hne - hse forms

2.0 HSE Forms

2.1 HNE-HSE-F-01 Contractors Safety Information

2.2 HNE-HSE-F-02 Tool Box Talk

2.3 HNE-HSE-F-03 HSE Meeting Report

2.4 HNE-HSE-F-04 Safety Observation Report

2.5 HNE-HSE-F-05 Environment Incident Report

2.6 HNE-HSE-F-06 Corrective Action Request

2.7 HNE-HSE-F-07 Course Attendance Sheet

2.8 HNE-HSE-F-08 Training Calendar

2.9 HNE-HSE-F-09 Fire Extinguisher Inspection Report

2.10 HNE-HSE-F-10 Safety Violation Notice

2.11 HNE-HSE-F-11 Mobile Crane Entry Permit

2.12 HNE-HSE-F-12 Hot Work Permit

2.13 HNE-HSE-F-13 Confined Space Entry Permit

2.14 HNE-HSE-F-14 Electrical Isolation Permit

2.15 HNE-HSE-F-15 Excavation Permit

2.16 HNE-HSE-F-16 PTW Register

2.17 HNE-HSE-F-17 Incident Notification Form

2.18 HNE-HSE-F-18 Incident Report

2.19 HNE-HSE-F-21 Incident Investigation Report

2.20 HNE-HSE-F-20 Suggestion and Near Miss Card

2.21 HNE-HSE-F-21 Safety Violation Register

2.22 HNE-HSE-F-22 First Aid Register

2.23 HNE-HSE-F-23 Site HSE Checklist

2.24 HNE-HSE-F-24 Emergency Contact

2.25 HNE-HSE-F-25 HSE Induction Record

2.26 HNE-HSE-F-26 Document Distribution record

HNE SAFETY DECLARATION

This information applies to HNE and others sub contractors under their control engaged in carrying out work on the project and premises.

It is HNE’s intention to secure a high standard of health safety and environment compliance in all our areas of control.

HNE will comply with national and local health and safety legislation and codes of practices and Client / Consultant HSE rules / HSE Plan whilst on site.

HNE submit risk assessments and method statements for all activities and get the Client / Consultant approval before carrying out the work. HNE will adhere to the identified control measures while executing the work activity.

When changes in health and safety controls may be necessary, such changes will be informed to the Client / Consultant HSE personnel. This will cover for example hazards, restricted access areas, fire precautions, emergency response, first aid facilities, accident reporting, welfare facilities, smoking restrictions, segregation of work activities, any other issues affecting health and safety.

HNE / CONTRACTOR will be responsible and accountable for all accidents involving their employees and equipment. All accidents will be notified to Client / Consultant HSE personnel as per the Client / Consultant HSE Plan and Policy.

The work area should be left tidy and secure, not only on completion of the work but each time the Contractors leaves project premises.

All Contractors must familiarise themselves with the Client / Consultant HSE rules/Plan.

High risk work e.g. hot work, demolition, excavation, working in confined spaces, working at height, electrical work and any other specified work will not be started unless a 'permit to work' has been obtained. For hot work only, work area must be checked one hour after completion of the works.

If in the opinion of Client / Consultant, Contractors are working in such a manner as to put themselves, employees, visitors any other person, or property and equipment at risk, the contractors can be requested to stop work immediately and rectify the controls.

HNE / Contractors must supply their own PPE, access equipment, electrical equipment / tools and hand tools.

HNE will ensure these terms and conditions are communicated to all their employees working at Company premises.

HNE / Contractor must immediately implement appropriate corrective / preventive actions for any safety issues identified.

Where a HNE / sub contractor employee has been violating safety rules even after being issued with a written warning letter (safety violation), he / she along with his supervisor shall be summoned to the HNE Office; issued with a termination order by the Company HSE Manager and both will be asked to leave the Project premises. The Contractor shall replace the employee with an alternative employee with the same or more competency

I have read the above conditions and accept them.

Signed: ......................................................, Position: ......................................................

On behalf of:.............................................., Date: ............................................................

