Document No 00

Revision 00
Health Safety and Environment Date of Release
Management System Manual Page 00

Formats and Checklists

Format No. Format Title Rev. No.

AF-HSE-01 Proforma for Screening of workmen/Induction 00

AF-HSE-02 Tool Box Talk 00

AF-HSE-03 RCCB Testing 01

AF-HSE-04 RSP (CRADLE) 01

AF-HSE-05 Scaffolding 00

AF-HSE-06 Glass Panel Shifting And Stacking 00

AF-HSE-07 Tools and Tackles 00

AF-HSE-08 Electricals 00

AF-HSE-09 Minutes of meeting 00

AF-HSE-10 Floor crane 00

AF-HSE-11 Vehicle Entry 00

AF-HSE-12 Welding 00

AF-HSE-13 Safety Training 00

AF-HSE-14 Near Miss / incident Report 00

AF-HSE-15 Monthly Safety Performance Report 00

AF-HSE-16 Vehicle inspection 00

AF-HSE-17 Safety Violation/Warning Report 00

AF-HSE-18 Hot Work Permit 00

AE-HSE-19 Height Work Permit 00

AF-HSE-20 Daily Observation format 00

AF-HSE-21 Façade Cleaning Checklist 00

AF-HSE-22 Night Work Permit 00

AF-HSE-23 HIRA 00

AF-HSE-24 JSA 00
 Doc.No AFPL –HSE- 01
Rev.No 00
Health Safety and Environment
Date
Management System Manual Page 1of 3

Proforma for Screening of Workmen

Affix Photo here

Project Name: …………………………………………………. Location: ………………………………… Date: ………………

Date of Screening: ……………………..

Name of the Contractor / Sub – Contractor: ………………………………………………

Full Name of the workmen: ……………………………………………………………………………………

Father / Husband’s Name: …………………………………………………………………………………….

Permanent Address: ……………………………………………………………………………………………

……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………….

Present Address: ……………………………………………………………………………………………….

……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………….

Date of birth: …………………… Age: ………………………

Married / Single / Widow / Widower: ………………………………. Number of Children: ……………….

Mother Tongue: ………………………. Other Languages Known: ………………………………………

In case of emergency, person to be contacted (With address and Telephone Number, if any) ………

……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………….

Signature or left Hand Thumb impression of the workmen for identification: …………………………….

Any other identification mark: ………………………………………………………………………………….

Weight: …………………….. Height: ………………………… Vision: ……………………..

Medical Fitness certificate General / Critical category Obtained……………… Yes / No

 Doc.No AFPL -HSE -01
Rev.No 00
Health Safety and Environment Management Date
System Manual Page 2 of 3

Education:

Examination Passed Year School / Board

Please obtain photocopy of birth certificate issued by School or Gram Panchayat as required under Workmen’s Compensation Act, 1923.

PREVIOUS WORK EXPERIENCE

Sr. Name of the Contractor

Project Site Category Period Salary / Wage Rate
NO Organization

1.

2.

Referred by / References:

Screened by me. Certificates / Details verified / not verified.

Referred to Mr. …………………………………… for ………………………………………on the job trial.

Suitable for employment as …………………………………………………….

Site in charge / Site Engineer

Trial Report

Briefed the safety rules of the Site

Safety Engineer

Approved for employment by M/s. …………………………………………………………………………….

Project Site ………………………………………………………………………………………………………

Resident Construction Manager

Employment Card issued and details entered into Register of workmen.

Site HR Personnel
 Doc.No AFPL -HSE -01
Rev.No 00
Health Safety and Environment Management Date
System Manual Page 3 of 3

MEDICAL CERTIFICATE General / Critical Workers

(To be conducted by registered medical practitioner only)

I / we do hereby certify that we have examined Mr/Mrs. __________________S/o, W/o, D/o _____________________
candidate for employment in the trade of ____________

