TUV Checklist - Master-Rev 0 (4) (2) (Recovered)

Sr.
No Document No
1 D0114401-V-CE-00-CM-CHK-001
2 D0114401-V-CE-00-CM-CHK-002
3 D0114401-V-CE-00-CM-CHK-003
4 D0114401-V-CE-00-CM-CHK-004
5 D0114401-V-CE-00-CM-CHK-005
6 D0114401-V-CE-00-CM-CHK-006
7 D0114401-V-CE-00-CM-CHK-007
8 D0114401-V-CE-00-CM-CHK-008
9 D0114401-V-CE-00-CM-CHK-009
10 D0114401-V-CE-00-CM-CHK-010
11 D0114401-V-CE-00-CM-CHK-011
12 D0114401-V-CE-00-CM-CHK-012
13 D0114401-V-CE-00-CM-CHK-013
14 D0114401-V-CE-00-CM-CHK-014
15 D0114401-V-CE-00-CM-CHK-015
16 D0114401-V-CE-00-CM-CHK-016
17 D0114401-V-CE-00-CM-CHK-017
18 D0114401-V-CE-00-CM-CHK-018
19 D0114401-V-CE-00-CM-CHK-019
20 D0114401-V-CE-00-CM-CHK-020
21 D0114401-V-CE-00-CM-CHK-021
22 D0114401-V-CE-00-CM-CHK-022
23 D0114401-V-CE-00-CM-CHK-023
24 D0114401-V-CE-00-CM-CHK-024
25 D0114401-V-CE-00-CM-CHK-025
26 D0114401-V-CE-00-CM-CHK-026
27 D0114401-V-CE-00-CM-CHK-027
28 D0114401-V-CE-00-CM-CHK-028
29 D0114401-V-CE-00-CM-CHK-029
30 D0114401-V-CE-00-CM-CHK-030
31 D0114401-V-CE-00-CM-CHK-031
32 D0114401-V-CE-00-CM-CHK-032
33 D0114401-V-CE-00-CM-CHK-033
34 D0114401-V-CE-00-CM-CHK-034
35 D0114401-V-CE-00-CM-CHK-035
36 D0114401-V-CE-00-CM-CHK-036
37 D0114401-V-CE-00-CM-CHK-037
38 D0114401-V-CE-00-CM-CHK-038
39 D0114401-V-CE-00-CM-CHK-039
40 D0114401-V-CE-00-CM-CHK-040
FTO-11 PROJECTS
LIST OF CHECKLISTS
Document Title Revision No Date of Preparation
Checklist for Farana 0 19-Jun-20
Checklist for Truck 0 19-Jun-20
Checklist for Dumpers 0 19-Jun-20
Checklist for Tractors 0 19-Jun-20
Checklist for Hydra 0 19-Jun-20
Checklist for Crawler Crane 0 19-Jun-20
Checklist for Welding Machine 0 19-Jun-20
Checklist of PPE Inspection 0 19-Jun-20
Checklist(Grinding Machine) 0 19-Jun-20
Checklist(Gas Cutting Set) 0 19-Jun-20
Checklist (Cutting Machine) 0 19-Jun-20
Checklist(DB Box) 0 19-Jun-20
Checklist(Scaffold) 0 19-Jun-20
Checklist for First Aid box Inspection 0 19-Jun-20
Checklist for Fullbody Harness 0 19-Jun-20
Issue Register Lifting Tools& tackles 0 19-Jun-20
Checklist for Weekly Inspection of MCB RCCB ELCB 0 19-Jun-20
Concrete Pump 0 19-Jun-20
Checklist for Eye bolt 0 19-Jun-20
Check list for Webbing Slings& Round Slings 0 19-Jun-20
Check list for Wire Slings 0 19-Jun-20
Checklist for Tyre Mounted Crane 0 19-Jun-20
Checklist of Tough rider 0 19-Jun-20
Checklis for Boom Pressure 0 19-Jun-20
Checklist of Vibrator Soil compactor 0 19-Jun-20
Checklist on Transit Mixer 0 19-Jun-20
Checklist of concrete mixer 0 19-Jun-20
Checklist for Grader 0 19-Jun-20
Checklist of Chain Pulley Block 0 19-Jun-20
Checklist of Ladder 0 19-Jun-20
Checklist of Bar bending machine 0 19-Jun-20
Checklist for Hand Tools Inspection 0 19-Jun-20
Checklist of (Drilling Machine) 0 19-Jun-20
Checklist for Scissor Lift 0 19-Jun-20
LMRA Last Minute Action Plan (003) 0 19-Jun-20
Checklist for Batching Plant 0 19-Jun-20
Checklist for labour camp 0 19-Jun-20
Checklist for DG set 0 19-Jun-20
Daily Checklist for Tower Crane 0 19-Jun-20
Daily checklist of Earth moving equipment 0 20-Jun-20
Remarks
For Review & Comments
Check List for Pre Entry Of Farana
Name of Contractor: Report No:

Farana's Driver Name Vech. No
Farana Capacity Date of Insp.
Farana 's Owner Name
Check List for Non Compliances
8 7 5
2
9 3 1
6
S.No Items Photos Y/N S.No Items Photo Y/N
whether Hoist limit

whether Safety latch switch (Or
1 in hook. Available & in 2 presence of
working condition plate).available&
working
whether Wire rope

and slings free
whether SWL mark in from tolerable
3 4
crane are visible damage( No kinks,
broken wires more
than 10% is N.G).
whether oil leak in

hydraulic parts (piston
5 6 whether Damage in
drums) has been
checked & ok Tyre ( Crack, cut,
has been checked
& tyre pressure ok
7 8 whether Front and

whether Head and tail reverse horn fitted
lamps are available & in working
(for night working). condition
whether Boom whether Boom
structure condition structure condition
while full expansion while full expansion
9 10
(damage, crack and (damage, crack
jamming while and jamming while
extending). extending).
Whether windshield Whether the

available & is in good Condition of D-
condition/ locable? shakals & hooks is
11 12
good?
Whether Fire- Whether the

