HSE TIER 1 CHECKLIST

SAFETY: CONFINED SPACE & INERT ENTRY

NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) PLANNING
1 Are personnel involved in confined space/ inert entry trained and competent?

2 Is the confined space certificate approved by appropriate authority (AA)?

Are physical (PIC), electrical isolation certificates (EIC) and spading/blinding list attached with
3
the permit?

4 Are there any other incompatible works nearby? i.e. Radiation, exhaust fume etc.

5 Are the workers certified medically fit for confined space and inert entry work?

6 Are the JSA and ERP attached with the confined space certificate?

B) EXECUTION & MONITORING

1 Are the workers wearing the proper PPE?

2 Is the confined space gas freed for respirable entry condition?

3 Is the oxygen at safe level for respirable entry condition?

4 Are the equipments used in confined space inspected and tagged?

5 Are portable gas detectors calibrated and tagged?

6 Are portable gas detectors calibration valid?

For the inert entry, are the following personnel available at site?
1.   Work Supervisor/Leader
7
2.   Stand-By Person/Rescue for Inert Confined Space
3.   Life Support equipment operator

8 Has an initial gas test been done and as per the frequency prescribed in PTW?

9 Is continuous air ventilation provided?

10 Are proper warning signs and barricades available?

11 Have JSA and emergency response plan been briefed to the workers?

Are the following mandatory equipment available, certified and inspected?

12 1. Escape Set (Inert Entry)
2. Portable Gas Detector
3. Life Support System (Inert Entry)

C) EMERGENCY & RESCUE

Are the following mandatory rescue equipment available at site?

1.    Tripod/Quadrapod
2.    Lifeline
1
3.    Full Body Harness
4.    Distressed Signal Unit
5.    Life Support System (Inert Entry)

2 Is the life support operator in continuous communication with inert entry workers?

Percentage Compliance (Total no complied/Total no of requirements) %

NOTE
For entry condition of respirable atmosphere:
1.    O2 content shall be at a minimum of 20% and maximum of 21% by volume.
2.    LEL less than 1% by volume AND;
3.    Toxic vapours : not greater than 50% of the PEL

For entry condition of Irrespirable Atmosphere:

1.    O2 content shall be less than of 20% OR more than of 21% by volume.
2.    LEL more than 1% by volume but should be less than 10% AND OR;
3.    Toxic vapours : greater than 50% of the PEL

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: CONTROL OF IGNITION SOURCES
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) IDENTIFICATION & CONTROL OF IGNITION SOURCES
1 Are all relevant personnel trained on control of ignition source procedure?

2 Have all potential ignition sources in the area been identified?

Has intentional release of flammable been controlled in the vicinity of known ignition source?
3
e.g. line breaking, draining, sampling, line flushing etc

B) OPEN FLAMES
1 Is nitrogen/ CO2 snuffing available at local vent for extinguishing of fire?

C) ELECTRICAL EQUIPMENT IN CLASSIFIED HAZARDOUS AREA

1 Is hazardous area classification map available?

2 Is integrity check of EX equipments carried out by Electrical / Instrument?

D) PERSONAL IGNITION SOURCES

Is the use of personal electronic or electrical devices in process area controlled via hot work
permit?
1
e.g. pager, cellular phone, personal digital assistant(PDA), personal radio, music player,
computer, walkie-talkie, camera, hand torch and car alarm key.

E) HOT WORK
1 Are all hot works in the area have approved hot work permits?

2 Have hot surfaces above xxx temperature been insulated?

F) VEHICLE & ENGINE

1 Is approved vehicle route/access area map available?

2 Is spark arrester used on vehicle in process area?

3 Do vehicles used in classified hazardous area have hot work permit?

4 Is diesel driven engine sited in safe area?

e.g. generator, air compressor, welding machine etc.
F) ELECTROSTATIC (LIGHTNING) AND STRAY ELECTRICAL CURRENTS
1 Has check been conducted on all earthing and bonding?
e.g. truck loading, tank, pipe, flange, etc.

