vedantfa

*3TSforming ei¢NICnfs balco

Dcavation more than 01 Meter

Person/s Conducting Verification: E. No- 57T1 Date and Time of Verification:

2 - I3 | ST0212022, 2:30M|
Name Hanshgnpte,DpakKPatel Ke
SUN
Name & E. No of Balco Job Executer
Location of Verification/Task Being Undertaken: SBU
Department
P'rjecf/Bake coVen
Kishna Pandey 1363)
Yes No
Mark v
Man (Interaction)
/ shoring stresses, Water accumulation & Access/ egress on daily
1. Authorized person checked Wall
understand his role in the Emergency Response Plan? Does he has
basis (see document)? Does he
communication device for trigger rescue team?
at site and Communicated Risk Assessment (Related Hazard, Consequences
2. Supervisor availableinvolved in work (ask to workers & check TBT Record)?
& Controls) workers,
to

3. Heavy equipment operators to have valid HMVlicenses specificto the equipment?

authorization card?
4. All persons who are performing excavation work, have validcondition like gum boot, gloves, mask etc.?
PPEs in good
5. Involved personal have their job specific LOTO lock at the Group LOTO Box jf
6. Has every person involved in the work applied personal
a
pipeline etc.? NG
isolation applied on any buried energy linelike electrical cable, steam/ pressurized Mark v
Machine / Material (Inspection)
machine?
6. Pre start Checklist filled & available at worksite for excavator
Excavation area is surrounded with hard barricading?
7.
8. Access walkway available to enter/ exit from pit? NA
kill people?
9. Is the work area clear of materials that could fallback/ entrap&hazardous
(all inlets & outlets) been de-
10. Have all the energy or hazardous substance
sources

energized/ drained lisolated & LOTO which mentioned in PTW? NA

excavation pit or excavation near structure?
11. Trench sheeting & shoring installed for vertical
Mark v
Method (Audit)
& HIRA.available at site?
13. Permit to work with Annexure Checklist (Class-1 PTVW) PTW
(Mention PTW Number .C?.0.z.k.... .& HIRA Number-.......9..1...

4. Do PTW Mentioned withallinvolved personal namewith Entry &Exit Timing?

15.DoHIRA document &worksite have matching hazards &implemented controls?

Inspectors RecommendationS
What Who (Need to Implement By) When (Target Date) Status (By EIC)
Cloge aA remangHmitSan
|é/oz/22
2
Notes/ Remarks/ Detail Observations & Recommendations:
Cone osiim not_adeq uote (CG1, AR -o/94)
Ba c hor
Bace hom isCe 2 Vehide Checkhtnet in ndi (CG1,/Ro1ss)

u_iNca mat_able to atrdChe KKE2alo lak of kea.

Note: Please fll this form at site and send scan copy to HOD & Balco Engg. Of concern department with Copy to
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