On Examination

Height : _________Cm Weight : ________ Kg

Blood pressure : _________ Pulse : _____ / min
Vision : Hearing :
Examination if Myopia (near sightedness) observed
Anemia : Spine :
if Yes CBC test result to be referred (Adequately flexible for the job concerned)
Mental Alertness & Stability : OK / NOT OK Alcoholic : (occasional / Regular / Non-alcoholic)
(good eye, hand and foot co-ordination)
Others (Tobacco / Pan / Bhang) Physically challenged
Upper limbs: Lower limbs:
Adequate arm function and grip ( both arms) Adequate leg and foot function
Blood group: ___________ If required: Complete Blood Count:
Breathing:
Measure peak flow rate using standard peak flow meter Any other medical history
For Critical Work
 HEIGHT WORK
History of Epilepsy/Convulsion : Yes / No If yes EEG is required:
Vertigo : Yes / No

 Welders, Grid blasters, Gas cutters

Chest X ray results :

 Drivers & Operators

Vision acuity Test :
Colour blindness test :
REMARKS
Defect in any ________________________________________.

I / we do not consider this as disqualification for the candidate for employment as ________, his / her age is according to her/his
statement _____ years and by appearances to be about _______ year's
He / She is Fit / Unfit for Employment
Date:

Signature of Candidate Signature and Designation of Medical Examiner

 Doc.No. AFPL –HSE- 02
Rev.No. 00
Health Safety and Environment Management
Date
System Manual
Page 1 of 1

TOOL BOX TALK RECORD

Project Name: …………………………………………………. Location: ……………………………………. Date: …………………………….

Point Discussed: ……………………………………………………………………………........

Sr.No Name of person Designation Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

Site Engineer /Supervisor Safety In-charge /Officer

 Doc.No. AFPL –HSE- 03
Health Safety and Environment Rev.No. 00
Date
Management System Manual
Page 1 of 1

RCCB TESTING REPORT

Project Name: …………………………………………………. Location: ……………………………………. Date: …………………………….

Sensitivity of RCCB
RCCB No Location Brief Details of equipments Date of Testing Remarks
connected (sec@30mA)

Signature of Inspectors: P&M / Electrician EHSO

…………………… ………………………..

P&M In-charge/Supervisor EHS In-charge/Officer

 Doc.No. AFPL –HSE- 04
Health Safety and Environment Management Rev.No. 00
Date
System Manual
Page 1 of 2

RSP (CRADLE) Daily Checklist

Project Name : Asset No: Name of operator: Date :

Mark accordingly: - Yes: Performed No: Not Carried NA: Not Applicable

Sr.No Points to be Checked 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total number of 25 kg counter weight Pieces ( it should be 25 kg*40 nos )

1

Whether the counter weight is locked to prevent unauthorized removal of counter weight
2

Whether the top suspension arrangement is arrested for the lateral movement
3

Condition of Power Cable

4

Whether all the Bolts, nuts and pins are placed properly

Reinforcement wire rope condition and tightness at top suspension frame

6

Condition of platform and handrails

7

Key control to prevent unauthorized operation

8

Whether over hoist limit switch is working

9

Whether emergency switch is working

10
 Whether Manual descending system is working.
11

Condition of main rope & Condition of safety rope

12

Heavy hammers fixed with wire ropes at ground level

13

Condition of anti-sway rope

14

Whether Display unit is functional & Display of capacity.

15

Display of Third Party Inspection Certificate and validity

16

Every workman should use separate fall arrestor.

17

Signature Of Operators

Signature Of Section In-charge

Signature Of P&M/Electrician

Signature Of EHS Officer/Supervisor

 Doc.No. AFPL –HSE- 05
Health Safety and Environment Rev.No. 00
Date
Management System Manual
Page 1 of 1

Scaffolding Checklist

Project Name: Date:

Date of Inspection: Scaffolding No:

Reason of Scaffolding: Location:

Contact Person:

Sr.No Description Yes No NA Remarks

1 Are landing platforms provided for access ladders more than 9 meters height?

2 Are relevant status boards (tags) attached to the scaffolding completed / under erection as
applicable?
3 Are the base plates provided for scaffolding posts?

4 Are the base plates are supported by sole plate at unpaved area?

5 Are the footing / anchorage for scaffolds sound and the bay lengths maintained as per the maximum
Intended load (duty)?
6 Are the planks/gratings placed in order without undue gaps and anchored?
7 Are the poles, legs or uprights of scaffolding are securely braced to prevent swaying / displacement?