2 Is the negative point placed nearest possible to the welding point? (to prevent arcing)

Is static discharge point available at the staircases of highly flammable products tank?
3 e.g. toluene, Jet A1, gasoline

Is the practice of spray loading prohibited/controlled? (for top loading of products, initial fill-up
4
of empty tank)

5 Is the flow rate of products controlled? (to prevent statics build up or two-phase flow)

F) AUTO IGNITION: HYDROCARBON, PYROPHORIC

1 Has pyrophoric material been identified?

Is purging, washing and blanketing procedures implemented during change-out of pyrophoric

2
materials?

G) HANDS & TOOL EQUIPMENT

Are all electrical / electronic equipments used in classified hazardous areas intrinsically safe / EX
1 classified?

2 Is the use of sparking tool prohibited in the classified hazardous areas?

3 Is inspection tag available and valid for hand tools and equipments?

4 Is the use of aluminum ladder prohibited in zone 0 or 1 area?

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 SAFETY TIER-1 CHECKLIST: CHEMICAL HANDLING
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) PLANNING
1 Are employees and contractors trained on chemical handling?

2 Are employees and contractors trained on proper use and maintenance of PPE issued?

B) EXECUTION & MONITORING

1 Does the worker know the PPE requirement for the job?

2 Does the worker wear the required PPE?

3 Are the PPE provided in good condition?

4 Are all chemical containers used properly labelled ?

5 Are CSDS prominently displayed at work site?

6 Are they in languages understood by employees and contractors?

7 Are proper warning signs or instruction board available?

8 Does worker know how to respond to chemical incident?

9 Are the eye wash and safety shower in the work area are in good condition / functioning?

Do workers know the location of the eye wash and safety shower in vicinity of their work
10 location?

11 Is there any chemical spill at the work area?

12 Are these chemical spills reported and cleaned?

13 Is there any chemical spill kit available at the work area?

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: ENERGY ISOLATION
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) PLANNING
1 Are all relevant personnel trained on energy isolation procedures?

Has all energy sources been identified for the job? e.g. electrical, chemical, hydraulic,
2
pneumatic, radioactive, etc

3 Is isolation and spading list available?

4 Has PTW been issued for all certificates? e.g EIC, PIC

5 For confined space entry, has ‘positive isolation’ as per PTS been applied?

B) ELECTRICAL ISOLATION
1 Is operation lock & tag applied at substation?

2 Is electrical lock & tag applied at substation?

3 Is motor control centre (MCC) racked out and locked? (for work inside substation)

4 Is field local switch tagged by Operation?

5 Has ‘try’ step been performed by Operation and witnessed by Maintenance?

C) PHYSICAL ISOLATION
1 Is equipment under maintenance has been isolated as per PIC?

2 Has operation group locks been applied?

3 Has operation tagged all isolation points?

4 Has the lock number and tag number been recorded in PIC?

D) LOCK OUT BOX

1 Are electrical trade key and Operation group lock key placed inside the lockout box?

2 Is the lockout box locked and tagged by AA?

3 Is the lockout box locked and tagged by trades?

E) APPROVAL
1 Has EIC been completed, signed and approved?

2
Has PIC been completed, signed and approved?
F) WORK EXECUTION
1 Check validity of PTW, EIC and PIC

Check locks and tags at site and electrical substation as per PTW, EIC, PIC and isolation and
2
spading list.

3 Is logbook updated on the recording of lock and key?

4 Are spading tags been applied by Maintenance and verified by Operations?

H) HAND BACK
1 Has Operation verified completion of work?

2 Has all locks and tags been removed?

3 Has all the spades been removed?

4 Has housekeeping been done?

5 Has PTW, EIC and PIC been signed off?

Percentage Compliance (Total no complied/Total no of requirements) %

NOTE FOR TURNAROUND:

Only tag is required for physical isolation. For confined space entry and electrical isolation normal lock out tag out (LOTO) requirement still applies.

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: EXCAVATION
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) PLANNING
1 Are valid excavation certificate and PTW available and displayed at site?

2 Is this work declared as confined space entry (if more than 1.5 meter)?

3 Is the CSE certificate attached with the PTW?

4 Is the person in-charge of the excavation work well trained and competent?

Is daily inspection of excavation site conducted by the AAR, RAR and WL to ensure no change in
5 conditions before the start of work

6 Are proper PPE being used?

7 Are high visibility clothing provided and worn by all workers exposed to high traffic flow

Has a warning system been established and utilised when mobile equipment is operating near
8 the edge of the excavation.

