HSE Site Instruction For Contractor Form

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HSE SITE INSTRUCTION FOR CONTRACTOR

Dept./Division Project Name


Name of Inspector Name of Site Manager
Date & Time Location

Details of Non-Compliance
N
# Compliance Yes
o
N/A If "No"; write the details
Has an individual been appointed with day-to-day
1 responsibility for Health, Safety & Environment ? approved by
SEC or not ?
Are activities stopped 12 :00 to 3:00pm during summer ? (June,
2
July, August)?

3 Are the activity is in going without the presence of supervisor ? √


Do they have Safe System of work?
Permit to Work Job Safe Practices Risk
4
Assessment √

√ Most workers w/o SEC IDs, iqama


Are employees having valid SEC ID and Iqama which
5 profession for two manlift operators
profession matching their work?
not matching actual job
Is lifting equipment & heavy vehicle and its operator(s)
6 having valid Inspection certification, training certification & √
valid license?
Is appropriate fall prevention/protection measures
Safety harness w/o inspection colour
7 provided for work at height? √ code and numbering
Guard Rail Life Line Safety Harness Rescue

Is appropriate scaffolds has been erected by certified erector
8
and inspector, and adequate tag was fixed ?

Is appropriate protective measures provided for
Excavation?
9
Shoring/Stepping Crush Barriers Traffic Signs

Access/Egress Vehicle Crossing Lighting
Are employees provided & used by standardized Personal
10 Protective Equipment? (Helmet, Safety Shoe, Coverall, Hi- √
Vest)
Do they have Safe Work Place?
Welfare Facilities Security Control
11
Access/Egress

Emergency Plan Fire Fighting System First Aid
Are there any defective Electrical installation ? √
Cable Insulation /Joining DB protection Socket/
12
Plug
RCD/ELCB DB Protection Cable Routing
Is SEC & Contractor's Policy Displayed (A0 Size) & √
13
Communicated with Employees?
Comments:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Non-compliance Status Major Medium Minor

Major : All activities must be stopped by contractor and resubmit all documents to Projects Department for approval . Do not
HSE SITE INSTRUCTION FOR CONTRACTOR
proceed any activity until the instruction come from Projects Department or Industrial Security Department.
Medium : Particular activity must be stopped by contractor and take corrective action and send report to Projects Department for
approval. Do not proceed that activity until the instruction come from Projects Department.
Minor : Proceed Activity and take Immediate action (correction) and send report to Projects Department for review.

__________________________ __________________________ ______________________________________


Signature of Safety Inspector Signature of Site Manager Signature of Projects Department Manager
(For Acknowledgment if Major Violation)

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