8 Are wall scaffolding anchored every 10 m of length and 8 m of height?

9 Has the scaffolding area suitably barricaded during erection / usage / dismantling? As far as
practicable, barricades shall be provided by keeping a clear distance of 1.0 meter from scaffold
structure.
10 If the scaffolding is erected above walkways or work areas, are the space between toe boards and
railings screened?
11 If two pipes are connected, are they overlapped at least 600 mm and at least two clamps used?
12 If work is done over men who are working on scaffolding, is overhead protection provided?
13 Is every work platform fitted with handrail (top rail 1200 mm and mid rail at 600 mm high) and a toe
board (150 mm) secured to the platform sides?
14 Is free standing scaffolding tower protected from tipping by guying or other means?
15 Is safe access to equipment or emergency egress restricted by scaffolds?
16 Is scaffolding erected by certified scaffolder?
17 Is scaffolding is erected against PTW?
18 Is the scaffolding in plumb and level?
19 Is the scaffoldings erected as per the load duty requested?
20 Is there a safe and convenient means of access? If a ladder is used, is it rising at least 1050mm above
the platform?

Inspected By: Area In-charge:

Signature: Signature:
 Doc.No. AFPL –HSE-06
Rev.No. 00
Health Safety and Environment Date
Management System Manual Page 1 of 1

CHECKLIST FOR GLASS PANEL SHIFTING & STACKING

Project Name: …………………………………………………. Location: ……………………………………. Date: …………………………….

Name of the Agency: Checked by :

Sr.No. Description Yes / No Remarks
Glass Stacking Checklist
Stacking of glass panel throughout on slipper
1
below level
Padding provided between two glass panels to
2
avoid breaking of glass
Glass panels should not be stacked more than
3
three
Provision of lifeline and fall arrestor made for
4
anchoring full body harness
Access area for panel shifting is free from any
5
obstruction to reach the working area

6 Adequate illumination has been provided

On designated place only glass panel should be

7
stacked

No. of workmen deployed for shifting of glass

panel of size
1500 mm X1500 mm- 4 Persons
8
1500 mm X3900 mm - 8-10 Persons
15 sq m - 22 Persons
10 sq m - 16 Person

Checked by : Section In-charge Site engineers EHSO

Name :

Signature :
 Doc.No. AFPL –HSE- 07
Health Safety and Environment Rev.No. 00
Management System Manual Date
Page 1 of 1

Tools and Tackles Checklist

Project Name: …………………………………………………. Location: ……………………………………. Date: …………………………….

Sr.No. Description Yes No N/A Remarks

1 Cutting tools having appropriate sharp edges
2 Hammerhead / axe properly secured and attached to handles
3 Hand tools are in good condition and free from damages
4 Hand tools Handles coated with soft material
5 Hand tools handles have no sharp edges or finger grooves
6 Hand tools used are manufactured as per standard and not home made
7 Handles with non-slip surfaces
8 Insulated tools available for working near electricity
9 No homemade tools are used
10 No Mushroomed / cracked heads on the tools (punch, chisel, hammer
etc)
11 The right tool for the job is available on site
12 Wrenches are having sharp jaws, with no bent and in good conditions

Inspected By: P&M/Electrician:

Signature: Signature:
 Doc.No. AFPL–HSE-08
Health Safety and Environment Rev.No . 00
Date
Management System Manual Page 1 of 1

Electricals Checklist

Project Name: …………………………………………………. Location: ……………………………………. Date: …………………………….

Date Of Inspection: Nature Of Work: Location:

Sr.No. Description Yes No N/A Remarks

1 All metal parts of electrical equipment & light fittings / accessories
grounded
2 Cable condition is satisfactory
3 Cable insulation resistance was checked prior to connecting with
supply
4 Cables are routed either overhead or underground (underground
cable is protected and marked)
5 Connection of portable power tools are satisfactory
6 Connections are routed through ELCB of 30 mA & Energized wiring in
junction boxes covered all times
7 Continuity & tightness of earth conductor up to DB / SDB
8 Correct / proper fuses & ELCB’s provided at main boards & sub-
boards
9 DBs & extension boards are protected from rain / water
10 Eearthing at the source of power (main DB at Generator or
Transformer)
11 ELCB numbered & tested periodically & test results recorded in a
logbook and countersigned by competent person
12 Industrial sockets and socket pins are used, Sockets to be with proper
plug tops
13 No over loading of DBs / SDBs