HNE-HSE-F-01 Page 1 of 1 R: 0 D: 01-07-2012

TOOL BOX TALK RECORD

Contractor/Subcontractor Name:

Following points were discussed in today’s toolbox talk:

a)

b)

c)

d)

Following persons attended the session:

Date:

SL No: Card Number* Name Designation Signature

(* If this pertains to the sub contractor employees, indicate the name of the

contractor) Toolbox talk was given by:

Name :

Position :

Signature :


HSE REVIEW MEETING REPORT

HNE-HSE-F-03

Page 1 of 2 R: 0 D: 01-07-2012

HSE Meeting Number:Members Present Distribution of Minutes

Place:Date: Time:

Minutes recorded by: Signature:

Sl. No

DescriptionAction by/ Target

Date

Closedout (Date& Sign)

1. Purpose and objective of the meeting:

2. Previous meeting points:3. Housekeeping (Edge Protection/ Slab penetration, signs etc):

Housekeeping:

Edge Protection:

4. Welfare measures:

Rest Area: Toilets:Drinking Water:

5. Safety Incentive Scheme:

Safety improvement slips: Suggestion Received:

6. Accidents/ Incidents/ FA cases:

7. Scaffolding and ladders:a. Scaffolds:b. Ladders:

8. Electrical safety:

9. PTW issues:1. Hot Work:2. Barricade Removal Permit System:3. Excavation4. Confined Space5. LOTO

10. HSE Inspections:

11. Induction and Tool box talks:

12. Fire Prevention:

HNE-HSE-F-03

Page 2 of 2 R: 0 D: 01-07-2012

HSE REVIEW MEETING REPORT

13. Emergency preparedness:

14. Lifting Tools & tackles / Hoists:

15. Plant & machineries:

16. Safety training and awareness sessions:

17. Risk Assessments:

18. Sub contractors: -

19. Scope for possible improvement in HSE:

20. Environmental Issues:1. Spillage –2. Waste Water –3. Noise –4. Dust -5. Construction Waste –6. Chemical Waste –7. Chemical Storage –.8. MSDS –

21. Authorities Issues:

22. Safety audit, if any:

23. Storage / Resource:

24. PPE:

25. Security:

26. Any other issues:27. Next meeting:

Next Meeting Date:

HSE OBSERVATION REPORT

HNE-HSE-F-04

Page 1 of 1 R: 0 D: 01-07-2012

Contractor :

Date :

SLNO

OBSERVATIONS ACTION TAKEN

Inspected By :

Report To :

This report shall be returned within 24 hours to the Contractor’s Safety Personnel indicating action taken against the observations made.

ENVIRONMENTAL INCIDENT REPORT

Contractor :

Time of Incident :

Date of Incident :

Air EmissionWater Pollution (Wastewater Discharges / Sanitary Waste) Solid or Hazardous WasteHazardous Materials or Chemicals Used / StoredNoise PollutionOdour / DustWater / Fuel / Electricity ConsumptionOther

Details of Incident

Reported By Date

Root Cause

Investigated By DateAction Taken

Taken By Date

Review & Close out

Carried out By Date


CORRECTIVE ACTION REQUEST


Contractor :

Date :

CAR Ref :

Nonconformity Minor Major Observation

Raised By Date

Results of Investigation & Root Causes

Investigated By Date

Corrective Action

Action Taken By Date

Follow-up Comments

Carried out By Date

COURSE ATTENDANCE SHEET


Course Title

Date

Trainer

Sl Name Designation Company Staff No: Signature

Trainer Signature :


TRAINING CALENDER

Year

Course Title Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Updated on:Date Planned

Date Completed

Signature:

FIRE EXTINGUISHER INSPECTION REPORT


Sl no

Type Of FireExtinguisher

Lo

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Saf

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Cli

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Pr

Gau

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Ho

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3rd P

arty

Insp

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Dat

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Rem

ark/

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Inspected by :

Signature :

Date :

SAFETY VIOLATION NOTICE


Warning Notice No: DateContractor LocationWarning issued to:

Name:Card / Staff No: Designation:

ApproximateLocation:

Date and Time:

You were found working unsafely at site, which could have resulted in serious accident andthus injuring you and / or others. The violation is as follow:

You were found working unsafely / allowing the operatives working under you to carry out work in on unsafe manner thus putting in danger their lives as well as others working nearby.The violation is as follow:

Is the violator given sufficient training related to the type of violation [Yes / No]

Safety training (Induction, specific training) reference to be attached with reference to the type of safety violation.

This is against our company safety policy and the local rules governing the Health and Safety ofemployees. The following action will be taken against you:

Repetition Nos. Action Taken

1st

Warning/

Repetition

The employee will be called during the toolbox talk and will be asked to address others thecircumstances in which he was forced to take the shortcut (follow the unsafe practice) and how it can be avoided; he has to also apologize for the said act and promise the whole group that he will not repeat the same in future

2nd

Warning/

Repetition

Concerned employee along with his supervisor will be asked to report to the Company HSE Manager. Contractor HSE Officer shall coordinate this. After appropriate counselling, bothof them will be issued with a warning letter.

