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EPCC-20 PACKAGE – ARAB MIX CRUDE OIL PIPELINE

Format No: HSE - 10


DAILY SAFETY CHECKLIST Rev: 0 Page 1 of 1

Project Sr. No
Name of the work Date
Name of Contractor Job No.

Description of job decided to perform:

• Uses of PPE’s / Safety Gadgets


Sr. No. PPE’s Compliance Sr. No. PPE’s Compliance
(Yes / No.) (Yes / No.)
01 Safety Helmets 06
Face Shield
02 Safety Shoes 07
Full body harness
03 Hand Gloves 08
Fall Arrest System
04 Dust Musk 09
Safety net
05 Safety Goggles 10
Horizontal life-line made of
steel wire, (dia not less than
8.0 mm.)
(Serial No. 1 & 2 are compulsory for everyone. Specify & ensure use of other safety gadgets as required for the job)

• Identify following important unsafe conditions: -


Sr. No. Conditions Yes / No
01 Access to work site / emergency escape clear
02 Soil / Loose earth kept away from excavated pit / slope / ladder provided
03 Electrical wire / welding lead lying entangled on ground / welding m/c. booth accessible
04 Elevated work platform / open ends are protected
05 Ground area cordoned off before lifting works or erection at height / ground area checked &
cordoned-off before start of height works
06 Structural members / erected pipes / wooden boards/pieces etc. are safely anchored at
heights and are not likely to fall on people when working
beneath
07 Ladders tied-up on tall steel structures, long before are removed to get rid of their use
08 Any Other

Indicate actions taken, if status of any of the above items is found “No”……………………………………………………...
………………………………………………………………………………………………………………………………………………...
Specific Safety guidelines / precautions, if any (communicated thro’ TBT)…………………………………………………..
………………………………………………………………………………………………………………………………………………...
Above conditions and PPE compliances are checked by undersigned and correct status are indicated after
verification

Prepared by Verification By
Contractor Site Engineer Contractor Safety Officer

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