Inspected By: Electrician/In-charge:

Signature: Signature:
 Doc.No. AFPL-HSE -09
Health Safety and Environment Management Rev.No. 01
Date
System Manual
Page. No 2 of 2

Minutes of EHS Committee Meeting

Project Name: ………………………….. Location: ………………………….. Date: ……………………

Sr.No Description of Discussion Action By Target Date Remarks

EHS MANAGER PROJECT MANAGER

 Doc.No. AFPL-HSE -09
Health Safety and Environment Management Rev.No. 00
Date
System Manual
Page. No 2 of 2

Project Name: ……………………………………………………. Location: ……………..………………………….. Date: ……………………………………

Sr.No Present Member/Representative Designation Signature Absent Member

10

11

12

13

EHS MANAGER PROJECT MANAGER

 Doc.No. AFPL-HSE -10
Health Safety and Environment Management Rev.No. 00
System Manual Date
Page. 1of 1
Floor Crane Checklist

Project Name: ………………………………………….Location: ………………………………… Date: …………………………………….

Condition: Ok √ Not Ok ×

Sr.No Inspection Points FC.01 FC.02 FC.03 FC.04 FC.05 Remarks

1 Floor Crane Wire Rope

Condition

2 Wire rope of the drum

3 Wire rope clamping condition

4 Counter weight locking system

5 Earthing system

6 Floor Crane wheel & Jack

condition

7 Electrical panel condition

8 Boom & Nut bolts Condition

9 Floor Crane Remote condition

10 Guard for moving parts

11 Pulley condition

12 Electrical cable condition

13 ELCB/RCCB working Condition

14 Over Head Limit Switch

15 Hook Latch & D-Shackle

condition

Sign of P&M /Electrician

Sign of Site In-Charge

Sign of EHSO
 Doc.No. AFPL-HSE -11
Health Safety and Environment Management Rev.No. 00
System Manual Date
Page. 1of 1

CHECKLIST FOR VEHICLE ENTRY

Sr.No. Description Ok Not Ok NA Remarks

1 Check for Valid Fitness Certificate of the Vehicle

2 Check for Load Carrying Capacity of the Vehicle

Check for Computerized Weighing slip for tare and gross weight
3
of the vehicle

4 Check for Physical Condition Of the Vehicle

5 Check for Physical Condition of the Tyres of the Vehicle

6 Road Tax receipt

7 Insurance Copy of the vehicle

8 Whether A Stand Used for Glass Stacking or not

Check for Strapping of Glasses on either side of A Frame with

9
independently

Vehicle should have reverse horn & parking lights in working

10
condition
11 Quantity of Glasses Stacked on either side of a "A" Stand
8mm -25nos.
28mm - 14nos.
30mm - 13nos.
32mm - 13nos.
34mm - 12nos.
12 Vehicle Driver Fitness

Store In-charge Site in-charge EHSD

Signature: Signature: Signature:

 Doc.No. AFPL-HSE -12
Rev.No. 00
Health Safety and Environment Date
Management System Manual Page. 1of 1

WELDING CHECKLIST

Project Name : …………………………………..Location: ……………………………………..Date of Inspection: ………………………………

Welding Set Identification No. : …………………………………………………..

Sr. No. CHECKS YES/ NO/ REMARKS

OK NOT OK
01. Hot Work Permit obtained?
02. Use of requisite PPE’s
(a) Safety Helmet
(b) Safety Shoes
(c) Welding Shield
(d) Safety Hand gloves
03. Condition of Welding Face Shield
(a) Dark Glass
(b) Plain glass
04. Rain protection provided to Welding Set
05. Earth connection to welding machine
06. Welding Cable condition
07. Welding cable connectivity
08. Welding cable joints
09. Power Lead connectivity at both ends.
10. Joint insulation intact or not
11. Whether power lead exposing on ground
12. Status of Isolation Power Switch of m/c
13. Earth connection to work job
14. Power supply connection to machine
15. Return Lead/Back Cable
16. Whether ELCB/RCCB provided in DB
17. Rain Protective Canopy to Power DB
18. Condition of Electrode Holder
19. Availability of Fire Extinguishers
20. Whether a helper to welder is provided?
21. Condition of chipping hammer?