Extinguishers condition of Slings
availabile in the cabin & Master link is
& in working good?
13 condition? 14
Documents
whether valid Third party certificate(Form 32) are whether Operator have license (heavy
available duty)
15.1 15.2
15.3 whether Vehicle have valid insurance paper 15.4 whether Road tax document are available
Supervisor Contractor Safety TUV HSE
Signature:
Name:
Date:
0
DV INFRA & PROJECTS
Check List for Truck

Name of Contractor: Date
Job No: Loc
Work Description
11
6
10
5
7
1
2
1
SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEMS PHOTOS Y/N
whether
whether Number plate Damage in Tyre
1 in front and back side 2 ( Crack, cut, &
are visible tyre air pressure
checked & ok.
whether Front
whether air leak in the
and reverse
3 air tank. Has been 4
horn.in working
checked.
condition.
whether Fire
whether oil leakage extinguisher
5 from the diesel tank has 6 available in
been checked & ok. driver cabin.
& OK
whether Brake,
Clutch and
8 accelerator are
in working
whether Head and tail condition
lamps for night Are
7
available& in working
condition.
whether Truck
9
is overloaded
whether Wind
whether Rear view
10 11 shield and wiper
mirror available
ok
Whether wheel nuts & Is the Jack &

wheel/ tyre lock in good spare tyre
12 condition 13 available
Is the helper/ co-driver

available
14
15 DOCUMENTS 15 DOCUMENTS
15.B whether Operator have license
whether Vehicle have valid
15.A
paper; D.L.,R.C.,P.U.C., Insurance 15.C Road tax paid document available
Contractor Safety
Supervisor TUV HSE
Officer
Signature
Name
Date
0
FTO-11 PROJECTS
Checklist for Dumpers #NAME?

Dumper's Driver Name Vech. No
Trailer Capacity Date of Insp.
Trailer's Owner Name

S.No Description of Items to be check Yes No
1 Is driver licenses available. HMV/HTV
2 Is the RC book available?
3 Are tyres in good condition?
4 Is the chassis in good condition?
5 Is there a Fitness certificate of the chassis (Approved by RTO)
6 Is cabin clean and free from oil/grease?
7 Is seating in good order?
8 An adequate rear-view mirror?
9 Are service brakes on trailers and semi trailers controlled from the driver’s seat of
the prime mover?
10 Are dead-man levers and foot pedals returning to the neutral position
automatically upon release by the driver?
11
Is there a legible copy of the operators manual with the Trailer (English)
12 Is the Trailer crew wearing appropriate PPE (e.g.: visibility vests, hard hats, safety
boots etc.)?
13 Is there a driver assistant for directing the trailer?
Jack & Spare Tyre
List of Issues Identify

Items No.# Issue Action taken by by Who
Signature:
Name:
Date:
0
#NAME?
NA
by Who
TUV HSE
FTO-11 PROJECTS
Check List for Tractor
Driver Name Vech. No
Owner Name Date of Insp.
whether Effective,
working horn and
whether Protection
reverse alarm.
(canopies, screens) is
Hydraulic system
1 provided to shield 2
in working
operator from falling
condition during
objects.
unloading of
materials
whether
whether Moving
Protection against
parts, shafts,
3 4 contact with hot
sprockets, belts, etc.
surfaces, exhaust,
are guarded.
etc.is provided.
whether Damage
Safe means of access in tyre
(steps, grab bars, (Crack, cut,& air
5 6
non-slip surfaces) to has been checked
the cab is provided & tyre pressure is
ok.
Whether Fuel Tank
cap is in place? whether Vehicle
7 Is there any signs of 8 rear view mirror is
oil leakage? available &
condition is ok
whether Head light, whether Brake,

Tail lamp are fitted & accelerator, clutch
9 10
in working condition are in good & in
(for night work) working condition
whether Lock of the whether Inter

back door (trolley) in locking system
good & in working between the
11 condition 12
tractor and the
trailer ok & in
working condition.
Whether Ignition
arrangement condition
is in good condition?
12
Documents
whether Visualization
of Check sheet and whether Vehicle
13 Operator details with 14 having valid
photo in the vehicle insurance paper
itself.
whether Operator
15 having license (LMV )
& I.D Card
Signature:
Name:
Date:
#NAME?
D0114401-V-CE-00-CM-CHK-005 Check List for Pre Entry Of Hydra #NAME?

Hydra's Driver Name Vech. No
Hydra Capacity Date of Insp.
Hydra 's Owner Name
8 7 5
2
4
9 1
3
6
whether Hoist limit

whether Safety latch switch (Or
1 in hook. Available & in 2 presence of
working condition plate).available&
working
whether Wire rope

and slings free
whether SWL mark in from tolerable
3 4
crane are visible damage( No kinks,
broken wires more
than 10% is N.G).
whether oil leak in

hydraulic parts (piston
5 6 whether Damage in
drums) has been
checked & ok Tyre ( Crack, cut,
has been checked
& tyre pressure ok
7 8 whether Front and
whether Head and tail reverse horn fitted
lamps are available & in working
(for night working). condition
whether Boom whether Boom

structure condition structure condition
while full expansion while full expansion
9 10
(damage, crack and (damage, crack
jamming while and jamming while
extending). extending).
Whether windshield Whether the

available & is in good Condition of D-
condition/ locable? shakals & hooks is
11 12
good?
Whether Fire- Whether the