9 Has the local utility agency/companies contacted as part of the work plan (if necessary)

10 Has exact location of utilities been identified and marked.

11 Are underground installations protected, supported, or removed when excavation is open.

12 Are protective or shoring systems designed by a competent person

B) EXECUTION AND MONITORING

Are protective or shoring systems installed to protect workers from hazards of cave-ins,
1
collapses, or struck by materials or equipment?

Has atmosphere within the excavation tested for oxygen deficiency, combustible or other
2 harmful contaminant

3 Are ladders used in excavations secured and extended 1.0 meter above the edge of the trench?

4 Are spoils, materials, and equipment set back at least 0.5 meter from the edge of the
excavation?

5 Are hard barriers and hazard lights (at night) provided for excavation sites in public areas to
prevent fall.
6 Have precautions been taken to protect workers from the accumulation of water.

7 Are the water removal equipment monitored by a WL or Safety Watch.

8 Is surface water runoff diverted or controlled to prevent accumulation in the excavation.

9 Are inspections made after every rainstorm

10 Are rescue equipment, such as breathing apparatus, safety harness and lifeline, and/or basket
stretcher readily available where hazardous atmospheres could or do exist.

11 Are standby or rescue personnel trained to use these rescue equipment.

12 No workers are allowed in the trench during back filling

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: HYDROJETTING
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) PLANNING
1 Are Hydro-jet operators trained and competent for the job?

B) EXECUTION AND MONITORING

1 Is the equipment operator able to control the pump pressure and flow?

2 Is a dedicated competent fire watch available nearby the equipment?

Is the operator equipped with mandatory PPE for hydro jetting i.e. face shield, rubber safety
3
boots, water proof protective suit, ear muff/plug, long rubber gloves, safety helmet etc.?

4 Are the PPE in good conditions

5 Is valid PTW available and displayed at site?

Is the job being supervised?

6 Supervisor Name:____________________

7 Is floor properly covered (if working at opening/grating )

8 Does operator have adequate room to operate safely

Is the site selected for equipment setup/location out of major personnel traffic area and is a
9
safe distance from operating equipment.

Is barricade tape extended around the hydro-jetting equipment as required for personnel and
10
operation safety?

11 Are the signs adequately placed?

Are additional sturdy barriers/panels installed to provide protection if hydro-jetting equipment

12 cannot be adequately spaced from process equipment or personnel traffic

13 Are all the hoses secured to solid structure

14 Are all hoses properly protected and barricaded and do not cause tripping hazard.

15 Is the equipment to be cleaned are properly secured and cannot be moved.

16 Is the JSA available (worker briefed and understood precautions)

17 Is the working platform properly erected ( suitable for hydro jetting activities)

18 Is worksite housekeeping carried out?

Are the arrangements in place to ensure that the material being blasted is contained and
19 disposed properly?

20 Is proper containment available to prevent diesel or engine oil spillage during top up and
maintenance activities?

21 Is the hydro-jetting equipment inspected and tagged by authoried person?

22 Are all hoses and fittings of the correct pressure rating and in good condition

23 Is the hose connection free from any quick connect fittings/couplings

24 Are all hoses and fitting inspected as per recognised international and manufacturer’s standards

25 Are hoses fitted with safety bridges (restraining devices i.e. whipped check) across couplings
and hoses.

Are all the hoses free from damaged

26
i.e. wire braids or any external defects

Is the equipment equipped with safety devices i.e. "dead man" switch, safety relief valve,
27
rupture disc

28 Are pressure control valves inspected, calibrated and tagged

29 Is the earthing cable properly grounded

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 SAFETY TIER-1 CHECKLIST: LIFTING
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARKS
Y N
A) PLANNING
Are all persons involved in planning, inspection and performing lifting (Crane inspector,
1 Signalman, rigger, lifting coordinator, crane operator, AA) and maintaining lifting equipment
trained and competent for their roles?