P&M /Fabrication Engineer EHS Officer

 Doc.No. AFPL-HSE -13
Health Safety and Environment Management Rev.No. 01
System Manual Date
Page. 1of 1

SAFETY TRAINING

Project Name: ………………………… Location: ………………………………………….Date: …………………………………………..

TOPICS: …………………………………………………………………………………………………………………………………………………….

NAME OF TRAINER: ……………………………………………………………………………………………………….

SR. NAME DESIGNATION SUB-CON/COMPANY SIGNATURE

NO.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

SIGN OF TRAINER
 Doc.No. AFPL-HSE -14
Health Safety and Environment Management Rev.No. 00
System Manual Date
Page. 1of 3
Format of near miss investigation report

PROJECT NAME : REPORT NO. DATE:

Date of incident : Time of incident : Location of incident :

CAUSES OF INCIDENT (Direct/indirect cause, Unsafe act/unsafe condition, actual cause)

UNSAFE ACT UNSAFE CONDTION

Unauthorized operation Inadequate control Noise exposure Inadequate / poor visibility

Untested lifting tools, tackles & Operating plant & machinery at improper speed Inadequate illumination Surface condition (oil spill, wet floor,
equipment grease etc.)

Over / improper loading Improper placement Defective tools Improper access & egress

Use of unfit vehicle / equipment Under service / maintenance equipment in Inadequate guards / protection Natural rock slide / land slide
operation

Improper Handling (mechanical / Not-functioning of safety device (reverse horn/ Ambient conditions (flood, snow, Exposure to temperature (heat / cold)
manual) SLI, SWL) heavy rains etc)

Improper lifting operation Improper PPE's usage Poor housekeeping Rock fall inside tunnel

Damaged electric cables Non-usage of PPE's Water ingress Flying particles

Uncertified blaster / wireman Ignoring overhead power lines Congestion / restricted area Inadequate warning system

Malfunction / defect in machine, Poorly maintained equipment Poor / improper plant layout / Unavailability of correct / suitable plant
equipment disorderly workplace & machinery

Untrained / incompetent Working at heights – improper platform, Terrain / stiff slope of roads / Exposure to dust, smoke, gas, fumes,
personnel scaffold etc. inadequate curves chemicals etc.

Lack of knowledge about Plant & Inadequate ventilation / suffocation Overtime

machinery operation

Other (specify) Poor Housekeeping Improper Access

Inadequate Locking system of DB Other (specify)

PERSONAL FACTOR JOB FACTOR SYSTEM FACTOR

Failure / ignorance to use PPE's Lack of supervision Non-availability of HIRAC/JSA/CTA

Influence of drink, drugs, misconduct Inadequate leadership Not following permit system

Adoption of unsafe / wrong work method Inadequate maintenance Non adoption of height pass system

Improper group task / communication gap Inadequate engineering Not following LOTO

Improper motivation Inadequate purchasing / selection Improper design

Inexperience in performing the assigned task / lack of Inadequate tools, equipment & material Insufficient/ inadequate instruction / information
skill

Mental or psychological stress (fatigue, heart condition Wear & tear in plant and machinery Inadequate / unapproved methodology
etc)

Horseplay Inadequate work standard Inadequate system / standard / TBT

Inadequate physical or physiological capability Abuse and misuse of plant & machinery Inadequate inspection / control (pre / post)

Other (specify) Failure to warn in emergency rescue

Other (specify) Not following SOP

Other (specify)

DESCRIPTION OF INCIDENT (Chronological order of events, staff notified, action taken etc), type of

work being performed

Elaborate identified cause of incident

PHOTOGRAPHS & SKETCH OF INCIDENT

REMEDIAL ACTION

Immediate Correction

CORRECTIVE ACTION

Proposed Action Person Responsible for implementation Target date for completion

PROPOSED PREVENTIVE ACTION

Proposed Action Person Responsible for implementation Target date for completion

COMMENTS BY PROJECT INCHARGE

NAME SIGNATURE DATE

INVESTIGATED BY

NAME DESIGNATION DATE SIGNATURE

1.