Extinguishers condition of Slings
availabile in the cabin & Master link is
& in working good?
13 condition? 14
Documents
whether valid Third party certificate(Form 32) are whether Operator have license (heavy
15.1
available duty)
15.2
15.3 whether Vehicle have valid insurance paper 15.4 whether Road tax document are available
Supervisor Contractor HSE TUV HSE
Signature:
Name:
Date:
D0114401-V-CE-00-CM-CHK-005
FTO-11
Check List for Crawler Crane

Crane's Driver Name Vech. No
Crane Capacity Date of Insp.
Crane's Owner Name
1-DETAIL OF CRANE
S.NO Description of Items to be Check Detail of Checked Items
1 Name And Address of Occupier
2 Identification No / Sr No
3 Make & Model
4 Manufacturing Date
5 RTO Registration No
6 Chassis No.
7 SWL (At basic boom length & Min. Radius)
8 Basic Boom Length
9 Min. Radius
10 Boom length (Maximum)
11 Type of Boom
12 Boom Jib
2-ENGINE DEATIL
1 Engine No.
2 Make
3 Model
4 BHP
3-GENERAL CHECK LIST
1 Identification Marking
2 SWL Marking
3 Valid Load Chart
4 Condition
5 Painting
6 Housekeeping
7 Oil or Fuel Leakage
8 Weather Protection
9 Rear View Mirror
10 Radiator Lock
11 Fuel Level & Fuel Tank Lock
12 Original Certificate of Crane
4-Documentation
1 RTO Reg. Book
2 Crane Specification
3 Working range diagram
4 Boom point elevation
5 Operator Name
6 License No. & Validity
7 Form 10 valid up to
8 Insurance Valid up to
9 PUC Valid up to
10 Operation & Maintenance Manual
11 Weight of Crane
12 Structure / Frame/ Chassis
5-Out Riggers
1 Condition & Level Tube
2 Oil Leakage
4 Operation
6-Crawler Belt & Chain
1 Condition
2 Lubrication
7-Counter Weights
2 Type
3 Weight
8-BOOM
1 Type of Boom
2 Basic Boom Length
3 Present Boom Length
4 No. of Extensions
9-Fly Jib (If Applicable)
1 Max. Length
2 Present length
3 Shock Absorbing Stop For Boom
4 Boom Condition
10-Wire Rope
1 Wire Rope Dia.
2 Construction & Main core
3 Condition
4 Load Lines
5 End Fittings
11-Hook Block
2 Capacity
3 Throat Opening
4 Safety Latch
5 Condition
12-Pulleys Bottom Block Boom Head
1 No. of Pulleys
2 Condition
OPERATIONAL CHECK POINTS
13-Engine
1 Condition
2 Oil Pressure
3 Air Pressure
4 Radiator
5 Fan, Fan Belt & Guard
6 Pipe lines, Hoses, Connections
7 All Gauges & Indicators
8 Noise
14-Brakes
1 Hoisting & Lowering
2 Swinging
3 Boom Down & Up, Extension
4 Battery Condition
14-Lights
1 Front Side
2 Rear Side / Reverse
3 Side Indicator
4 Parking / Hazard Indicator
5 Brake Light
6 Aviation / Boom Top Light
7 Boom Light
8 Flickering Lights
15-Horns & Alarms
1 Reverse Horn / Alarm
2 Swinging Horn / Alarm
3 Forward Horn / Alarm
16-Safety Devices
1 Safe Load Indicator
2 Boom Angle Indicator
3 Shock absorbing boom stop
17-Limit switches
1 Over Hoist limit switch
2 Boom Hoist Limit Switch
3 Over Load Limit Switch
18-Operators Cabin
1 Condition & Sitting Arrangement
2 All Operational Levers
3 Direction Marking at Levers
4 Dead man control on lever & pedal
5 Lights & Fan
6 Safe Entry & Exit
7 Housekeeping
8 Visibility
9 Tool Box
10 Fire Extinguisher
19-LOAD TEST DETAILS

1 Operational Test
2 Lowering & Hoisting
3 Swinging
4 Boom up & down, Extension
20-Load Test
1 Total Dead Weight
2 Present Boom configuration
3 Wire Rope dia
4 No of Falls
5 Radius as per load chart
6 Radius Measured
7 Angle as per Load chart
21- REMARKS / OBSERVATION IF ANY
Supervisor Contractor Safety Officer TUV HSE
Signature:
Name:
Date:
0
Checklist for Welding machine
Name of Contractor: Inspection

Date:
whether ON / OFF knob

whether Regulator
is provided(Check for
1 damage and insulated
2 with indicator is
provided
knob)
whether Welding cables

whether any cuts/
connected to the welding
damage in the
3 machine with lugs at the 4 insulation of welding
joints tightely with proper
cables
insulation.
whether Electrode rod

holder and earthing whether Industrial
5 holder are having any 6 type Plug / socket
cuts/ damage/ broken being used for power
and properly insulated. tapping cable of
welding machine.
whether Trolley
whether any internal live
being used w/o
electrical parts of
7 welding machine is
8 damaged wheels.
Double earthing has
exposed
been provided to
machine.
whether double
whether co2 Fire earthing has been
extinguisher and fire provided to m/c
9 10
bucket with sand are
available near m/c.
Whether Metal waste Bin Are voltmeter &
(electrodes collector bin) ampmeter available &
11 is available or not? 12 working?
Documents
Signature:
Name:
Date:
FTO-11 PROJECTS
Name of Contractor:
Daily PPE Inspection Checklist
PPE
S.No Name Head Foot Hand
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Inspected By: Sign:

