M/s UNIQUE ENGINEERS

Work Order No. : Work permit no. :

Audit Date : Work Area :
Audit Time : Audit by : Mr. RAJESH KUMAR Supervisor's Name : Mr.
Sl.No Description of SAFETY condition STATUS (Yes/No) REMARS
1 Whether Stumbling Hazard found
2 Whether House Keeping done
3 Tools & Tackles (Availability, Right kind & how they are using)
4 Whether Tool box meeting organise by supervisor daily
5 Is Material Handling Methods found to be satisfactory
6 Is Adequate of Aisle space and working space available
7 Is Guarding of transmission machinery done properly
8 Point of Operation guards
9 Maintenance
10 Whether Hand tools found adequate to work at site
11 Ladders, portable, stops, hoses etc.
12 Is condition of Hand/Power-trucks, wheel barrows, buggies etc. are OK
13 Floors, platforms, stairs, railings.
14 Crane hoists, derricks, plant railways
15 Is Lighting condition of job site appropriates
16 Condition of Electrical Equipment i.e. extension cords are safe
17 Elevators
18 Is condition of Personal Protective Equipment (PPE) are satisfactory
19 Environmental condition : Dusts, fumes, gases, vapours etc.
20 Pressure vessels
21 Any other explosion hazards as volatiles, gases chemicals
22 Other dangerous substances recognised (if so, mention)
23 Status of Oiling methods
24 Inspection of chains, cables, slings and other lighting tackles found OK
25 Access to over head equipment
26 Is Safety belt condition and their uses (as per safety measure)
27 Is job doing as per SOP (mention No.)
28 Is Exists-point available are site.
29 Yards, roofs and roadways
Any other conditions suggested by the accident records
30 (mention in details)
Addition Note/Remarks : -
 WEEKLY FIELD SAFETY OBSERVATIONS
Agency - M/S J.P.CONSTRUCTION

Work Order No. :

Audit Date/Time :
Sl. No. Description of Severity Rating Audit Team Mr.
1 Untidy Area Minor Issues sets pool Example Mr.
2 Restricted access, Unacceptable Trash, Disorderly Mr.
3 Rule or Procedure violation, Potential Injury Mr.
4 Unsafe Conditions, Serious Injury Potential Location
5 Immediate Serious Injury Potential, Stop Activity Audit Time
Immediately and correct Weather
Total No of employees

Description Responsible No. of Person Violations Leading Indicators

Tata Steel Engineers

Violations x Severity

SOP & Six Direction

Unsafe Condition
No. of Violations
Good Citizens

Work Permit
Contractors

Unsafe Acts
Comments
Violators

Severity

Scaffold
Trash
4&5
1

Sub Total

No. of People on Site

Approximate No. of workers Observed

No. of Observed People Working Safely

% of Worker Observed

No. Of Violations

Average Severity of Violations

Severity Index (S.I)