Crew Name:___ Location: ____________________
Project Name: ____________________________________________________________________ CRF #: ____________________
Audit by : ________________________________________________________________________ Date: ____________________
S# ITEMS Acceptable Unacceptable N/A SOC SC REMARKS ACTION BY
1 Site and Job Specific TRA * (Mandatory)
2 HSE Induction for New Hires
Emergency Response Plan / Stand by Vehicle
3
Availability
4 Fire Extinguisher, Safety device * (Mandatory)
Permit to Work (availability & compliance)
5
* (Mandatory)
6 Compliance of PTW procedure
Excavation not allow with out PTW / Certificate in
7
side or out side of Facility * (Mandatory)
8 Tool Box Meeting / GCM
9 First Aid Box & it's contents, expiry dates
10 Medic Man / First aider /Doctor
Drive Right & Seat Belts / DSS Trained Drivers
11
* (Mandatory)
12 PPE (condition & usage)
Confined Space / Certificate / Attendant
13
* (Mandatory)
14 Lifting Plan * (Mandatory)
Lifting Equipment & Lifting gear (Certification &
15
Validity) * (Mandatory)
Compressed gas cylinders properly stored /
16
labeled
Scaffolds Certificate / Tag and scaffolding
17
checklist* (Mandatory)
Certified Personnel and Validity of certification
18
* (Mandatory)
19 Equipment Checklist
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