Date:
Legends:
PPE in good condition Good
Damaged PPE Bad
No PPE NO
Date
PPE
Eye Nose Ears
CHECK LIS FOR PORTABLE GRINDING MACHINE
DATE OF CHECK- CONTR NAME-
2 1
1
4
4
5 5
6
7 8 7
2
3 8 6
3
SL N0 CHECK ITEM PHOTOS Y/N SL N0 CHECK ITEM PHOTOS Y/N
whether Wheel
whether fibre handle
guard available &
1 without damage & 2
(covering 3/4th
condition is ok.
area).
whether Grinding
wheel having any
crack/ damage.And
whether Rear
Grinding wheels’
3 4 handle is having
expiry date & its RPM
any damage.
match with the
machine RPM” has
been checked.
whether Presence of
whether Trigger
Cord strain reliever
5 6 switch is having
(glands).are available
any damage.
& ok
whether Electric
wire having any
whethe Presence of cuts and joints.
7 Switch lock is ok. And 8 Double earthing
in working condition. has been
provided in m/c
to avoid shock.
NAME SIGNATURE DATE

Checked by Electrician
NAME SIGNATURE DATE

Checked by Contractor safety in charge
NAME SIGNATURE DATE

Checked by TUV HSE
CHECK LIST(PRE ENTRY) FOR GAS CUTTING SET
CONTR NAME- DATE OF CHECK-
4 5
2
6 7
1
8 3
CHECK ITEMS
SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEM PHOTOS Y/N
whether Protective whether Pressure

valve cap firmly gauges two for each
fixed for both cylinder(in & out)are in
1 2
cylinder(Check for working condition(both
damage/crack in the Oxygen & Acetylene
valve cap) gas)
whether Non return

whether Flash back valves (NRVs) is
arrestor (FBAs)has provided for both
3 been provided for 4 acetylene & oxygen
acetylene & oxygen cylinders hose fitted
cylinders with cutting torch to
avoid back fire.
whether Tight whether Hose free from

Crimping of hoses damage(cut and crack /
5 6
with jubilee clamps oil & grease to avoid
are fitted. leakage/ fire.
whether Cylinder whether Trolley tyre are

7 secured by chain to 8 free from damage and in
the trolley. working condition.
Availability of
industrial type
lighter(no match box 10 whether gas leak test has been done before starting the job
9
/ commercial to avoid fire
lighters) are
allowed.
NAME SIGNATURE DATE

Checked by Contractor safety in charge
NAME SIGNATURE DATE

Checked by TUV HSE
CHECK LIST FOR CUTTING MACHINE
5
6
2
1 4 3
SL NO CHECK ITEMS PHOTOS Y/N SL NO CHECK ITEMS PHOTOS Y/N
Whether cutting wheel Presence of

having any crack/ Cutting plate
damage. And cutting guard. Double
1 wheels’ expiry date & its 2 earthing has
RPM match with the been provided
machine RPM” has been in m/c to avoid
checked. shock.
whether
whether Presence of
Presence of job
3 locking system for the 4
clamp and its
plate & Guard is available
conditionis ok
whether Cable
condition(Any
whether Presence of
cut,wear etc)
5 fibre body handel and its 6
and presence
condition is ok
of wire top plug
is ok
whether Presence of
7 cutting dust guard is
available
NAME SIGNATURE DATE

NAME SIGNATURE DATE

Checked by Contractor Safety Officer
NAME SIGNATURE DATE

Checked by TUV HSE
FTO-11 PROJECTS
Check Sheet (Pre Entry) For Main Distribution Board / Panel

Board
2 4
3 8
9 14
5 7
O/P cable
I/P cable
1
6
15
13
CHECK ITEMS
SL SL
NO
CHECK ITEM PHOTOS Y/N NO
CHECK ITEM PHOTOS Y/N
whether Firm Base

whether D.B .set is
with grouting & Easily
weather proof and cover
1 accessable panel 2
all around To avoid
(height of the leg is
water/ dust
equal to 1m)
whether Authorized whether Visualization of

Operator/Elec. Name/ voltage, current and
3 4
Photo/ Contact No.on type of tools to be used
DB panel are aval. in the socket & Panel.
Whether Confirmation
5 6 of LOTO(lock out/ tag
O/P cable out) are available.
I/P cable
WHETHER Safety
whether Hylem sheet stickers/ signboards /
7 to be provided over 8 isolate flammable Fire
live bus bars Hazard are display in
D.B,
WHETHER Double
Whether Separate ELCB
Earthing System of
with tripping current of
9 MDB / DB panel with 10
30 mA & in working
Std earthing pit has
condition.
been provided.
whether Condition of
whether Color coding
Cable,Power Socket
11 12 being followed (RYBWG)
and Plug are having
for all cables/wires
any damage.
whether availibility of whether Plug/ Socket

13 rubber mat infornt of 14 are being used of
the D.B . Industrial type
NAME SIGNATURE DATE

