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SAFETY CHECKLIST FOR

CONCRETE REPAIR WORK

DOCUMENT No :
REV. No: R0 DATE: 20-08-2022 PAGE 1
VSC/SHE/KNP/01

CHECKLIST FOR CONCRETE REPAIR WORKS.

FORM – 1

PROJECT NAME: KANPUR METRO PROJECT, KNPCC-10 Name of Sub- Contractor:

CLIENT NAME: UTTAR PRADESH METRO RAIL CORPORATION LIMITED (UPMRCL)

Precise location work: VALIDITY (Max. 12 HRS)

From To

Work activity: Date

Time

Safe System: A suitable and sufficient safe system of work must be available for this activity. Essential checkpoints are as
below:

S. No Condition Yes/No NA Comments

Risk Assessment available


1.
Tool box talk performed, attendance recorded
2.
Area cordoned off and precautionary sign board displayed
3. prominently for traffic

Proper means of escape / exit available


4.
Adequate illumination is ensured during dark hours.
5.
Operation of vehicles, plants and machineries is done by
6. authorized people.

The entire activity carried out in the presence of experienced


7. engineer/supervisor.

Appropriate PPEs provided and used by co- workers all time.


8.
Good housekeeping maintained at work area.
9.
VSC Representative UPMRC REPRESENTATIVE

NAME & SIGNATURE : NAME & SIGNATURE :

DESIGNATION: DESIGNATION:

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