NIGHT SHIFT AND EXTENDED HOURS CHECKLIST

(INVALID WITHOUT AN ACCOMPANYING NIGHT, PUBLIC HOLIDAY AND WEEKEND ACTIVITIES REPORT FORM )
SECTION 1 – GENERAL INFORMATION (To be filled by Appplicant)
DATE: …………………… FROM: ………………..hrs TO:
LOCATION EQUIPMENT
………………..hrs
PTW NO.: APPLICANT
………………………….. NAME: …………………………….
SERVICE:
BADGE NO.:
…………………………..
SECTION 2 –WORK DESCRIPTION (To be filled by Applicant)

SECTION 3 – CONDITIONS TO BE CHECKED BY

In Not
SUPERVISION Comment
compliance Incompliance
Site Project Team available
Site Safety Supervisors available (ratio 30 employees;1 SSS)
LIGHTING AT WORK AREA
150 Lux for work areas, 100 Lux for access ways and 50 Lux for walk ways,
access ways and break areas
Portable / Hand Lamps available
Visible Barricaded available
LOGISTIC, MACHINERY AND VEHICLE MOVEMENT
Plant/machinery/vehicle with sensors
Establish dedicated pathway for all machinery/vehicle movement and well
illuminated
Establish a safe walkway for pedestrian and well illuminated
Transportation available for workers.
Signalman escorting the machinery/vehicles in the site to use baton lights.
FOOD AND BREAKS
Meals and Drinks provided
Rest Shade Area & Smoking Shelter
PPE & EQUIPMENT FOR NIGHT WORK DEPENDING ON SCOPE OF WORK
Clear Safety Glasses, Reflective Vests, Portable Hand Lights, Portable Head
Lamps, Blinker light, Baton light, safety caution reflective tape & etc.
EMERGENCY RESPONSE PLAN
First Aid Box
Eye Wash Station
Certified First Aider (20 to 1 ratio)
Evacuation Plan / Routes for all work groups and display on Notice Boards
Emergency Contact List available
Workers Understanding on ERP Procedures
Fire extinguisher available and ready to use
SECTION 4 – APPROVAL AND CERTIFICATE VALIDATION BY CONSTRUCTION MANAGER
This certificate is valid on: DATE: ............................... FROM:....................hrs TO: :....................hrs
I hereby accept with the controls in place for the work to be conducted safely and approve the commencement of night work
activities.

NAME: SIGNATURE: DATE: TIME:

……………………………………………….. ………………………………………… ………………………. …………………hrs

SECTION 5 – COMPLETION OF WORK SECTION 11 – ACKNOWLEDGEMENT OF COMPLETION

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