NAME SIGNATURE DATE

Checked by Contractor safety
NAME SIGNATURE DATE

Checked by TUV HSE
FTO-11 PROJECTS

CHECKLIST FOR WORKING AT
HEIGHT/SCAFFOLDING
Date of Insp.
Location:
Time :
The following points shall be checked before starting the work.
S.No POINT OBSERVATION YES NO NA Remarks
1 Whether all the workers have been explained safe work method.
2 Whether proper PPE’s has been provided to workers.
3 Whether adequate illumination has been provide incase if night work.
4 Whether working area inspected prior to start the work.
5 Whether area below the work place barricaded.
6 Whether workers provided proper bags to carry hand tools.
7 Whether all work platforms ensured to be of adequate strength and suitable for work.
8 Whether proper hand rail, mid rail and guard rail provided in S/F.
9 Whether toe guard has been provided in s/f to avoid falling materials.
10 Whether all the wooden/metallic planks, gratings tightened with binding wires
11 Whether ladders are provided at the working site & in good condition.
12 Whether ladders are properly secured to prevent slipping, sliding and falling
13 Whether Aluminum ladder has been used to avoid electrical hazards.
14 Whether ladder placed at right angle(65 to 70 degree)
15 Whether 1 meter landing has been provided for landing on S/F.
16 Whether proper bracing has been fixed to avoid S/F toppled
17 Whether proper base plate provided to S/F for maintaining equally balance
18 Whether scaffolding pipes and clamps are in good condition
19 Whether Platform, walkways and working area are free from unused scaffolding materials
20 Whether common lifeline provided in critical work place to secure safety belt/ harness
21 Whether common lifeline provided in critical work place to secure safety belt/ harness
22 Whether tools and scarp material should not be left on the scaffolding after completion of work
Whether Scaffolding has been inspected by S/F supervisor/safety officer after erection and before
23
starting the work.
Comments
Contractor's
SCAFFOLDER / FOREMAN Safety officer Contractor Supervisor TUV HSE
Signature:
Name:
Date:
FTO-11 PROJECTS
Inspection of First Aid Box

Job No: Date:
Work Description: Location :
Sr No. Check Point/Deficiency QTY Yes No Remarks
Sufficient numbers of eye wash bottles filled with distilled water or suitable
1.0 1
liquid clearly indicated by a distinctive sign which shall bevisible at site.
4%xylocaine eyedrops, and boric acid eye drops and soda by carbonate
2.0 1
eye drops.
3.0 Small sterilized dressings 24
4.0 Medium size sterilized dressings 12
5.0 Large size sterilized dressings 12

6.0 Large size sterilized burn dressings 12
7.0 Sterilized cotton wool. (15 cm.) 12
(Two hundred ml) bottle of cetrimide solution (1%) or suitable antiseptic
8.0 1
solution
9.0 (Two hundred ml.)bottle of mercurochrome (2%) solution in water. 1
(One hundred twenty ml.) bottle of salvolatile having the doses and mode
10.0 1
of administration indicated on the label.
11.0 Pair of scissors 1
12.0 Roll of adhersive plaster (six cm. x one mtr) 1
13.0 Rolls of adhesive plaster (two cms.x one mtr) 2

14.0 Sterilized eye pads in separate sealed packets 12
Bottle containing hundred tablets (each of three hundred twenty five mg)
15.0 1
of aspirin or any other analgesic.
16.0 Roller bandages ten cms. Wide 12
17.0 Roller bandages five cms. Wide 12
18.0 Tourniquet 1
19.0 Splints 1
20.0 Safety pins 3 pkt
21.0 Kidney tray 1
22.0 Snake bite lancet 1
23.0 (Thirty ml.) bottle containing potassium permanganate crystals. 1
24.0 First-aid leaflet issued by the Directorate General 1
25.0 Triangular bandages 6
26.0 Pairs of suitable sterilized, latex hand gloves. 2
27.0 Any Other (please specify)
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Check List for full body Harness.
Type of Harness Date of Insp.
Identification No. of full body Harness

Description Of Check Points Remark.
S.No 1 2 3 4 5 6 7
Hard wares - (D-Rings, Buckles, Back Pad) Any damage, distortion, sharp
1 edges, burrs, cracks and corrosion
Webbings – Any cuts, burns, tears, abrasion, frays, excessive soiling and
2 discoloration.
3 Stitching – Any pulled or cut stitches.
Lanyards (Double)
a) Hard wares - (D-Rings) Any damage, distortion, sharp edges, burrs, cracks
and corrosion
c) Stitching – Any pulled or cut stitches
d) Synthetic rope – Any pulled or cut yarns, burns, abrasion, knots, excessive
soiling and discoloration
Anchoring Hook
a) Hard wares – (D-Rings) Any damage, distortion, sharp edges, burrs,
cracks and corrosion
b) Physical damage – Any cracks, sharp edges, deformities and locking
operation
c) Excessive corrosion – Any corrosion which effects the operation
d) Fasteners – Any corrosion, tightness, damage or distortion.
RESULT (A: ACCEPTED ,R : REJECTED )
Signature:
Name:
Date:
0 Rev 00
FTO-11 PROJECTS
Issue Register for Tools & Tackles #NAME?

Type of lifting tool & Tackles Date of Insp.
Description Of Tools Capacity / Department/

S.No Date Of Issue Id No. Issued To Issued By Received Remarks
& Tackles SWL Division
Comments
TCE Client's
Supervisor
Representative Representative
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Check List for `Weekly Inspection of MCB/RCCB/ELCB

MCB/ELCB/RCCB Date of Insp.
Location/ Result of Test Condition of cable

S.No Board No. ID. No./Make Capacity & Sensitivity Condition laying/continuity/
R-E Y-E B-E of earthing Plug/socket etc.
Supervisor Contractor Safety Person TUV HSE
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Concrete Pump Checklist
Name of Contractor: ID No:
Inspection date: Next dueDate:
Sl No Check Point
CONCRETE PUMP Yes No Remarks
1 STABILITY OF CONCRETE PUMP
2 BATTERY CONDITION
3 IGNITION SWITH WORKING CONDITION
4 ALL GAUGES ARE WORKING PROPERLY

5 STOPPER CONDITION
6 GUARD ARE PROVIDED FOR HOOPER
7 HYDRULIC CONNECTION CONDITION IS GOOD OR BAD(LEACKAGE OF OIL)
CONCRETE PIPELINE
1 PIPELINE CONDITION
2 PROPER SUPPORT PROVIDED FOR PIPELINE
3 STABILITY OF PIPELINE
Remarks
Supervisor Contratcor Safety Officer TUV HSE
Signature:
Name:
Date:
FTO-11 PROJECTS
Check List for Eye Bolt Inspection #NAME?