3rd

Warning/

Repetition

The Contractor employee, along with his supervisor shall be summoned to the CompanyOffice; issued with a termination/ de-mobilized notice by the Company HSE Manager and shall not be allowed to work within the Company premises.Any Contractor staff found working within the Company premises without a valid (UAE)work permit; he/she along with his supervisor shall be issued with a termination/ de-mobilized notice immediately by the Company HSE Manager and will be asked to leave Company premises. Contractor will be given 24hours to submit the original work/permit to Company HSE, failing which contractor will be asked to permanently demobilize the identified staff and his immediate supervisor from the site.

Safety violation noticed by: Safety Warning issued by: Warning Accepted by:

Name:Designation:

Signature:

MOBILE CRANE ENTRY PERMIT


Contractor Name: Date: Permit No:Vehicle No: Capacity: Place:

SL Check Points Yes No Remarks

Section 1: Document Verification (Mandatory) – to be checked by site engineer

1 UAE valid Crane Registration with at least one month validity uponentry

2 UAE valid Driving License of the operator

3 Valid Third Party test Certificate for crane (Every 12 Months)

4 Valid Operators Third Party Competency Certificate

5 Test certificate for the Lifting Gear available in the crane

Name & Signature:

Section 2: Physical Condition of Equipment – to be checked by Site engineer / Site Supervisor

1 Display/Availability of Load chart in crane.

2 Automatic safe load indicator/ Top Limit Switch

3 Audible alarm linked to safe load indicator

4 Automatic Reverse Horn

5 Out riggers with base supports in good condition

6 Rear /Side view mirrors (as Applicable)

7 Free from Hydraulic Oil Leakage /Diesel

8 Availability of safety Latch in the slings and lifting hook

9 Warning Lamps /Lights (Night Working)

10 Proper functioning of control levers/brakes/Steering

Name & Signature

Section 3: Operators Assessment - to be checked by Safety

1 Site safety rules and norms

2 Safety awareness & Emergency Preparedness

3 Knowledge of job to be executed.

Name:

Signature:

Equipment is Authorized to enter the site

HOT WORK PERMIT


Contractor Name: Date: Permit No:Name of the sub contractor (if applicable):

Section I: (To be filled by authorized Receiver)Location of the hot work (indicate level and grid no and enclose location sketch if required):

Description of the work: Arc welding / C utting / Grinding near flammables / Soldering / Brazing /Metal cutting / Electric Cable termination and jointing

Section II:(Request for the permit) Permit Receiver to mark all boxes either with (only for

relevant ones) or mark as X No flammable/combustible materials around/below

the work spot. Suitable Fire Extinguisher and trained personnel

(Operation of Fire extinguisher) at the work place Wet gunny bag/fire resistant sheet to arrest flying spark Welding m/c with proper insulated welding

cable/lugs Standby person for watching falling molten metals. Welding & supply cable without joints/ damages. Gas cutting torch fitted with Flash back arrestor. Separate Ele. supply cable with ELCB from DB Soap water test conducted for detecting leakage. No criss-cross of power & welding cables Gas Cylinder with proper Pressure Gage & Regulator. Proper/overhead routing of Electrical cables Gas Cylinders with Chain/ trolley to arrest falling. Availability of proper scaffolding/platform/ladder Gas Hose of sound condition & proper hose clips. Proper ventilation Suitable Spark lighter available- never use smoking lighter. Separate permit incase of work in confined space Barriers to avoid exposure of UV / IR rays to passers Safety inducted welder / Helper and others involved Do not gas cut containers of flammable liquids. Required PPE for helper PPE - Helmet Welding Screen Suitable Goggles Welding Apron Dust Masks Leather Hand Gloves Safety Shoes Full Body HarnessAny other precautions (Specify):

I request for a Hot Work Permit for the above-mentioned work at the location specified above. I have personally inspected the work place to ensure that the applicable precautions mentioned above have been complied with.

Name & Signature of the Authorized Receiver (Engineer / Supervisor/ foreman):

Name: Signature:

Section III: (Permit Approval - To be filled by authorized Issuer)I have personally verified the work spot and compliance of the relevant precautions given insection II of this permit.

The permit is valid from _ _ _ _ _ _ (hrs) to _ _ _ _ _ (hrs).

