Professional Documents
Culture Documents
Project: Task: ________________________________ Supervisor: I have addressed the hazards of this task and controls
__________________ Brief description: have been communicated to all crew members in their language.
_____________________________________ As the Supervisor I take full responsibility to implement all
Company _____________________________________ required measures and keep safe all workers in my crew.
__________________ _____________________________________ Name /Signature:_______________________________
Date: ______________ ESH responsible: Concur with selected Supervisor notes:
Start time: __________ hazards and controls on this STARRT Card. __ Workers arriving after STARRT delivered: ______________
End time: ___________ Name/Signature:_____________________
Job Location: _________________________________________________
ESH notes:
___________________ New hazards/ corrections:____________ __ Feedback from workers during STARRT:
# of Workers: ________
__________________________________
Mandatory Topic:
___________________ __________________________________
___________________ __________________________________
___________________ Need for Re-STARRT: Yes ☐ No ☐
Mandatory PPE Additional PPE for the task as necessary
Other
Type______ ______ ______ ______ ______ Type______ ______ ______ ______ ______ ______ ______
Task hazards and Preventive measures. Please fill the box with the
360 walk round
controls implemented. Some controls shown in watermark
Look for hazards above and below;
right and left; in front and behind
Above:_______________________________________
____________________________________________
_________
Behind:______________________________________
____________________________________________
__________
Left:________________ Right:_________________
____________________ _____________________
____________________ _____________________
__
Left:________________ Right:_________________
____________________ _____________________
____________________ _____________________
__
Below:_______________________________________
____________________________________________
_________
Front:_______________________________________
__________________________________________
Hazards by Fire
Lifting operations
others Falling objects
With my signature below I acknowledge to have understood the hazards of this task and how to prevent
them, I will comply with all safety measures discussed because I care for me and my family.
بتوقيعي آذناه قد فهمت و وعيت األخطار التي تحتويه هذه المهمة وعرفت طرق الوقاية منها بأتباع وسائل السالمة التي تمت
مناقشتها و ذلك ألني اعرف اهميته لي و لعائلتي