2 Has the crane being inspected by DOSH and HSE/Maintenance

3 Are valid crane lifting certificate, JSA and risk assessment attached with Permit to Work (PTW)

Has the critical lift been identified i.e. more than 85% of Safe Working Load (SWL) of the crane
4
chart capacity and multiple crane lift

Critical Lifting: Is the lifting plan, load calculations, shackle capacity, sling capacity, spreader
5 beam capacity are incorporated with the lifting certificate and verified by competent
personnel?

6 Is the approved Lifting plan available?

B) EXECUTION AND MONITORING

1 Is pre-lifting check carried out and authorised

2 Is the crane on solid footing and level ground before making a lift (out rigger fully extended)

3 Have the lifting area being barricaded and cleared from unauthorised personnel

4 Is night lifting authorised with additional control measures in place i.e. JSA, sufficient lighting.

Are the lifting activities allowed during bad weather condition (i.e. heavy rain, strong wind,
5 lightning, snowing)

6 Is signal man available?

7 Is communication established between signal man and crane operator

Have the crane operator and rigger ensure that no personnel walks under the load and boom
8 during lifting

9 Is there any sharp edges that can damage the slings during lift

10 Has the crane operator ensure that the load not being suspended when leaving the crane
unattended

Does the crane operator or person in-charge (PIC) ensure that there is no personnel riding on
11
the load

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 SAFETY TIER-1 CHECKLIST: PTW
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) ADMINISTRATION & ORGANIZATION
1 Is the form properly filled-up and signed?

2 Is the list of PTW authorized signatories updated and displayed at the PTW Office/Station?

Copies of PTW available : Original (Worksite), Copy 1 (Control Room/PTW Office/Station), Copy
3 2 (RA)

4 Are personnel involved in PTW trained, assessed and appointed?

B) IMPLEMENTATION & MONITORING

1 Is the work description clear and specific (e.g. exact location, equipment)?

2 Have all hazards associated with the work been identified and necessary precautions specified ?

3 Are personnel using correct PPE specified in PTW?

Are the supporting certificates, JHA/JSA and relevant drawings for the work attached with the
4 PTW?

5 Has joint-site inspection been conducted by AAR and RAR and WL

6 Has toolbox talk been conducted for the work?

Has revalidation been carried out during shift change or if there is any change to the conditions
7 of the permit?

8 Has the work been hand back and PTW signed off by RA and AA upon completion of the job?

9 Has the housekeeping been done after completion of the job?

C) HOT WORK
Are incompatible activities e.g. atmospheric venting, draining, line breaking, sampling been
1
prohibited at adjacent areas?

2 Are firefighting equipment e.g. fire extinguisher, fire blanket available and working?

3 Is the assigned fire-watch present at site?

D) GAS TESTING
1 Are the AGTs certified?

Is the gas testing frequency specified on the PTW and carried out i.e. Continuous or at specified
2 intervals?

3 Have the Gas testing meters been calibrated and valid?

Percentage Compliance (Total no complied/Total no of requirements) %

NOTE: AA (Approving Authority), AAR (Approving Authority Representative), RA (Receiving, authority) , RAR (Receiving Authority Representative), WS (Work Supervisor), WL (Work Leader)

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: SAFETY SYSTEM BYPASS / OVERRIDE (SSB/O)
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) REQUEST FOR SAFETY SYSTEM BYPASS AND OVERRIDE
1 Are detailed procedures available for specific SSB/O execution?

B) RISK ASSESSMENT
1 Has risk assessment been carried out by relevant involved party?

2 Have all identified control and mitigation measures been implemented?

E) APPROVAL
1 Is SSB/O approved by appropriate AA?

F) WORK EXECUTION
1 Is the SSB/O certificate still valid?

Are the SSB/O Certificates revalidated every 7 days and renewed after 3 months when required
2
for an extended period?

3 Is SSB/O status closely tracked, closed and updated in the log book or SSB/O Status Board?

4 Has all SSB/O status communicated to all shift personnel and status reported during shift
handover?

H) HAND BACK
1 Has the safety system returned to its original state?