Name of the concerned engineer (Authorized Issuer): _ _ _ _ _ Signature: _ _ _ _ _

Section IV: (Permit close out cum Revalidation details)(To be returned to the authorized approving authority immediately after the completion of work for

closing / revalidation at the end of the work everyday)

Revalidation datesSign of Receiver for proper closing the work with time.Sign of Receiver for proper starting the work on next day with time.Sign of Issuer for proper starting the work on next day with time.

Note:1. Total 2 copies-Original at the work place, Second copy-with issuer; Closed permits (Original)

to be submitted to Safety2. The permit must be registered and a unique number to be given for each permit for follow up.3. This permit is not valid for cutting containers of flammables.4. This permit is valid for the location mentioned in section I and for one day only. Can be

revalidated (if location is not changed) on a daily basis for a maximum period of one week.

5. Permit can be cancelled at any time if any violation observed.

CONFINED SPACE ENTRY PERMIT



Section I: (To be filled by authorized Receiver)Location of the work (indicate level and grid no and enclose location sketch if required):

Description of the work /Reason for Entry:

Section II:(Request for the permit) Permit Receiver to mark all boxes either with (only for relevant

ones) or mark as X Suitable & Sufficient access provided to the

confined space? All the employees trained in working in confined space?

Required warnings signs (Danger – Restricted Entry, Permit Required), Emergency Contacts no displayed

Gas test been done to check the absence of flammable gases

If any other gases are anticipated, has it been checked? Have low voltage & flameproof lighting been arranged? Confined space checked for oxygen deficiency All concerned persons been informed Enough ventilation ensured. Entrants provided with emergency lights A stand-by (Buddy) is deputed outside the manhole /

confined space In-Out Register ready to maintain / Available with

buddy All entrants provided with safety harness with long

lifeline Necessary safety appliances been provided

Any other precautions (Specify): LEL

Oxygen

I request for a Confined Space Entry Permit for the above-mentioned work at the location specified above. I have personally inspected the work place to ensure that the applicable precautions mentioned above have been complied with.

Name & Signature of the Authorized Receiver (Engineer / Supervisor/ foreman):Name: Signature:

Section III: (Permit Approval - To be filled by authorized Issuer)I have personally verified the work spot and compliance of the relevant precautions given insection II of this permit.The permit is valid from _ _ _ _ _ _ (hrs) to _ _ _ _ _ (hrs).Name of the concerned engineer (Authorized Issuer): _ _ _ _ _Signature_ _ _ _ _ _ _

Section IV: (Permit close out - To be filled by authorized Receiver)(To be returned to the authorized approving authority immediately after the completion of work)The said job is completed and all the entrants have come out from confined space. Name(Authorized Receiver): Signature:

Date and Time:


to be submitted to Safety2. The permit must be registered and a unique number to be given for each permit for follow up.3. Percentage of O2 should not be less than 20%4. This permit is valid only for the location mentioned in section I and for one day only.5. Permit can be cancelled at any time if any violation observed.

ELECTRICAL ISOLATION PERMIT



Section I: (To be filled by authorized Receiver)Location of the work (indicate level and grid no and enclose location sketch if required):Test Description: Test Equipment:


relevant ones) or mark as X

Competent working crew has been deputed Sufficient training conducted for concerned staff and documented

Power supply switched off Circuit breaker Deactivated Isolator switch locked* Required warning notices” DANGER”, “RESTRICTED

ENTRY”, “HIGH VOLTAGE TESTING IN PROGRESS”,“NO SMOKING” etc are provided

Earthing available

All testing equipments are calibrated and sticker available

All floor & roof openings are covered and barricaded

Stand by (Buddy) Provided Emergency Contacts are displayed. Fiber ladder is available for testing work. Testing area identified and barricaded Area is free from flammable and

combustible materials Suitable Fire Extinguishers are provided

ELCB available with supply source DB Illumination is sufficient Necessary safety appliances provided Unauthorized entry is restricted by suitable meansAny other precautions (Specify):

I request for a Pre Commissioning Testing Permit for the above-mentioned work at the location specified above. I have personally inspected the work place to ensure that the applicable precautions mentioned above have been complied with.


Name: Signature:

Section III: (Permit Approval - To be filled by authorized Issuer)I have personally verified the work spot and compliance of the relevant precautions given insection II of this permit.

The permit is valid from _ _ _ _ _ _ (hrs) to _ _ _ _ _ (hrs).

