PLANT AND FACILITY SAFETY

OHS-PR-09-09-F32(A)
OHS REPRESENTATIVES’ MONTHLY SAFETY INSPECTION FORM
Operating Area: WOA Department: SEPDC
Project Name: CONSTRUCTION OF 380KV D/C OHTL BETWEEN DUBA GREEN TO ALWAJH
Contractor Name: NCC Project Type: OHTL Contract No.: 4400012611

LOCATION:SITE
NAME:AHMED ABDUL
RAZAK DATE: 22-1-2022

Hazard
STANDARD Y N Comments
Y N
1. Structure, furniture, and equipment in good and

safe condition
2. Floors - clean and free of dirt or other dangers. 
3. Good Lighting, natural or artificial. 
4. Ventilation adequate and checked. 
5. Rest room facilities - toilets, wash basins, 
clean, drinking water and hygienic.
6. Kitchen, lunchroom clean. No food in 
unauthorized areas.
7. Pollution of air, water, ground. 
8. Hazardous waste disposal in responsible 
manner.
9. Areas demarcated to standard. 
10. Stacking - stable, neat, and safe. 
11. Areas inside and outside of buildings are neat
 P#01 
and tidy. General housekeeping.
12. Scrap and refuse bins enough, correctly 
placed, color coded or labeled.
13. Color coding of pipes and plant in order. 
14. Machine and Electrical guards in place. 
15. All equipment / hazardous areas can be 
isolated / locked out and procedure displayed
where applicable.
16. Switches, isolators and valves labeled, outlets 
marked.
17. Ladders, scaffolds, walkways and handrails in

good condition
18. Lifting gear in good condition. 
19. Gas cylinders and pressure vessels in order. 
20. Hazardous substances handled / stored using 
correct procedures. MSDS available.

21. Portable electric equipment in good condition. 

OHS Forms Procedure Reference Revision Number Revision Date Approved By
OHS Representatives’ Monthly Safety Inspection Form OHS-PR-09-09-F32(A) 0 MAY 2021 OHSMS
 PLANT AND FACILITY SAFETY
OHS-PR-09-09-F32(A)
OHS REPRESENTATIVES’ MONTHLY SAFETY INSPECTION FORM
Operating Area: WOA Department: SEPDC
Project Name: CONSTRUCTION OF 380KV D/C OHTL BETWEEN DUBA GREEN TO ALWAJH
Contractor Name: NCC Project Type: OHTL Contract No.: 4400012611

No cords over floors.

22. General electrical installations / flameproof 
equipment is safe.
23. Hand tools in good condition and properly

stored.
24. Ergonomics: conditions safe and comfortable. 
25. Appropriate protective clothing / equipment 
available, properly utilized and in good
condition.
26. Safety signs and notices in place. 
27. Fire Extinguishers in position 
28. Location of Fire Extinguishers clearly visible, 
demarcated, and unobstructed.
29. Fire Extinguishing Equipment maintained / 
inspected.
30. Flammable materials stored correctly. 
31. Alarm System working, employees aware of 
system.
32. Emergency plan available and understood by 
staff.
33. Injuries / Accidents which occurred since 
previous inspection recorded.
34. Names of First Aiders displayed and First Aid 
Boxes in place.
35. Safe Work Procedures available and used. 
36. Safety display board up to date. 
Other Items not mentioned above:
37.
38.
39.
40.

Report by OHS Representative:

Does the above report contain any hazard to the safety of any Employee?
(Hazard: Something that has the potential to cause harm)
 YES  NO

If yes, complete the following: The matter was reported as soon as practical.

 In Writing  Verbally

OHS Forms Procedure Reference Revision Number Revision Date Approved By

OHS Representatives’ Monthly Safety Inspection Form OHS-PR-09-09-F32(A) 0 MAY 2021 OHSMS
 PLANT AND FACILITY SAFETY
OHS-PR-09-09-F32(A)
OHS REPRESENTATIVES’ MONTHLY SAFETY INSPECTION FORM
Operating Area: WOA Department: SEPDC
Project Name: CONSTRUCTION OF 380KV D/C OHTL BETWEEN DUBA GREEN TO ALWAJH
Contractor Name: NCC Project Type: OHTL Contract No.: 4400012611

To: K.B.RAMESH (Manager of the area) Date reported: 22-1-2022

Signature of OHS Representative:

This OHS Safety Inspection Report must be discussed with the Manager / Supervisor as soon as possible.

I have reviewed this inspection report and have taken action on correcting the deviations noted below.

Signature of Supervisor /Manager: Date: 23-1-2022

No Deviation Corrective Action Action By Closeout Date

1 Housekeeping carried out MOBIN 23-1-2022

***

OHS Forms Procedure Reference Revision Number Revision Date Approved By

OHS Representatives’ Monthly Safety Inspection Form OHS-PR-09-09-F32(A) 0 MAY 2021 OHSMS
 PLANT AND FACILITY SAFETY
OHS-PR-09-09-F32(A)
OHS REPRESENTATIVES’ MONTHLY SAFETY INSPECTION FORM
Operating Area: WOA Department: SEPDC
Project Name: CONSTRUCTION OF 380KV D/C OHTL BETWEEN DUBA GREEN TO ALWAJH
Contractor Name: NCC Project Type: OHTL Contract No.: 4400012611

CORRECTION REPORT
Date 22-1-2022 Date 23-1-2022
Inspection Inspected by TALAH ALI Correction Corrected by MOBIN
Report Report
Signature Signature
BEFORE AFTER

Safety Observation 1:POOR HOUSE KEEPING Action Taken: Housekeeping carried out

Safety Observation 2: Action Taken:

Safety Observation 3: Actioned Taken:

OHS Forms Procedure Reference Revision Number Revision Date Approved By

OHS Representatives’ Monthly Safety Inspection Form OHS-PR-09-09-F32(A) 0 MAY 2021 OHSMS
 PLANT AND FACILITY SAFETY
OHS-PR-09-09-F32(A)
OHS REPRESENTATIVES’ MONTHLY SAFETY INSPECTION FORM
Operating Area: WOA Department: SEPDC
Project Name: CONSTRUCTION OF 380KV D/C OHTL BETWEEN DUBA GREEN TO ALWAJH
Contractor Name: NCC Project Type: OHTL Contract No.: 4400012611

Safety Observation 3: Actioned Taken:

OHS Forms Procedure Reference Revision Number Revision Date Approved By

OHS Representatives’ Monthly Safety Inspection Form OHS-PR-09-09-F32(A) 0 MAY 2021 OHSMS