CONTRACTOR'S EHS CLEARANCE

Date Prepared:
Name of Contractor: ______________________________ Plant/Unit #:
Activity: _____________________________________________________________________
Location: Project #:
Activity WO #: __________________________________________ PO/WO #: ____________

Particular Point of Verification:

WASTE DISPOSAL
Residual Waste Disposal
Hazardous Materials:
Yes If Yes, date of disposal: _______________
No Particular area of disposal: ____________________________
Non-hazardous Materials:
Yes If Yes, date of disposal: _______________
No Particular area of disposal: ____________________________

WORKING AREA HOUSEKEEPING

Cleanliness of Area prior Demobilization
Yes If Yes, date of cleaning: _______________
No Note: Attached picture (before & after)

UNUSED AND EXCESS MATERIALS HANDLING

Seggregated & Safekeep
Yes If Yes, date of safekeep: _______________
No Where: ______________________________________________

SCAFFOLDING MATERIALS STATUS

Removed & Return
Yes If Yes, date of return: _______________
No Where: ______________________________________________
N/A

CAUTION TAPE/SAFETY SIGNAGES/BARRICADE

Removed
Yes If Yes, date of removal: _______________
No Where: ______________________________________________
N/A

Prepared by: Confirmed:

Contractor Project-In-Charge

Inspected & Validated by: Inspected & Validated by: Witnessed:

Environmental Safety Operations On-Duty

 IN-HOUSE CONTRACTOR'S HOUSEKEEPING CHECKLIST

Date of Implementation:

Personnel Confirmed by Operator On-Duty

Area as Found Waste Disposal Hazardous
Ref # WO # Activity Date Started Date Finished Area Remarks Cleaned as Left (Y/N) Reason
Prior Work SCPC Regular In-House Area Materials (Y/N)
Name Signature
(Name/Initial) Contractor/Quantity
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Prepared by: Confirmed:

Contractor Project-In-Charge

Inspected & Validated by: Inspected & Validated by:

Environmental Safety