Name of the concerned engineer (Authorized Issuer): _ _ _ _ _ _Signature _ _ _ _ _ _

Section IV: (Permit close out - To be filled by authorized Receiver)(To be returned to the authorized approving authority immediately after the completion of work) The said job is completed and the equipment is safe for re-energizing. Name(Authorized Receiver): Signature:

Date and Time:


to be submitted to Safety2. The permit must be registered and a unique number to be given for each permit for

follow up.3. All dead cables shall be terminated with insulation properly during / after test.4. This permit is valid only for the location mentioned in section I and for one day only.5. Permit can be cancelled at any time if any violation observed.6. *- The key shall be available only with the technician performing the job

EXCAVATION PERMIT


Verification of the condition of shoring at regular intervals Usage of PPE such as Verification of the condition of handrails, access, flashers etc Storage of surplus earth at least m away from the edges of excavation Block stops at the edges of excavation to limit the access of vehicles Emergency escape (evacuation procedures) Construction equipment exhaust away from excavation


Section I: (To be filled by authorized Receiver)Location of the work (indicate level and grid no and enclose location sketch if required):Description of the work:


relevant ones) or mark as X Required permit for buried services has been

obtained from the concerned authority. Workers are given training – Risk Identification

and Precaution Are all the buried services located (with the

help of drawings and by trial pit, detectors etc) Required caution boards / warning notices are

provided Is Shoring / sloping required? If so, has the

material been arranged? Barricades / Handrails installed around the

proposed excavation site The access details to the pit finalized and

materials arranged accordingly Are any traffic diversion signs / flashers required If

yes are these items provided? Following additional precautions shall be taken after taking up the excavation work: (Tick relevant boxes

alone)

I request for an Excavation Permit for the above-mentioned work at the location specified above. I have personally inspected the work place to ensure that the applicable precautions mentioned above have been complied with.


Name: Signature:

Section III: (Permit Approval - To be filled by authorized Issuer)I have personally verified the work spot and compliance of the relevant precautions given insection II of this permit.The permit is valid from _ _ _ _ _ _ (hrs) to _ _ _ _ _ (hrs).Name of the concerned engineer (Authorized Issuer): _ _ _ _ _ _Signature_ _ _ _ _ _

Section IV: (Permit close out - To be filled by authorized Receiver)(To be returned to the authorized approving authority immediately after the completion of work)Name(Authorized Receiver): Signature:

Date and Time:Note:1. Total 2 copies-Original at the work place, Second copy-with issuer; Closed permits (Original)

to be submitted to Safety2. The permit must be registered and a unique number to be given for each permit for

follow up.3. Ensure the no residual risk after completion of work.4. This permit is valid only for the location mentioned in section I and for one day only.5. Permit can be cancelled at any time if any violation observed.

PERMIT TO WORK REGISTER

DATEPERMIT NUMBER

PERMITTYPE

LOCATION ISSUER NAME

RECEIVER NAME

SUB - CONTRACTOR

(if any)

REVALIDATION / CLOSING STATUS

WRITE REVALIDATION DATE


INCIDENT NOTIFICATION FORM

Contractor Name: Date :Employee Name (s): Card No / Staff No:

Age: Designation / Category:Contact Number:

Name of the Concerned Engineer/Foreman:Contact number concerned engineer/foreman:

Witness of Accident (Name, Designation, Contacts):

Person (s) Involved:Card No / Staff No Name Designation Employer

Circumstances and brief description of the Incident / ill health:

Immediate Action taken after the Incident / ill health:

Injury / Illness Details:Nature / Extent of Injury or Illness /

Disease:Location of Accident:

Date & Time:Present Condition:

Referral Details (If applicable):Hospital / Clinic:

Ward No / Bed No:

Name & SignatureFirst Aid Provider Safety Engineer / PM / CM

Note: This form is to be filled immediately in case of injury / illness immediately and submitted to Company HSE Personnel.


HSE INCIDENT REPORT


EmployeeName

Date of Incident

Job Title Time of IncidentType of InjuryLost Time Injury Yes No Nature of Injury Major

MinorNo. of Days/ hours Lost

Property Damage Yes No Extent of Damage

Incident Description

Primary Cause

Contributory FactorsProtective Equipment not used Yes No Inattention Yes NoProtective Equipment notavailable

Yes No Fatigue Yes No

Identified controls and giveninstructions not followed

Yes No Defective Equipment Yes No

Lack of Communication Yes No Poor Judgment Yes NoLack of Training Yes No Poor Housekeeping Yes NoContributory Negligence byOthers

Yes No Shortcuts Yes No

Reported By: DateAction Taken

Reviewed By: DateThis report to be submitted to the Company HSE personnel by the contractor within 24 hours for all HSE

incidents (accidents & near miss)

