SAMPLE

Weekly Safety Inspection Report

Plant/Project: ___________________________________ Date: ____________________

Location: ___________________________________

Satisfactory
Item Description Yes No Remarks
1 WELFARE FACILITIES
Clean toilets with exhaust fan
Potable water provided
Eating and resting areas
Canteen facilities
2 FIRST AID STATION
Paramedics
Medical record book
Emergency medical handbook
Telephone numbers displayed
Adequate first aid supplies
Adequate first aid equipment
Clean room with potable water supply
3 HOUSEKEEPING
Segregation of waste and scrap
Waste and scrap regularly collected &
disposed of
No build up of flammable materials
4 SITE SECURITY ACCESS
Security check correctly performed
Guardhouse continuously manned
Round check register updated
Perimeter fence intact
Inspection of materials' gate passes
5 Personal Protective Equipment (PPE)
Eye protection
Head protection
Hand protection
Foot protection
Any other protection
6 EXCAVATIONS
Signs posted
Hard barrier installed
Shoring provided (if applicable)
1m spoil clearance from the excavated pit
Sloping maintained (if applicable)
Appropriate access provided
7 Mechanical and Electrical
Adequate guarding on machines
Insulation, cables, industrial plugs in good
condition
Cables suspended using S hooks and lead
stands
Inspected regularly with color code sticker
ELCB provided to site power boards
Grounding installed to equipment/machine
Unused machines electrically isolated

5MCSS 1 WEEKLY INSPECTION FORM REV2

 Satisfactory
Item Description Yes No Remarks
8 SCAFFOLDS/ LADDER
Scaffolds correctly erected
Scaffolds properly secured
Toe boards, guardrails (top & midrail),
handrails & access checked
Fully boarded platforms
Scaffolds correctly tagged
Materials in good condition
9 PLANT & EQUIPMENT
Available license for drivers/operators
Vehicle and equipment condition
Reverse alarm installed
Flashing light installed
Generators and welding machine condition
Compressors and water pumps condition
10 LIFTS & CRANES
Available license or third party certificate
for operators and certificate for banksmen
and riggers
Load capacity displayed
Certification updated
Condition of access, foundation and
supports
Stability
Chains & slings in good condition
11 LIFTING OPERATIONS
Lifting locations properly identified
Loads correctly secured
Lifting gear conditions
Rigging plan
12 COMPRESSED GAS CYLINDERS
Stored upright, valves protected
Gauges working; hoses inspected
Flashback arrestor fitted
Cylinders are securely tied or with trolley
Type of gas clearly marked on cylinders
13 SAFETY SIGNAGE
Clearly displayed
Clean and legible
WORK PERMITS (Confined Space, Hot
14 Work, Excavation and Electrical Work)
Work permit correctly issued and signed
Work permit requirements enforced
15 FIRE PROTECTION
Fire Extinguisher available at hot work
locations
Welding and grinding works locations
properly secured
Fire extinguisher not obstructed
Expiration date of fire extinguisher
checked.

5MCSS 2 WEEKLY INSPECTION FORM REV2

 Satisfactory
Item Description Yes No Remarks
16 HAZARDOUS SUBSTANCES
Toxic/ hazardous substance correctly
tagged/ labelled and secured
Adequate storage provided
Appropriate bundwall provided
Safety Data Sheet (SDS) present
17 OTHER RELATED SAFETY ITEMS

SUMMARY
Item Concern (Problem) Action Plan Responsible Target Time Status

Inspected by: ____________________ Approved By: ________________________

5MCSS 3 WEEKLY INSPECTION FORM REV2