2.

WITNESS

NAME DESIGNATION / TRADE

1.

NAME & SIGNATURE OF HSE INCHARGE: NAME & SIGNATURE OF PROJECT INCHARGE:
 Doc.No. AFPL-HSE -15
Health Safety and Environment Rev.No. 00
Management System Manual Date
Page. 1of 1
Monthly Safety Performance Report
Project Name : Nature of the work :

Actual Work Start Date :

Sr.No Descriptions Up To Month Cum Up to Date
1 Total Number of Staff

2 Total number of workers

3 Total Man Hours Worked

(Daily manpower * 26 days * 11 working Hrs)
4 Safe Man-hours worked Since Last Reportable Accident

5 Number of Workers Inducted (New Employee)

6 Tool Box Meeting

7 Safety Checklist

8 Training Sessions

9 Total Numbers of Work Permits Issued

10 Warning notes/Debit notes issued

11 Unsafe Act/Condition Identified

11.a Unsafe Condition & Closed

12 Number of Near Misses

13 Industrial Accident / Injury Data

13.a Sickness

13.b First Aid Cases ( Less than 08 hrs)

13.c Non reportable Cases

( More than 08 hrs and less than 48)
13.d Reportable Cases ( More than 48 hrs)

13.e Fatal

13.f Total Industrial Accident / Injury

14 Total days Lost

14.a Due to Non reportable Cases

14.b Due to Non reportable Cases

15 Frequency Rate
(Number of reportable accidents per million man-hours worked.)
16 Severity Rate
(Number of man-days lost per million man-hours worked.)
17 Injury Rate
( Industrial Accidents / Strength of Employee)

EHS Manager/Officer Project Manager

 Doc.No. AFPL-HSE -16
Rev.No. 00
Health Safety and Environment
Date
Management System Manual
Page 1 of 1

VEHICLE INSPECTION CHECKLIST

Project Name & No: …………………………………………………………

Model/Vehicle No: ……………………………………………………………

Date of Inspection: ………………………….. Owner’s Name: …………………………………………

Sr.No Check Points OK Not Ok Remarks

1. Engine Condition

2. Clutch

3.
Brakes/Hand Brakes
4. Hydraulic System

5.
Doors
6. Horn

7. Reverse Horn

8. Lights

9. Indicators

10. Wiper Blades

11. Driver’s License

12. Tyre Pressure

13. Condition of Battery

14. Steering

15. Gauges, Warning Devices

16. Others

Inspected by (Name & Sign.):-……………………………………

Driver P&M Engineer EHS Officer

 Doc.No. AFPL-HSE -17
Health Safety and Environment Rev.No. 00
Management System Manual Date
Page. 1 of 1

SITE SAFETY VIOLATION WARNING / NOTICE

REFERENCE CLAUSE : ……………………………. DATE: ……………………………. Time: ……………….
SUBCONTRACTOR : ………………………………
SUBCONTRACTOR WORKS :………………………………….

FIRST WARNING SECOND WARNING REPLACEMENT

DETAILS OF VIOLATION / NON-COMPLIANCE: ………........................................................................................................

………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………..

THE FOLLOWING DISCIPLAINARY ACITON WILL BE TAKEN:

Rs. SHALL BE DEDUCTED FROM NEXT SUBCONTRACTOR BILL.

TO BE REPLACED HIM AFTER SECOND VIOLATION.

OTHERS: __________________________________________________________

EHS Manager Project Manager

 Doc.No. AFPL-HSE -18
Health Safety and Environment Management Rev.No. 00
System Manual Date
Page. 1 of 1
HOT WORK PERMIT
Project Name : Permit No :

SECTION 1: WORK REQUEST BY CONTRACTOR / PROCESS OWNER

PTW Requestor
Purpose of hot work:…………………………. Location:…………………………
Work Descriptions:
WELDING GAS CUTTING USE OF OPEN FLAME BURNING GRINDING OTHER ………….
Approximate time duration of work from - ____hrs to___hrs on date --/--/----
NAME: DESIGNATION : MOBILE NO : INDETIFICATION NO :

SECTION 2:
Reviewed / checked by
Attributes
Electrical In-charge/P&M Execution Sec In-charge

