Daily Checklist

SWP number: Location:

Permit Executor: Permit Issuer:
Day Tuesday Wednesday Thursday Friday Saturday Sunday

Date
S. No. Precautions to be taken Yes No/NA Yes No/NA Yes No/NA Yes No/NA Yes No/NA Yes No/NA
A General Work
1 Simultaneous operations/affected personnel managed
2 Performing operators have necessary knowledge of procedures applicable for work
3 A toolbox talk will be conducted and agreed with all personnel involved
4 PPE requirements identified and will be adhered too
Controls to prevent dropped objects identified and will be implemented (area cordoned off, tools/equipment secured etc.)
5

6 Tools and equipment verified and concluded safe

7 Sufficient communication measures identified and will be implemented
8 Required fire, first aid- and emergency preparedness equipment identified and implemented
9 Energy-isolation (Lock-Out/Tag-Out) will be established
B Hot Work
1 Is the area around the hot work spot clean and free of combustible & flammable material?
2 Are all combustible materials protected (kept 35ft away from the place of hot work) ?
3 Are all operations in the surrounding area suspended, in order to prevent leakage / splash of inflammable material?
4 Are suitable fire extinguishers, in adequate numbers, kept ready for firefighting? Specify the type:
5 Gas test required? If “Yes’ attach gas test record sheet.
6 Is Fire watch personnel is provided? Name:
7 Are the persons taking up the job adequately trained?
8 Are necessary PPEs used by the personnel carrying out the work?
9 Is a proper escape route ensured and adequately marked? Are the personnel made aware of The same?
10 Does the welding machine / gas cutting set or any other power tool used have a valid inspection tag?
11 Are earthing & electrical insulations proper for hand tools and Portable Electrical Equipment used?
12 Are all the power cables in the vicinity adequately protected?
13 Have NRV / Flash back Arrestor been provided in the cutting nozzles and the cylinder outlet ?
14 Are Compressed gas cylinders located at a safe distance from the area of hot work and protected from sparks?
15 Is a "Hot Work Under Progress" caution sign board available at the spot?
16 Is the site of hot work enclosed from all sides with GI Sheets/fire blankets?
17 Has the area been surveyed to identify the presence of any additional potential hazards?
18 Is the Contract supervisor present at the job site till the time the job is completed?
19 Firewatch shall be present at work location after completion of work for 15 mins.
Done by Area Engineer/Supervisor
Verified by Contractor HSE officer
 Daily Checklist
SWP number: Location:
Permit Executor: Permit Issuer:
Day Tuesday Wednesday Thursday Friday Saturday Sunday

Date
S. No. Precautions to be taken Yes No/NA Yes No/NA Yes No/NA Yes No/NA Yes No/NA Yes No/NA
C Height Work
Is the area cordoned off using barricading tape and caution sign board is prominently Displayed at the site of operation?
1

2 Are Scaffolding / ladder used, in good condition and safe for use? Are inspection tags Available on them?
3 Ladder\Scaffolding\MEWP Inspected\Approved along with the checklist?
Is the safety harness provided in good condition and having the inspection tag? Is the anchor point identified and adequate?
4
5 Is the area clear from over-head electrical lines?
Is it ensured that none of the persons working at elevation is suffering from ailments like Low/high blood pressure, vertigo and
6
epilepsy?
7 Is a Safety net provided below the work area?
8 Is a proper escape route ensured and adequately marked? Are the personnel made aware of the same?
9 All hand tools are secured against accidental fall?
10 Loose materials at height are secured?
11 Open areas/gratings are adequate covered and protected. Warning signs are conspicuously posted?
12 Steel erection work has safe access and egress and secure anchor points?
13 Adequate illumination provided in the work area?
14 100% Fall Protection complied toe board, guard rails are secured. Static line provided where required?
D Excavation Work
1 Does the dig involve deep excavations i.e. greater than 1.2?
2 Have the proposed dig location(s) been surveyed for presence of existing services?
Have underground services been established in the location of the excavation(s)? (if yes fill up the underground utilities section)
3

4 Are there any overhead lines in the vicinity of the excavations? (if yes fill up the overhead services section)
5 Has a Risk Assessment being carried out and control measures actioned ?
Has a Work Method Statement (WMS) been completed and communicated for all high-risk construction works identified?
6

7 Is underground utility information checked and attached to this permit?

8 Have all services marked on the ground?
9 Excavator or Equipment / Tool inspected, and checklist attached?
10 Cordoned off the area and caution signage’s displayed?
Overhead Services
1 Is the approach distance within prescribed clearances?
2 Do power line risks need to be controlled by isolation or placed into a protected state?
3 What is the voltage of the power line?
4 What is the clearance distance between power line and excavator / equipment?
Done by Area Engineer/Supervisor
Verified by Contractor HSE officer