INCIDENT INVESTIGATION REPORT


Section 1 - Incident Details:Incident Investigation Report No

Date of IncidentTime of Incident

Exact Location of IncidentNature of Incident Over 2 Days

Hospital referral case (< 2 days)Fatality

Dangerous Occurrence / NearmissFIRE

Property DamageEnvironment Disturbance

Other (specify)Type of injury (If any) : Bruise Sprain

Fracture CutAmputation Crush

Burn Electric ShockPuncture wound Heat Related Illness

Eye Injury Other (State)

Details of Damage (If any):

Details of the plant / Equipmentinvolved in the Incident:

Incident Reported By (Name andPosition):

Section 2 – Injured Person (s) Details:Name (s):

Name of Sub Contractor (If any):Card No / Staff No:

Designation / Category:Age:

Experience:Training Attended / Experience:Include the induction, related TBT, job specific training given – attach records


Section 3A – Person Involved (Details):Name of Sub Contractor (If any)

Name of Concerned Engineers:Name of the person involved:

Designation / Category:

Card No / Staff No:Age:

Section 3B – Witness Details:Name Position Contact No Company

Section 4 - Circumstances and description of the Incident:

Section 5 – Facts observed during investigation:

Section 6 – Casual Factors:

Immediate / Underlying Cause Root Cause

Section 7 – Control measure present while Incident:



Section 8 – Recommendation / Action to be taken to avoid recurrence:

Sl. RecommendationsTargetDate

Close outdate

Incident investigation conducted by, Submitted to,

Name Designation Signature

Project Manager / Construction Manager

Add pictures of IncidentsPicture 1 Picture 2



Picture 3 Picture 4

Distribution:


SU GG ES TI O N / N E A R M I SS/ UNSAFE ACT/ UNSAFE CONDITION CARD

Contractor DateEmployee Name Location.

Section 1: Problem Description (Please write what you observed, you may write in any language)

Section 2: What is your suggestion / recommendation to eliminate the problem?

Section 3: Expected benefits from your suggestions:

Section 4: Reviewer - Safety Supervisor/Safety Manager

Section 4: Comments from Client Project Director

Staff/Card No Name Designation Signature


SAFETY VIOLATION REGISTER

Detail of the Violator: Details of the Violation:Name of the supervisor

SI Slip Issued

ByRemarksSl

NoCompany Name Employee

NameCard

number*Date Exact

locationDescription of the Violation

Note: * If the violator belongs to a sub contractor, indicate the name of the company.


FIRST AID REGISTER

Detail of the injured: Details of the accident:Name of the supervisor

RemarksSL Name

Card number* Category Age Date Time

Exact location

Part of body

injured

Brief Description of the Accident**

Date and time of returningback to work

* If the injured belongs to a sub contractor, indicate the name of the company.** Mention what the injured was doing, the equipment, material he was handling at the time of accident etc.


HSE WEEKLY INSPECTION CHECKLIST

PROJECT NAME:Sl No Description Observation Remarks Action By

EXCAVATION

SCAFFOLDS

CONCRETING

WORK AT HEIGHT

MATERIAL HANDLING

GRINDING

WELDING & GAS CUTTING

PLANT & MACHINERY


ELECTRICAL SAFETY

FIRE PROTECTION

HOUSEKEEPING

PERSONAL PROTECTIVE EQUIPMENT

HEALTH & HYGIENE

ENVIRONMENT

SIGNATURE WITH DATE :


EMERGENCY PREPAREDNESS – CONTACT LIST

NAME DESIGNATION TELEPHONE NUMBER

Updated On:

Updated By:


HSE INDUCTION RECORD

Company: Date: Time:

Important Note: When you sign below you are agreeing that you have understood induction and that you know the site regulations on the topics listed below:

- Project Details- Saverglass HSE Policy- First Aid arrangements- Medical Facilities- Accident Prevention

- Accident Reporting- Emergency Numbers- Housekeeping- Fire Prevention- Hot Work Permits

- Excavation Safety- Traffic Management- Smoking Policy- Evacuation Procedure- PPE

Sl Name Company Designation Signature

1

2

3

4

5

6

7

8

9

10

Induction By: Name Sig. Date

Witnessed By: Name Sig. Date


DOCUMENT DISTRIBUTION RECORD

Sl Name of the DocumentDocument Issued to

Name / Title Date Signature


hne - hse forms

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site hse checklist

client consultant hse

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