Document Number

LAL-HSE-CKL-002
INSPECTION CHECKLISTS Date: 7 Jan 2022
Next: 7 Jan 2023
Rev :001
Pollution Checklist Page 1 of 2

Site_____________________________________Date:____________________________________

ITEM CHECKED YES/NO COMMENTS/ACTION

AIR: Is there excessive:

1. Dust

2. Smoke

3. Other Pollutants (specify)

4. Suspended in the atmosphere:

 Inside Building/s?

 Outside Building/s?
GROUND: Are there excessive amounts of
spilled/unclear materials:

1. Cement?

2. Plastic Bags/Cement Packets?

3. Paper/Cardboard?

4. Stagnant water?

5. Diesel/Oil?

WATER:

1. Are any drains polluted

2. Is clean drinking water available?

GENERAL: Are yard areas free of:

1. Paper/Litter?

2. Weeds?

3. Off Cuts?

4. Scrap/Steel/Timber?
/conversion/tmp/activity_task_scratch/592331523.doc
 Document Number
LAL-HSE-CKL-002
INSPECTION CHECKLISTS Date: 7 Jan 2022
Next: 7 Jan 2023
Rev :001
Pollution Checklist Page 2 of 2

POLLUTION CHECKLIST AND DEVIATIONS

DATE Description of deviations noted Actions by whom Target Date Complete Y/N

/conversion/tmp/activity_task_scratch/592331523.doc