The First by DTHE

S RFIRST
.
BY D S R
Srno
Date:
List of Passenge Hoist Check list,
control
measu List of Control Measures Action by
res.
Existing Control Measures yes No

1 Authourized person to operate hoist only

2
All the moving and rotating parts of PM hoist should
be gaurded.

3
Floor edges to be covered with hard barricationand
safety gates shoulde be the place.

4 Pm Hoist third party certificate is avaialable

5 Body earthing is provided to pm hoist.

6 Is there portable fire extenguisure is avaialble in hoist.

7 Is there first aid box available in hoist.

8 Top and bottom limit switches are working condtion.

9
Mechanical and electrical interlocks system is working
in good condition.

10 Safety devices is in working conditions

11
All the DB boards should be in good condition and
protect by rain

12 Safe working load chart display in hoist.

13
counter roller, safety for trailing cable guide roller
should be check in weekly once.
: Project Manager Name
Safety officer:

Name Name

Signature: Signature:
 THE FIRST BY D S R & ANUKAR PROJECT PRIVATE LIMITED.

DE SHUTTETING PERMIT DATE:

Permit Validity
Issuing Date: Start Time

Expiry date: Finish time

Location of work
Description of work
Total number of workes:
Work to be carried out
Precautions yes no
SR NO
1 Are athorized persons only to de shuttering the slab.
2 Is the platform been provided areas below is barricated with
caution board displayed.
3 Ensure safety net has been fixed under the de shuttering area.

4 Check wheather safety harness and necessary arrangements has

been made for tying life line.
5 Ensure safety net has been fixed under the de shuttering area.

6 Safety helmet shoes and safety belts has been properly worn and
secure.
7 Proper lighting arrangements t be done if work is continued in
night .

8
Is the platform been provided areas below is barricated with caution
board displayed.

9 First aid box has been kept near de shuttering area.

10 Is safety training given for all the persons of de shuttering.

Any specific precautions:

Sub Contractor
Project Engineer
Safety incharge.
supervisor Name name;
signature signature. signature.
signature of PMC
1 Permit shall be displaced at work till the completion of work
2 permit to be obtained for working at height of 0.2mts of above
3 De shuttering to be stop during rain and high wind speed.
4 Permit to be hand over to site safety incharge after completion of work.
 The First By D S R
INCIDENT REPORT
TO: D G M ( The first by D S R(
FROM: HSE OFFICER
Name: C M A G pm hoist installation
Contractor
Full adress of contractor: hyderabad

Date:21/12/2018 Accident: Basement AM/PM : 3:45pm

Add location: B 1 ( Ground Floor)
Description Full description:Around 3:45pm while fixing new hoist muster with jib saw fixed to pm
of accident. hoist on top accidently wire rope got broken due to that reason one muster fall down on
another stand by new pm hoist from top.

name of the person: nil gender : nil age: nil

nationality: nil occupation: nil Adhar card no:

Information
of injury Full adress : nil
mobile number: nil
subcontractor responsible: nil
Nature and extend of injury(Sickness)
Hospital Name
Medical Has the injured resume to work:
Treatment Attach medical certificate (Report any)
name of owner: Telephone no:
Adress:
Property kind of property and extent of damage: (C M A G pm hoist) roof top sheet damage, front
Damage and backside railling damage.

Root cause main wire rope damage and helper not available.

Corrertive 1) to be monitored by competent person

and
preventive
action 2) area to be barricated.

Name: Signature: Date:

Site Project Manager:

Name of Hse signature: Date:
officer:khaja asifuddin
 THE FIRST BY D S R
CONDUCT VOILATION NOTICE.
1) Notice No: Date:

2) Contractor Name : MITRA COSTRUCTION

3) Name:
4)Designation: SITE FOREMAN
5) Date of voilation: 0 /8/2019 Time of voilation:
6) Voilation and category of voilation:
please tick ( ) as necessary
Repeated voilation. Descripton of voilation: WORKING ON SITE WITHOUT SAFETY HELMET AND
NOT FOLLOWING SITE SAFETY INSTRUCITONS.
Misbehavior

Not following Hse

documented
procidure.

Other voilations:

7) Evidenced description any photographe Attached:

8) Issued by (intiator) D S R Hse Officer 9) Approved by D G M:
Name:

10) This is your ………. Warning letter by he 11) under th rule of the comp;any
company .if you commit another offence second
warning letter will be issued with penalty. a)first writter warning ;
b)Fine of rupees:
c) Any other offence:
12)Employee warned: 13) Witness:

Note: when the employee does not understand english this warning letter to be explained to
him in his native language.