Distance from flammable material storage. ___ meters Name Name

Fire blanket or tray to prevents falling sparks (yes / no)
Have fire extinguishers been kept handy at site? (yes / no) Designation Designation
Proper Housekeeping & removal of combustible materials (yes / no)
Display of signage's & caution boards (yes / no) Identification No Identification No
Has the area below the work spot been cleared / removed of oil, grease & waste
cotton etc.? (yes / no)
Has Gas concentration been tested in case there is gas valve/gas line nearby? (yes Mobile No Mobile No
/ no)
Has tin sheet/ wet gunny bag/ fire retardant cloth / sheet been placed to prevent
sparks from causing fire? (yes / no)
Approach for emergency (yes / no)
Dust mask, eye protection, hand gloves, safety shoes, other specify (yes / no)
Provide Barricades, Road blocks (yes / no)
Availability of first aid box (yes / no)
Any other precautions taken (specify): I, declare that mentioned location is safe to work and (required) shut down is
given and the same will not be made alive till the permit is cancelled in writing
by the person taking shutdown.
SECTION 3: APPROVAL
Departments Name Identification No Signature
P&M
Execution
EHS
Permit start date / time: Permit valid until date / time:
SECTION 4: PTW ACCEPTED BY
PTW Holder (Work supervisor) Name: Identification No: Signature:
SECTION 5: PTW CLOSED
I, declare that the mentioned job has been completed satisfactorily. Men and materials have been removed from the work location. Apparatus / equipment are
safe for use. Hence PTW hereby closed.
PTW Issuing & Closing Authority Name: Identification No: Signature:
PTW closed at ------- hrs, Date --/--/--
Remarks if any:
 Doc.No. AFPL-HSE -19
Health Safety and Environment Management System Rev.No. 00
Manual Date
Page. 1 of 1
HEIGHT WORK PERMIT
Project Name : Permit No :
SECTION 1: WORK REQUEST BY CONTRACTOR / PROCESS OWNER
PTW Requestor
Approximate time to execute the job from - ____hrs to___hrs on date --/--/----
NAME: DESIGNATION : MOBILE NO : INDETIFICATION NO :
SECTION 2: PRECAUTIONS
Yes No NA Remarks
Attributes
Competency & Medical certificates seen and found FIT
Are all surfaces capable of supporting workers weight?
The persons will work from a fully completed approved scaffolding or approved man cage?
Is the correct fall arrest equipment available?
Working platform provided with hand rails and toe boards.
Fragile areas of roofs identified and marked.
Is there a slip hazard associated with height? Detail slip hazard:
Are secure anchor point(s) available?
Tools and tackles are attached with safety slings and secured against fall.
Sufficient Illumination available for work?
Any simultaneous work at the same location at below levels or not?
Whether loose materials at the top of working platform are secured?
Workers equipped with full body harness.
Safety nets provided?
Area below height work cordoned off, entry restricted for unauthorized person and ‘NO
ENTRY’ board is displayed?
Ensure that no personnel are there exactly below or in the working zone during lifting of
material.
Are loose materials removed from erected parts?
Whether sling and other tools n tackles are visually inspected by competent person
(Mechanical or erection engineer/ trained erection foreman) prior to lifting and are free
from any defects?
Availability of first aid box
Any other precautions taken (specify):
SECTION 3: APPROVAL
I certify that all the above mentioned safety precautions are ensured at work location.
Departments Name Designation Signature & Date
Execution
EHS
Permit start date / time: Permit valid until date / time:
SECTION 4: PTW ACCEPTED BY
PTW Holder (Work supervisor) Name: Identification No: Signature:
SECTION 5: PTW CLOSED
I, declare that the mentioned job has been completed satisfactorily. Men and materials have been removed from the work location. Apparatus / equipment are
safe for use. Hence PTW hereby closed.
PTW Issuing & Closing Authority Name: Identification No: Signature:
PTW closed at ------- hrs, Date --/--/--
Remarks if any:
 Doc.No AFPL –HSE -20
Health Safety and Environment Management Rev.No 00
Date
System Manual
Page 1of 1

SITE SAFETY OBSERVATIONS

Date: Final Date of Compliance:

Project Name: Date Of Reporting:

Location:

Auditors Name:

Sr .No Area for improvement Risk Action to be taken Image Before Image After Remarks

Observed By: EHSO/Manager Reviewed By: Project Manager

 Doc.No AFPL -HSE -21
Health Safety and Environment Rev.No 00
Date
Management System Manual
Page 1of 1

Façade Cleaning Checklist

Project Name: ………………………………………………………………. Location: ……………………………………..

