PROJECT SITE

REF. NO.
SAFETY, HEALTH & ENVIRONMET INDUCTION FORM EFFECTIVE DATE

Name (Nama): Company (Syarikat):

Designation (Jawatan): Date (Tarikh):

1.0 Occupational Safety & Health Act 1994 & EQA 1974 (Akta Keselamatan & Kesihatan Pekerjaan 1994 & EQA 1974)
1.1 Section 24
1.2 Section 25
1.3 EQA 1974
2.0 HSE Policy & Objectives (Polisi & Matlamat HSE)
2.1 HSE Policy (Polisi HSE)
2.2 HSE Objectives (Matlamat HSE)
3.0 Personal Protective Equipment (Peralatan Perlindungan Diri)
3.1 Safety Helmet (Topi Keselamatan)
3.2 Safety Shoe (Kasut Keselamatan)
3.3 Safety Belt/Full Body Harness (Tali pinggang/penyangkut keselamatan)
3.4 Ear Plug/Ear Muff
3.5 Safety Goggle/Glasses (Cermin Mata Keselamatan)
3.6 Safety Vest/Work Attire (Jaket Keselamatan/Pakaian)
3.7 Welding Shield (Pelindung Kimpalan)
3.8 Dust Mask (Pelindung Muka)
3.9 Respirator (Alat Pernafasan)
3.10 Glove (Sarung Tangan)
4.0 Safe & Unsafe Acts/Condition (Tindakan/Keadaan Selamat & Tidak Selamat)
4.1 Sling/Lifting (Kerja Mengangkat)
4.2 Earthworks/Excavation (Kerja Tanah/Pengorekan)
4.3 Scaffolding/Netting (Perancah/Jaring Keselamatan)
4.4 Machineries Guarding (Pengadang Mesin)
4.5 Housekeeping (Kekemasan)
4.6 Material Arrangement (Penyusunan Barang)
4.7 Demolition/Blasting (Penghancuran/Peletupan)
5.0 Environment (Alam sekitar)
5.1 Environment Aspects & Impacts (Air, Water, Noise Pollution
5.2 Waste Control (Construction, Domestic, Scheduled Waste)
5.3 3R Practices (Reduce, Reuse & Recycle)
5.4 Conservation of Natural Resources/Energy Saving (Water, Electricity & Fuel)
6.0 Other (Lain-lain)
6.1 Emergency Procedure (Prosedur Keselamatan)
6.2 Accommodation (Kediaman)
6.3 Personal Hygiene (Kebersihan Diri)
6.4 Drugs & Alcohol (Dadah & Alkohol
6.5 Health & Welfare (Kesihatan & Kebajikan)
6.6 Security (Sekuriti)026
6.7 Penalty (Denda)
6.8 Video Presentation (Pembentangan Video)
6.9 Safety Induction Course by CIDB (Kursus Induksi Keselamatan CIDB)

I hereby acknowledge that I have received a Health & Safety Induction in the language that I understand. I duly acknowledge and
confirm that the above mentioned items and topics have been covered in the induction attended by me. (Saya dengan ini
mengesahkan bahawa saya telah menerima latihan Induksi Kesihatan & Keselamatan di dalam bahasa yang saya fahami. Saya
mengesahkan bahawa kesemua perkara di atas telah diterangkan kepada saya.
Inducted by:

___________________ ____________________
Name: Name:
IC/Permit: Designation:
 SAFETY INDUCTION ATTENDANCE
PROJECT :
VENUE : SITE OFFICE REF. NO : 002/SHE/SRIL/22
PURPOSE : SAFETY INDUCTION DATE :

BIL NAME IC/PERMIT NO. TRADE SIGN

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