

Version no:
F01(HSE-M-01)
Rev.0
Site Observation Checklist Date Approved:
05.10.2018
QHSE

NAME OF SITE :
Observer Name : Date of Visit :
Not
S/NO CHECK POINTS Ok REMARK (IF ANY)
Ok
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Are all workers/staff wearing mandatory PPEs - Safety Helmet with
1
chin strap, safety shoes & reflective jacket
2 Is Condition of PPEs good for use
WORKING AT HEIGHT
3 Is available scaffolding / elevated platform safe for usage
Does toe board, mid rail & hand rail exists on scaffolding / elevated
4
platform
5 Are all people at height using Safety harness with proper anchorage
6 Is area below scaffolding barricaded
7 Condition of Safety harness good to use
LIFTING OPERATION
8 Are People standing below suspended load
Is there a banksman/khalasi/guide man/sling-man to tie slings & to
9
guide the load
ELECTRICAL WORK
10 Are there any loose wiring connection at site
11 Is there any Floor opening without proper protection?
FIRE
Are there Sufficient fire extinguishers installed specially at place
12
where hot work is being done
13 Is first aid box available & easily accessible
LABOUR CAMP
Availability of adequate lodging space in labours camp without
14
tarpaulin
15 Adequate toilet & bathing facilities separate for male & female
16 Availability of drinking water for labours
GENERAL ISSUES
17 Are there Adequate safety warning signboards & stickers on display
18 Is housekeeping at site good
19 Does identified Scrap yard exists at site and is being used
Is the EHS process for visitor to site like induction training,
20
emergency nos., feedback form, PPEs etc fulfilled

OVER ALL FEEDBACK OF THE SITE

Date: Signature:

The official copy of this file is available on the Renew Portal.

Before using a printed, uncontrolled copy, verify that it is the current version.
Document Number Created By Reviewed By Approved By
F01 (HSE-M-01) Rev
Colin Varghese Anurag Jain
.0
Page 1 of 1