Name of Cleaner: ……………………………………………………………..

Mark accordingly: √ Performed × Not Carried out

DATE
Sr.No Points to be checked 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1 Total number of 25 kg counter weight Pieces ( it should be kg*25x20 nos )/

Tied with Permanent Structure RCC/ Boom
2 Whether the counter weight is locked to prevent unauthorized removal of
counter weight
3 Both the Polyamide Ropes to be free of Wear & Tear

5 Rope Knot to be Properly tied

6 D clamp to be provided at the end of knot

7 Availability of Cushion to Protect ACP and Polyamide Ropes

8 Descender to be checked for Properly placed in Rope

9 Grab Arrestors to be in Working Condition

10 Cleaning Harness Kit to be checked

11 Authorized Cleaner to be allowed and Medically fit.

12 Eye watcher to be present at terrace

13 Eye watcher to be present at Ground/ below Level

14 Availability of Walky Talky

15 Cleaner to be in proper PPE's

16 Hand Tools to be protected with rope tied to hand of cleaner

Signature Of Cleaner

Signature of Cleaner Supervisor

Signature of Engineer/ Supervisor

Signature of Ehs officer/Supervisor

 Doc.No. AFPL-HSE -22
Rev.No. 00
Health Safety and Environment Management Date.
System Manual Page. 1 of 1

NIGHT WORK PERMIT

Project Name : Location: Permit No :
SECTION 1: WORK REQUEST BY CONTRACTOR / PROCESS OWNER
PTW Requestor
Approximate time to execute the job from - ____hrs to___hrs on date --/--/----
NAME: DESIGNATION : MOBILE NO : INDETIFICATION NO :
SECTION 2: PRECAUTIONS
Attributes Yes No NA Remarks

The work will not produce High noise level.

No air compressed tools and power tools will be used

The work area is inside the site fencing and security available full time for restricting
unauthorized personnel

Supervision provided (Company & Contractor) Name________________ Mob

No______________ Name________________ Mob No ______________

Safety Coordinator

Name________________ Mob No______________

Required safety controls implemented

All workers are inducted & given Tool Box Talk

All workers are equipped with required PPEs

First aid Box available, Location_____________

Sufficient illumination provided

Emergence procedure briefed

SECTION 3: APPROVAL

Execution Signature & Date

EHS
Permit start date / time: Permit valid until date / time:
SECTION 4: PTW ACCEPTED BY
PTW Holder (Work supervisor) Name: Identification No: Signature:
SECTION 5: PTW CLOSED
I, declare that the mentioned job has been completed satisfactorily. Men and materials have been removed from the work location. Apparatus / equipment
are safe for use. Hence PTW hereby closed.
PTW Issuing & Closing Authority Name: Identification No: Signature:
PTW closed at ------- hrs, Date --/--/--
Remarks if any:
 Doc.No. AFPL-HSE -23
Rev.No. 00
Health Safety and Environment Management Date.
System Manual Page. 1 of 1

Name of the Project:

Activity:

Existing Additional
Sub Hazard Possible Population Probability Severity Risk Residual Action
Sr.No Hazard Control Control
activity Event Outcome at risk Rating Rating Level Risk By
Measure Measures

EHS Manager Sign: Project Manager Sign:

 Doc.No. AFPL-HSE -24
Rev.No. 00
Health Safety and Environment Management Date.
System Manual Page. 1 of 1

JOB SAFETY ANALYSIS

PROJECT: JSA NUMBER:

JOB TITLE: NAME OF CONTRACTOR:

DATE: DETAIL LOCATION:

SR.N. ACTIVITIES HAZARD RISK CONTROL MEASURES

EHS Engineer/
Almech PM Clint EHS / Engineer Client EHS Manager
Officer
Prepared By Checked by Reviewed By Approved By