LIGHT VEHICLE INSPECTION CHECKLIST

Name of Operator/Driver

Nokia Subcontractor Company (if Available)

Transfer of vehicle from – Name of
Operator/Driver
Location of Inspection

Date & Time

Vehicle Plate Number

Odometer

Vehicle size/bearable weight

Vehicle Brand

Nominated Name in case of Emergency Merlinda Pagalan – 0915-8816660

Vehicle verification and visual walkthrough Yes No N/A Remarks

1 Seat belts available for all passengers in the vehicle

Check availability of suitable/calibrated fire extinguisher,
2
jumper cable, safety sign (if local requirement), first aid box
3 Check the oil and water level
4 Check the brakes if functioning correctly
Check rear markings and reflectors are clean and well
5
functioning (mandatory if traveling at night)
6 Check wipers are functioning well and water is provided
7 Check the horn of the vehicle
8 Check mirrors are in good condition and easily adjustable
9 Check that the speedometer is functioning correctly
10 Check vehicle to trailer coupling
11 Check bumper bars are in good condition
12 Fuel indicator shows sufficient fuel for the journey
Audible reversing device available and functioning (for
13
pickup, van and heavy vehicles)
14 Check the service history/maintenance records
15 Check the validity of the vehicle license
Check the spare tire and reflective triangle is available and
16
in good condition

Life Saving Rules - Road Safety

 RISK HAZARD ASSESSMENT
SCOPE OF WORK :
PLA ID/Site Name :
Date Start :
Date End :

Sequential Steps for Potential Hazards Risk Safety Precautions/Preventive

No.
Completion of Works Arise from the Work Level Measures to Control the Hazards

Acknowledgement
I understand this work plan
requirements and agree that the above
proposed work activities will always be
accomplished in a safe condition, in
accordance with the controlled
measures. All person under my
supervision have been informed.
I have reviewed & endorsed that the
proposal work will be completed in on
effective safe practice and condition.
I have been informed that these job
activities and all the preventive
measures are appropriate, in place and
will be followed. The safety
requirements of this permit have been
explained to the permit holder and
work may proceed with initial risk.

Prepared By Team Reviewed By Project Manager/HSE Checked by NOKIA HSE Persnnel

leader/Supv/Appointed and Trained Personnel/Site Safety Supervisor & (When on Site Check or Any
Personnel: /Appointed& Trained Personel: Communication Means)

Name : ____________________ Name : ____________________ Name : ____________________

Signature:__________________ Signature:__________________ Signature:__________________
Date : _____________________ Date : _____________________ Date : _____________________
*Risk Level:
HIGH RISK (H): Extensive actions are required to control this risk level (i.e can cause fatality, Major and Minor Injury, High Property
Damage,
Etc.
MODERATE RISK(M): Appropriate controls are required (i.e can cause First Aids, Moderate Property Damaged, etc.)
LOW RISK (L) : Control may still be justified ( i.e can cause Near miss, Mild Property Damaged, etc.)

Note:*It shall be the Full Responsibility of Supervisor/Team Leader to explain the Risk Hazard Assessment to his worker prior start of
work.
 TOOL BOX MEETING
Tool Box Meeting No. :
Site Name :
Location :
Date :
Time :
Contractors Name :
Agenda :
No. Topics Remarks
1 Health Check-Fit to Work

2 Communicate Plans & Techniques

3 Communicate Hazards & Countermeasure

4 Communicate Emergency Plans

5 Check PPE’s

Attendance:

No. Name NOKIA PTID WAH Certificate Signature

Conducted By :
Position :
Signature :
 CLIMB PERMIT

Date :
PLA ID/Site Name :
Location :
Type of Work :
Riggers/Climbers :

I agree that I’ve attended an approved working at height training. With my knowledge I will utilize
relevant Personal Protective Equipment(PPE) and appropriate tools to perform the working at
height at the above mentioned address/location.

No. Name, Certificate/Card reference number Expiry Date Signature

Supervisor:

I verify that the rigger(s)/climber(s) as named above have been briefed on the Hazard, risk, proper
climbing techniques and the proper use of relevant PPE’s and right tools for the mentioned work.

Start Work: End Work:

Name: Name:
Signature: Signature:
Date: Date:
Pre-Start Check Sheets

Region/Area: PLA ID/Site Name:

Site Supervisor’s initial assessment checklist in identifying hazards on site

Y N N/A Comments
1. All workers are feeling well and fit to work?
2. Enough team support? How many i.e Riggers,
Installer, etc
3. Riggers have been trained with valid certificates?
i.e Working in Height certificate
4. Tool box meeting have been conducted and
defined on HS requirements?
5. Personal protective equipment (Safety Harness
with double hook helmet w/ validity, safety boots
used, gloves available and good condition?)
6. Tools, electrical equipment & devices, etc.
available and good condition?
7. Condition of routes-leading to site in good
condition?
8. Worksite condition-compound/fence/gate/tower
conditions in good condition?
9. First aid kit available at Site?
10. Crane has been inspected & in good conditions
and valid certificates?, if any?
11. Hoisting gear & lifting by hand equipment in a
good condition?
12. Miscellaneous

Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Completed By : Date :

Signature :