Type of lifting tool Date of Insp.
Nick/
Thread Wear on Deformation / Evidence of Overall
S.No. Location ID.No. Thread Size SWL Crack/ Remark
Damage Y/N Shank/Body Bending Calib. Condition
Gouge
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Check List for Webbing & Round Slings.(Lifting tools)

Abrasion/
Acid or Melting Snags/ Tear Evidence of
Broken or Broken or Knot in any Overall
S.No Location Capacity Caustic or Cut/ Heat Remarks
Worn Stitches Damage Part Condition
Burns Charring Punctures damage
Corn Yarn
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Check List for Wire Slings

Broken Wear Kinking / Bird Distortion/ Evidence of Missing Or Evidence of Overall

S.No ID NO. SWL Wire Corrosion Scrapping Crushing Caging Structure Heat damage Illegible Id Calibration Condition Remark
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Check List for Tyre Mounted Crane

Crane's Driver Name Vech. No
Crane Capacity Date of Insp.
Crane's Owner Name
1-DETAIL OF CRANE
S.NO Description of Items to be Check Detail of Checked Items
1 Name And Address of Occupier
2 Identification No / Sr No
3 Make & Model
4 Manufacturing Date
5 RTO Registration No
6 Chassis No.
7 SWL (At basic boom length & Min. Radius)
8 Basic Boom Length
9 Min. Radius
10 Boom length (Maximum)

11 Type of Boom
12 Boom Jib
2-ENGINE DEATIL
1 Engine No.
2 Make
3 Model
4 BHP
3-GENERAL CHECK LIST
2 SWL Marking
3 Valid Load Chart
4 Condition
5 Painting
6 Housekeeping
7 Oil or Fuel Leakage
8 Weather Protection
9 Rear View Mirror
10 Radiator Lock
11 Fuel Level & Fuel Tank Lock
4-Documentation
1 RTO Reg. Book
2 Crane Specification
3 Working range diagram
4 Boom point elevation
5 Operator Name
6 License No. & Validity
7 Competent persons certificate as per factories Act
8 Insurance Valid up to
9 PUC Valid up to
10 Operation & Maintenance Manual

11 Weight of Crane
12 tyre Condition
13 Structure / Chassis
5-Out Riggers
1 Condition & Level Tube
2 Oil Leakage
3 Operation
6-Counter Weights
2 Tyre
3 Weight
7-BOOM
1 Type of Boom
2 Basic Boom Length
3 Present Boom Length
4 No. of Extensions
8-Fly Jib (If Applicable)
1 Max. Length
2 Present length
3 Shock Absorbing Stop For Boom
4 Boom Condition
9-Wire Rope
1 Wire Rope Dia.
2 Construction & Main core
3 Condition
4 Load Lines
5 End Fittings
10-Hook Block
2 Capacity
3 Throat Opening
4 Safety Latch
5 Condition
11-Pulleys Bottom Block Boom Head
1 No. of Pulleys
2 Condition
12-Engine
1 Condition
2 Oil Pressure
3 Air Pressure
4 Radiator
5 Fan, Fan Belt & Guard
6 Pipe lines, Hoses, Connections
7 All Gauges & Indicators
8 Noise
12-Brakes
1 Hoisting & Lowering
2 Swinging
3 Boom Down & Up, Extension
4 Battery Condition
13-Lights
1 Front Side
2 Rear Side / Reverse
3 Side Indicator
4 Parking / Hazard Indicator
5 Brake Light
6 Aviation / Boom Top Light
7 Boom Light
8 Flickering Lights
14-Horns & Alarms
1 Reverse Horn / Alarm
2 Swinging Horn / Alarm
3 Forward Horn / Alarm

15-Safety Devices
1 Safe Load Indicator
2 Boom Angle Indicator
3 Shock absorbing boom stop

16-Limit switches
1 Over Hoist limit switch
2 Boom Hoist Limit Switch
3 Over Load Limit Switch

17-Operators Cabin
1 Condition & Sitting Arrangement
2 All Operational Levers
3 Direction Marking at Levers
4 Dead man control on lever & pedal
5 Lights & Fan
6 Safe Entry & Exit
7 Housekeeping
8 Visibility
9 Tool Box
10 Fire Extinguisher
18-LOAD TEST DETAILS
1 Operational Test
2 Lowering & Hoisting
3 Swinging
4 Boom up & down, Extension

19-Load Test
1 Total Dead Weight
2 Present Boom configuration
3 Wire Rope dia
4 No of Falls
5 Radius as per load chart
6 Radius Measured
7 Angle as per Load chart

20- REMARKS / OBSERVATION IF ANY
Signature:
Name:
Date:
0
CTO SEZ PROJECTS
Pre-entry Checksheet for Cherry Packer

Job No: Date:
CHECK ITEMS (To be checked Weekly)
Sl No.: Check Items Yes No Remarks
1 Physical damage in body of the vehicle and in the bucket
2 Working condition of the vehicle forward and reversed gear
3 Working condition of the hydraulic brakes (4 wheels)
4 Oil leakage from the hydraulic cylinder and from the diesel tank.
5 Starter shaft covered by guard
6 No Damage in Tire ( Crack, cut, air pressure etc).
7 Driver seat hood is available and no damage
8 Head and tail lamps (for night working).
9 Exhaust pipe is bended outside(Not faced on operator)
10 Reverse horn available with good working condition
All the above parameters are checked for visual confirmation
Remarks
Supervisor Contractor Safety Officer DRL/TUV HSE
Signature:
Name
Date:
0
FTO-11 PROJECTS
Checklist For Boom Pressure

