Inspection Check List-Pursuant to Clause 22.
2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 1 of 6
MARKING SYMBOLS Satisfactory Needs Improvement Not Applicable
WORKPLACE SAFETY
Mark Description Corrective Action/Remark
Workplace is clean and orderly maintained
Employee’s work areas are adequately illuminated for late night
Work.
Employees are not engaged ergonomic hazard, e.g. awkward
Posture, prolonged repetitive motion, contact stress, etc.
Exits are cleared of obstructions and accessible
Stored materials are secured and limited in height to prevent
Collapse
Employees are not engaged in unsafe acts, e.g. using chairs or
Tables as step stools etc.
Are ladder in good condition; free from defects
Are safe step stools and ladders available when necessary and
Are they properly used
Is air passes is good in working area, it is not suffocative
Are chemical products properly used, labeled and stored
Are Health and Hygiene is in practice? Nobody eating at work
Place.
Is the Company Safety Policy posted up-to-date?
Are routine Workplace Safety Inspection being conducted and
Recorded in file?
Are unsafe/unhealthful report forms readily available to
Employees?
Are AHA’s readily available at work center?
Is MSDS available at work site?
Are manhole and ditches are safely covered or barricade?
HOUSEKEEPING
Mark Description Corrective Action/Remarks
Are walkways correctly maintained and clear
No evidence of possible tripping hazards
Floors dry – not slippery
Cords are not stretched across aisles or under carpets
Floors are clean and free from slippery
Entrance Is properly marked, lighted for night
Access and egress are free from hazards
Toilets and baths clean and well ventilated
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 2 of 6
Construction materials are in correct place in proper order.
Electrical cables, water pipe line are not crossing walkways
Cement bags are not stack as brick style not more than 10 bags
In height
Bricks are stacking less than 6’ height with proper space in layer
Timbers and logs are managed properly after concrete aged
Steels are properly covered the sharp tips with red cloths
Constructions equipment are cleaned and are in proper place
Scaffolding pipes and clamps are safe keeping
While curing water is not access to the sensitive area
While storing material ensure about emergency access
Fuel storage is free from ignition source
STAIRWAYS, STORAGE ROOMS, EMERGENCY EXITS, FIRE EXTINGUISHERS, KITCHENS
Mark Description Corrective Action/Remarks
Adequate lighting in stairway, aisle, or storage room
Rooms are clean and good condition
Stairways are clear of materials and equipment – not cluttered
Emergency exits are clearly marked and accessible
Fire extinguishers are accessible and fully charged
Stairways are provided with anti-slip treads and in good condition
Fixtures and signage securely fastened to the walk
Supplies and materials stored properly on shelves
Does storage layout minimize lifting problems
Heavy storage shelves are fastened to the wall
Trolleys/dollies available to move heavy items
Racks and shelves properly installed and good in condition
Electrical outlet and switch are safe distance for material
Storing on shelves heavy items are on bottom and light on top
MSD are maintained for each sensitive item stored
Spill control measure are in places
Fire extinguisher is available at store and is in good condition
Emergency handling equipment and material available
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 3 of 6
Access and egress is not blocked and those are marked
Unauthorized person are not entering at store
Material on shelves are not overloaded
Designated staff is attending on the store (storekeeper)
Store staff is using mandatory PPE
First AID box is available near the working area
Emergency number and route map is fixed on the wall
Store staff know how to handle emergency situation
Employee are familiar on assembly point and escape procedure
Everyone are familiar to emergency program, kits
ELECTRICAL SAFETY AND LIGHTING
Mark Description Corrective Action/Remarks
Electrical outlets are not overloaded
Equipment is properly grounded
Electrical cords and plugs are in good condition
Extension cords are not being used for permanent wiring
Clear access to electrical panels and switches
Sockets and switches are in good condition
Lighting levels adequate for the work area
Work areas free from glare or excessive lighting contrast
Task lighting provided in areas of low light or high glare
Power strips and extension cords UL-Approved
Electrical cords arranged in such a way as to not create tripping
or other hazards
Electrical cords kept out of doorways or isles
Breaker boxes and junction boxes securely covered
Heat-producing appliances plugged directly into a hard-wired
Outlet, not extension cords
Electrical panel boxes closed and lock properly
Emergency light is in operational
NOISE
Mark Description Corrective Action/Remarks
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 4 of 6
Feasible engineering controls is in place
Hearing protection provided where sound levels exceed
Hazardous noise areas identified and marked
TOOLS EQUIPMENT AND MACHINERY
Mark Description Corrective Action/Remarks
Lockout procedures in place
Tag out procedures in place
Guards cover and safety devices on equipment
Tools grounded or double insulated cords are in use
Load rating on the equipment and power supplied marched
Equipment clean and free from defect
Operator’s service manuals available for the equipment
Electrical cords in good condition with proper grounding, GFCI
Emergency stop buttons is operational
Area adequately ventilated
Appropriate PPE (Safety glasses, gloves, hearing protection,
respirators, etc. ) available.
