a a Fo Fuji E = (Checklist/Form No.: veces Anmovating Energy Technology sera CONTRACTORWORKER ASSESSMENT AND DECLARATION Contractor Supervisor/Leader shall be responsible to communicate/brief the questions/information in this document to the workers that not able to read or understand English. Tick or circle the correct answer (Passing Mark: 100%) [ No. ‘Questions 1 | Allcontractor workers that performed work activities inside FEM MUST possess valid _ @rem contractor Safety Passport 8) CIDB card CC) NIOSH Safety Passport 0) O11 & Gas Safety Passport Z| What is the minimum PPE required when you are performing work at height inside FEM premise? fate helmet, safety harness 8) Safety helmet, safety shoes. | | C) Safety harness a = ) Safety helmet [3 Tou need to perform welding works inside FEM premise. What is additional permit you need to apply? A) Excavation permit 8) Working at height permit jot work permit ) Confined space permit Z| All electrical equipment/tools for any work activities inside FEM MUST be used with ___ for electrical protection @BPorcable E1cB 8) Equipment tag C) Fire extinguisher s ___D) Extension wire : 5 | Where are the emergency assembly for Media Plant? A) In front of ERT room Gear parkin front of MA Shipping | ) Multi-purpose court D)Just outside of each building @ | All SCHEDULED WASTE must be segregated and dispose inside designated bin. Which of the below is classified as scheduled waste? 1) contaminated rag and glove 8) Used chemical container |_| chcontaminated bearing Gai-a2,c | 7 | what are the minimum age requirements to enter FEM premise? A) at least 16 years and above 3) at least 20 years and above ©) no minimum age requirements (Bjat least 18 years and above 8 | You must wear clean room garments correctly and as per correct sequence. True OR False? Wire a) fose 3 nih of he blows WOT slowed bide dean oor? A) Wood B) Boxes €) Corroded materials ABC 30 | Alltools/materials must be clean and free of any stain before been brought inside clean room. True OR False? rue 8) False MARKS:Checklist/Form No.: CL-FC-0018 FO Fuji Electric = Innovating Energy Technology Serial No: DECLARATION BY WORKERS _ DECLARATION BY SUPERVISOR / LEADER 1) Thave read/been trained, fully understand and will follow all the Facility requirements for vendors & contractors to perform work activities in FEM. 2) Thereby agree and consent that FEM can collect and use my personal information in this form for age 1) The workers as named here have been trained, understand and will follow all the Facility requirements for vendors & contractors to perform work activities in FEM. verification. NAME aeleu: NAME COMPANY ie Kaiki Cn) Wah ‘COMPANY IC/ PASSPORT NO _| PrOC31-07, -KV\9, DATE OF BIRTH (FOR NON MALAYSIAN ONLY) DATE or Stprewlbor “Jes é