2 Has the SSB/O been hand back and signed off by RA and AA?

Percentage Compliance (Total no complied/Total no of requirements) %

NOTE: Safety Integrity Level (SIL) 4 ESD loops shall not be bypassed under any operational conditions

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 SAFETY TIER-1 CHECKLIST: SCAFFOLDING
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY

Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) ADMINISTRATION & ORGANIZATION

For specialised scaffoldings (e.g Hung/Suspended, load bearing, tubular above 40 meter),
1
Designed and approved by competent person or Professional Engineer and drawing available

2 Levels of competency of workers meet DOSH requirements. (eg. Level 2 or advanced scaffolder)

3 Are inspection tags available and periodically revalidated (weekly or other specified interval)?

4 Are the scaffolding re-inspected after been modified?

5 Are the scaffolding re-inspected after been subjected to severe weather conditions e.g. storm?

B) SCAFFOLD STRUCTURE & WORKING PLATFORM

1 Is scaffold used only for personnel access?

2 Has it been erected on firm ground?

3 Are proper sole plates used for uneven surfaces? e.g. soft soil, grating

4 Is the scaffold sufficiently stable?

Are barricade and warning signs installed to protect against vehicle movement and crane
5 operations?

Are the tubes, fitting and floorboards free from signs of damage or deterioration e.g. rusting,
6 sufficient thickness, not split, rotten?

7 Are the working platforms free from obstruction, loose objects, debris and tripping hazards?

8 Are floorboards adequately secured with no gap

9 Are guardrails fitted and connected to standards

C) ACCESS & EGRESS

1 Is there safe means of access and egress to working platforms?

2 Is barricade chain available at working platform?

D) SUPPORTING STRUCTURES & ANCHORING POINTS (ie: plant structures where scaffoldings are secured or anchored to)

1 Are supporting structures adequate to support scaffolding?

2 Plant equipment e.g. pipings, cable trays etc are not used as supporting structure

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :
 HSE TIER 1 CHECKLIST
SAFETY: WORKING AT HEIGHT
NO WORK IS SO URGENT THAT WE CANNOT TAKE TIME TO DO IT SAFELY
Date:
Lead Auditor:

Auditor
Members:

Projects:
Compliance
No Check List Items REMARK
Y N
A) GENERAL

1 Are hazards associated with working at height are specified in the PTW and JHA/JSA?

2 Are tools and equipment safely stored and secured to prevent fall from height or trip hazard?

3 Has working at height equipment (e.g. ladder, mobile platform) been inspected before use?

4 Is ground area is properly barricaded and warning signs displayed to protect personnel from
falling objects

Does personnel use 100% tie-off with full body harness when working at height with risk of fall
5
e.g. working edge of platform, during installation/dismantling of scaffolding?

B) BODY HARNESS & LANYARD

1 Does body harnesses comply with approved standard?

2 Have users of safety harness attended training on safe use of safety harness?

3 Is the lanyard secured to a suitable anchorage point?

4 Are lifeline and lanyard protected from abrasive or cutting edges?

5 Are lifeline and lanyard in good conditions?

C) LADDER
1 Is ladder rested on level and stable ground?

2 Does worker practice 3-point contacts while ascending/descending ladder?

3 Is ladder free from signs of corrosion, cracks, defects?

Is the locking mechanism for interlocking/extension ladder in working condition to prevent

4 movement of the sections while in use?

D) WORKING ON ROOF

1 Is scaffold used for all roof access and egress (use of ladder is prohibited)?

2 Is 100% tie-off practiced and lifeline provided?

E) WORK OVER OR NEAR WATER/SLUDGE/MUD

1 Do personnel wear lifejacket?

2 Are rescue plan and equipment e.g. safety line, ladder, lifebuoy available?

3 Is rescue boat provided when working over water?

F) ROPE ACCESS/ABSEILING

1 Is the Team Leader certified to IRATA (International Rope Access Training Association) Level 3
Technician or equivalent

2 Are the workers certified to IRATA Level 1 or equivalent

3 Is rescue plan available for the rope access activity?

4 Are spading tags been applied by Maintenance and verified by Operations?

H) REMOVAL OF GUARDRAIL, GRATING, COVER PLATE

1 Has risk of fall been assessed and control measures implemented?

Percentage Compliance (Total no complied/Total no of requirements) %

Item no Recommended Action Items Assigned To Completion Date

Prepared By : Reviewed By :