without LTI)
Previous Cumulative
No. Indicator This Month Total Total to Date
Total
1 HIRADC Establishment
2 HIRADC Review
3 Toolbox Meetings
4 On Job Training
5 Emergency Response Drills
6 HSE Committee Inspection
7 Daily/Weekly Observations
8 Environmental Monitoring Conduct
You See You Act
9 HSE Promotion/Campaign (Provide Details at 8.2)
4.1 Compliance with OSH Legal and Other Requirements [Reg. 19(2) a]
4.2 Method of Establishing and Maintaining a Safe and Healthy Working Condition at the workplace [Reg. 19(2) b]
Elements Date Status (Pass / Fail) ; if fail please include Action Taken Status follow-up
the parameter
Air
Water
Noise/Vibration
Waste/Recycling
Flora/Founa
No. Date Inspected Previous Rating Current Rating Category Close Out Status
4.2.4 Internal/External Audit (i.e TCS Internal Audit, SIRIM Audit, Client Audit, Authority Audit)
6.0 Any Machinery, Equipment, Appliance, Substances or PPE Required for the Purpose of Minimizing Any Such Risk [Reg. 19(2) e]
7.0 Recommendation Any Alteration to Structure and Layout for OSH Purpose [Reg. 19(2) f]
9.1 Issuances of Notices from Authority Body ( eg DOSH, DOE, CIDB or Local Authority)
Type of Notices
No Date Non-Conformance Issues Status
(NOI/NOP/Others)
Type of Project
No Accident Date Pending Action Action By
Accident Investigation Status
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
……………………………………………………………………………………………………………………………............................
………………………………………. ……………………………………….
Name: Name:
Date: Date:
Note: This report to be produced and submitted to Person in Charge before the 10th every month.