Job No: Date:
Date : Date: Date: Date:
Sl.No Check Points
1st Week 2nd Week 3rd Week 4th Week Remarks
1 OPERATOR
a Valid License
b Trained Driver/ Operator
c Insurance, Registration & PUC
d Trained Helper
2 GENERAL EQUIPMENT LAVEL
a Safe Guard for moving equipments
b Safety Needles/ locks
c Body Condition/ Boom Condition
d Brake/ Hand Brake
e Lights / Indicators / Parking Light.
f Tyre Condition / Out Rigger Condition.
Electrical Systems for Presece of dirt moisture and
g
frayed wires
h Seat Belt / First Aid Kit
Pins,bearing, shafts,gears,rollers and locking
i
devices for wear cracks, corrosion and distortion.
J Lights for night work
3 CONCRETE LEVEL
a Stability of Boom Pressure.
b Ignition Swith is good & working condition.
c All Gauges are working properly
d Emergency Stopper Condition
e Guard are provided for hopper
f Battery Condition
Hydrulic Connection condition is good or bad
g
[Leackage of oil]
h PUC of Concrete Pump
4 CONCRETE PIPELINE
a Pipeline Condition
b Proper support provided for pipeline
c Prper Clamping.
d Stability of Pipeline.
Remarks
Operator Contractor Safety Officer TUV HSE
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Vibrator Soil Compactor
Contractor: Report No
Job No: Location :
Work Description Date:
S No. Description Yes No Remarks
From the ground:
1 Tires, Wheels, Lug Nuts, Stem CapsInflation, Leaks, Damage, Wear
2 Leveling BladeExcessive Wear, Damage, Leaks
3 Cutting Edges (Leveling Blade)Excessive Wear, Damage
4 Drum ScrapersExcessive Wear, Damage
5 Drum Cooling OilLeaks
6 Vibratory SupportLeaks
7 Eccentric Weight HousingLeaks
8 Isolation MountsDamage, Cracking, Splitting
9 Steering Cylinders / EndsDamage, Wear / Leaks
10 Steps and HandholdsCondition, Cleanliness
11 Underneath MachineLeaks, Damage
12 Axles – Final Drives (Axle / Drum)Leaks, Damage, Wear
13 Hydraulic Tank & FiltersFluid Level, Damage, Leaks
14 Fuel TankFuel Level, Damage, Leaks
15 All Covers and GuardsDamage, Securely Attached
Lights, Front and Rear, BeaconFunction, Damage to Lens, Housing, or
16
Wiring
17 Battery CompartmentCleanliness, Loose Nuts & Bolts
Engine Compartment:
18 Engine Oil (Fluid level)
19 Engine Coolant (Fluid level)
20 Radiator /AC Condenser/Oil Cooler ( Fin, Blockage, Leaks)
21 All Hoses (Cracks, wear spots, Leaks)
22 Fuel Filters / Water Separator ( Leaks, Drain water)
23 All Belts (Tension, Wear, Cracks)
24 Air Filter ( Service Indicator)
25 Overall Engine Compartment ( Trashor dirt build up leaks)
On the Machine outside the Cab:
26 Handholds (Condition and Cleanliness)
27 ROPS (Damage, Loose Mounting Bolts)
28 Fire Extinguisher (Charge, Damage)
29 Windshield, Windows (Broken Glass, Cleanliness)
30 Windshield Wipers / Washers (Wear, Damage / Fluid Level)
31 Doors (Open properly, broken glass)
Inside the Cab:
32 Seat (Adjustment-Height, Weight, Able to Reach Pedals)
33 Seat Belt & Mounting (Damage, Wear, Adjustment, Age)
34 Horn, Backup Alarm, Lights (Proper Function)
35 Mirrors (Damage, Adjust for Best Visibility)
36 Gauges, Indicators, Switches, Controls (Damage, function)
37 Overall Cab Interior (Cleanliness)
Signature:
Name:
Date:
DV INFRA & PROJECTS
Checklist on Transit Mixer
PROJECT NAME: INSP DATE:

Name of Contractor: DUE DATE:
LOCATION: TAG NO:
11
10
1
2
No Damage in
Number plate
Tire ( Crack,
1 in front and 2
cut, air
back side
pressure etc).
No air leak in Front and

3 4
the air tank. reverse horn.
No oil leak Fire

5 from the diesal 6 extinguisher in
tank. driver cabin.
Brake,Clutch
and
8 accelerator are
in w orking
Head and tail condition
7 lamps (for
night w orking).
Rotating parts
9
fully protected
Rear view Wind shield

10 11
mirror w ith w iper
12.B Operator license (heavy duty).

12.A Vehicle valid insurance
12.C Road tax
Remarks
CONTRACTOR SAFETY
TUV HSE DRL HSE
OFFICER
Signature:
Name:
Date:
DV INFRA & PROJECTS
Checklist for Concrete Mixer (Motor Mixer)
NAME OF THE CONTRACTOR: DUE DATE:
LOCATION: Location :
Sr No. Safety Check Points Yes No Remarks
1 Condition of the base

2 Presence of the hoper stopper
3 Condition of the m/c stand with wheel
4 Presence of guard for rotating parts
Condition of the jack of the feeder/hopper (free from damage,
5
kinks, broken strings)
6 Cover of the starter
7 Hydraulic cylinder leakage
8 Condition of Drum
9 Diesel/Electric leakage from the machine
10 Condition of Roller
Note:- Ensure barricading on both sides of the hopper when the machine in operation
Remarks
CONTRACTOR SAFETY TUV DRL
Signature:
Name:
Date:
FTO-11 PROJECTS
Checklist for Grader
Name of Contractor: Permit No:

