AUDIT OF CRANE AND HSE DEPARTMENT

OPERATOR HSE-007
PROJECT: CADANGAN PEMBANGUNAN KOMPLEKS KEJIRANAN DAN
KEMUDAHAN LAIN
DI ATAS PT12615, SELUAS 2.52 EKAR DI PRESINT 18, PUTRAJAYA UNTUK
PERBADANAN PUTRAJAYA

CONTRACTOR : DATE :
SITE : AUDITOR :

CRANE :

OWNER :

TYPE :

CAPACITY :

REGISTRATION NO. :

PLANT NO. :

CONDITION :

PMA NO :

MAINTENANCE RECORD AVAILABLE : YES / NO

SAFETY CHECK RECORDS AVAILABLE : YES / NO

PMA CERTIFICATE : AVAILABLE YES / NO

(A copy for record) VALID YES / NO

DATE OF EXPIRY

CRANE OPERATOR :

NAME :

AGE :

I/C NO. :

NO. OF YEARS EXPERIENCE AS A CRANE OPERATOR :

JPJ LICENCE F Wheeled, BTM < 5000Kg YES / NO H Wheeled, BTM >5000Kg YES / NO

G Tracked, BTM > 5000Kg YES / NO I Tracked, BTM > 5000Kg YES / NO

COMPETENCE CERTIFICATE YES / NO

JKKP REGISTRATION NO.: YES / NO

FURTHER ACTION REQUIRED (FOR AUDITOR)

The subject have been inspected.
COMMENTS:
Issuance of Safety Improvement Notice (SIN) YES / NO
Issuance of Safety Violation Notice (SVN) YES / NO
Issuance of Stop Work Order (SWO) YES / NO