Hindustan Coca-Cola Beverages Pvt.

Ltd

Annexure 3 Pre Startup Safety Review for Any change in existing line/process/Location
in Existing Plant

Equipment Name: Date:

Checked By:

Sr.No. Description Status Remark

1 Coupling guard
2 Motor Guard
3 Belt guard
4 Chain guard
5 M/C front guard
6 M/C Rear guard
7 M/C Top guard
8 Pre conveyor guard
9 Motor double earthling
10 MCBS’s
11 ELCB’s/RCCB
12 Glands
13 Wiring
14 Emergency switch
15 Lock Out Tag Out provision done
16 Inter lock system/ Limit switch
17 Panel double earthing
18 Heater double earthing
19 Panel door closing
20 Safety rubber mat available
21 Space for GHK
22 Men Machine Segregation
23 Appropriate Safety Signage’s
provided
24 Swing Gate for all intersection of
men/machine movement & at
work at height platform
25 Monkey cage gate and Locking
Arrangement
26 Cage extension to 1m height
from the top landing

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 Hindustan Coca-Cola Beverages Pvt. Ltd

Annexure 3 Pre Startup Safety Review for Any change in existing line/process/Location
in Existing Plant

27 Toe guard provided

28 MSDS Available
29 Boiler Safety Automation With
SMS services
30 Guy Rope for Chimney
31 Separate Ozone Chamber with
interlock
32 O2 meter for Asphyxiant gases
33 PPE Matrix
34 Locking arrangement for
Confined space entry
35 Gas Cylinder Storage area with
proper segregation arrangement
and Vertical tie up arrangement
36 Fire Extinguisher/Fire
Hydrant/Sprinkler/Alarm &
Smoke Detection system
provided
37 Jumpers for flange joints for
material which can generate
static charge
38 Has work being done as per
Mode Note & PHAR
39 Risk Assessment Completed
40 All Legal License/Certificate
Obtain -Pressure vessel/Lifting
tools Certificate/Structure
stability certificate
41 Others:

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 Hindustan Coca-Cola Beverages Pvt. Ltd

Annexure 3 Pre Startup Safety Review for Any change in existing line/process/Location
in Existing Plant

Change Initiator: Dept. Head: Safety in Charge:

Name: Name: Name:

Sign: Sign: Sign:

FORMAL CLOSURE OF CHANGE – After All precaution & Action implemented, The
Change will formally closed by Initiator and site safety in charge.

Initiator:

Safety in Charge:

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