SAFETY CHECK FOR
LUBE OIL FLUSHING
Name of site: -
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Date: -
Job Location: - Equipment Number:
SI. Observation
Description Remarks
No. Yes/No/NA
1. Circulation loop identified
2. Leak test of the line completed
3. Permit available
4. Housekeeping of the area complete
5. Greasing done on the rotary parts
6. Guards provided on rotary parts
7. Entry to area restricted & warning board placed
8. Proper light and Access ensured
9. Information communicated through tool box talks
10. Fire extinguishers/ sand buckets placed
11. SIMOPS in the area stopped
12. Emergency stop button provided
13. Temporary connections are checked for integrity
14. Tagging of the lines
Name of Site Engineer: _______________________Name of HSE Engineer: ____________________
Signature: _________________________________ Signature: ______________________________
Date: _____________________________________ Date: __________________________________
Document number 1