EMERGENCY PREPAREDNESS & HANDLING
Mark Description Corrective Action/Remarks
Emergency response plan in place for work area
Emergency response team is formed and are trained
Personnel aware of what number to call for emergencies and
reporting procedures
Assembly point clearly visible, unobstructed
Do personnel know who their safety Rep/Camp Warden
Alarm system is established
Access/egress safe for employees and visitors
Emergency Kits are in place
Wheel barrow for emergency use
Personnel trained in the handling of HAZMAT
Containers containing chemicals properly labeled
Containers of non-hazardous chemicals also labeled to avoid
confusion
Current MSDS readily available for each HAZMAT
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 5 of 6
Inventory of all HAZMAT maintained
Appropriate PPE worn when required
Gas cylinders properly supported and stored
Flammable materials are stored properly and ventilated
Decanted flammable liquids vessels are also properly
NO HAZMAT store above or next to sinks
Employees have completed hazard communication
Fluorescent light tubes properly disposed
Hazard warning signage with emergency contact names and
numbers posted on entry door
Eyewashes available, accessible and functional
Personnel trained in proper spill clean-up
Emergency contact Number
Emergency evacuation Route
Emergency contact number for key personnel
Nearest Hospital contact number
Social Mobilizer’s contact Number
Emergency response plan
PPE
Mark Check Points Remarks
Eye Protection applied correctly to protect eye from flying
particles and corrosive substances?
Are gloves using at the site as per job nature on the sites?
Are provided Hard Hat applying by Workers?
Are Hard Hat being checked its shell and suspension system?
Are foot protection using to protect from corrosive, poisonous
substances, cursing and penetration?
Are provided respirator regularly using by workers and staff?
Are ear plug, ear-muff using by workers working at the noisy
workplace?
Are provided PPE have been inspected, cleaned and sanitized?
WALK-WAY
Mark Check Points Remarks
Are wet and slippery surface guarded and signs put to warn road
users?
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 6 of 6
Are holes in floor, sidewalk or other walking surface repaired
properly, covered or made safe?
Are floor opening guarded by cover?
Are toe-board installed around the edges of the permanent floor
opening?
Are unused pits are guarded or covered?
Are signs posted, when appropriate, showing the elevated
surface load capacity?
Is material piled, stacked or racked in a manner to prevent it
from tipping, falling or rolling?
Are emergency exit clear free from obstruction?
Are special precaution taken when carrying construction
material to the worksite in walk way?
LADDER
Mark Check Points Remarks
Are all ladder checked and maintained?
Are rungs and steps are free from greasy substances?
Are those free from defects, while it is being used, is it
positioned correctly?
Are workers and staff oriented for the use of particular ladder?
Are the rungs of the ladder uniformly spaced at 24” and is
perfectly centered.
Are ladder keeping in safe place to protect from weathering?
HAND TOOLS AND EQUIPMENT
Check Points Remarks
Are all tools and equipment used by workers at workplace in
good condition?
Are hand tools, chisel, punches, having mushroomed heads
during use and replaced as necessary?
Are broken or fractured handles on hammers and similar
equipment corrected promptly?
Are worn and bet wrenches replaced regularly?
Are safety glasses, face shields, and similar equipment used
while using hand tools or equipment?
Are tool handle wedges tightly in the head of all tools?
Are tools stored in dry, secure location where there won’t be
tampered and rusted?
INSPECTION TEAM
NAME POSITION SIGN DATE
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST
Date: Number of Page 7 of 6