Vehicle No: Date:
Operator Name: Location :
Sr No Points to be Checked Comments
1 Protection(Canopies, Screen) Is Provide to Shield operator from falling objects
2 Effective, working horn and reverse alarm/Signalman
3 Moving parts, shafts, sprockets, belts, Etc. are guarded
4 Protection against contact with hot surfaces, Exhaust, etc. is provide.
5 Safe means of access (Steps, grab bars, non-slip surfaces) to cab is provided.
No damage tyre and roller

6
(Crack, cut, air pressure etc.)
7 No leakages of oil from the vehicle and vehicle oil tank
8 Vehicle rear view mirror
Headlight, tail lamp are in working condition

9
(For Night Work)
10 Brake, Accelerator, Clutch are in working condition
11 Operator License & I.D Card
12 Vehicle Valid Insurance, Registration & Road Tax Certificates
13 Conditions of Hydraulic Tanks & Pipes are in good working conditions
Checked By Name Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Remarks
Contractor
Engineer
Contractor
Safety EHS
Approved by
LTTS EHS
Supervisor Contractor Safety TUV Safety
Signature:
Name:
Date:
0
FTO-11 PROJECTS
CHAIN PULLEY BLOCK

Job No: Date:
Occupier Name: Date:
Occupier Address:
GENERAL DETAILS
First Time Test Certificate No.
Identification No. / Tag No.
Manufacturer Sr. No.
Make
Manufacturing Date:
No. of Load Chain Falls:
Load Chain Dia.: mm.
Load Hook’s throat opening: mm.
Anchor Hook’s throat opening: mm.
Original Dimensions: (Manufacturing Standards Lift: Mtrs.
Machine Body Width: mm
Machine Body Thickness: mm
Head Room: mm
Hand Wheel Dia. : mm
SWL:
Material Grade (Load chain)
Initial Heat treatment of Load chain Annealing/ Normalizing/ Hardened and Tempered.
Location
VISUAL CHECKS
CHECK POINTS REMARKS
No. of Load Chain Falls:
Load Chain Dia.: mm.
Load Hook’s throat opening: mm.
Anchor Hook’s throat opening: mm.
01. Measured Dimensions: Lift: Mtrs.
Machine Body Width: mm
Machine Body Thickness: mm
Head Room: mm
Hand Wheel Dia. : mm
Chain Cracked: YES/NO.
Elongated: YES/NO.
02. Load Chain Inter link wear: YES/NO.
Manufacturing Standard: IS 6216 / DIN 5684
Bent: YES/NO.
Twisted: YES/NO.
Welding crack: YES/NO.
Twisted: YES/NO
Bent: YES/NO.
Crack on hook: YES/NO.
03. Load Hook
Safety latch: Provided/ Not provided.
Swivel of Hook: Jam /O.K.
Throat opening of hook is in permissible limit Yes/No
Twisted: YES/NO.
Bent: YES/NO.
Crack on hook: YES/NO.
04. Anchor Hook
Safety latch: Provided/ Not provided.
Swivel of Hook: Jam /O.K.
Throat opening of hook is in permissible limit Yes/No
05. PARTS NAME CHECK
Satisfactory
1. Screw brake Plate assembly Not Satisfactory: Bent/ Damaged/ Cracked/loose /
Corroded
Satisfactory
2. Ratchet Wheel Not Satisfactory: Not Working/ Bent/ Damaged Teeth
/ Crack in teeth / Cracked/ Corroded
Satisfactory
3. Hand Wheel & Centry Assembly
Not Satisfactory: Bent/ Damaged/ Cracked/Corroded
Satisfactory
4. Square Plate Assembly
Not Satisfactory: Bent/ Damaged/ Cracked/Corroded
Satisfactory
5. Tripple Gears Not Satisfactory: Cracked/Bent/Damaged/Damaged
Teeth/Cracked/Loose/bearing lock not provided/Corroded .
Satisfactory
6. Side Plate Assembly (Gear side) Not Satisfactory: Bent/ Damaged/ Cracked/ loose/
Corroded
Satisfactory
7. Pawl Assembly Not Satisfactory: Not Working/ Damaged/
Cracked/loose / Corroded
Satisfactory
8. Side Plate Assembly (Hand wheel Side) Not Satisfactory: Bent/ Damaged/ Cracked/ loose/
Corroded
Satisfactory
9. Pinion Shaft Assembly Not Satisfactory: Cracked/ loose/ alignment/
Corroded
Satisfactory
10. Load Wheel Not Satisfactory: loose/ alignment/ Corroded
/Dmaged
Satisfactory
11. Guide Roller
Not Satisfactory: Damaged/ Corroded
Satisfactory
12. Hand Chain (Pulling chain) Not Satisfactory: Cracked/ Bent/ Elongated/ Inter link
wear/ Twisted/ Welding Crack
Satisfactory
13. Hand Chain (Pulling chain) joint link Not Satisfactory: Cracked/ Bent/ Elongated/ Inter link
wear/ Twisted/ Welding Crack
Provide:Working / Not Working :Spring is not effective
14. Safety Latch Assembly
Not Provided
Satisfactory
15. Gear Cover Not Satisfactory: Loose/ Bent/ Damaged/
Cracked/loose / Corroded
Satisfactory
16. Friction Disk Not Satisfactory: Bent/ Damaged/ Cracked/loose /
Corroded
17. Condition of suspension pin Good/ Damaged/ Bent.
18. Ball bearing
19. Bolt/ Nut and Other fastening devices At the contact point between roller and pinion
20. Lubrication At the contact points between roller & pins
21.Hand Wheel G/L/D/M. (Good/Loose/Damage/missing)
22. Up down movement
23. Chain live End position
24. Chain dead end locking condition
25. Chain looping(Winding)
26. Corrosion/Pitting
27. Proof load Test.(If Applicable)
PROOF LOAD TEST REPORT
The above said chain pulley block is physically checked and load tested at ________________ proof load. Thorough
visual examination shall be done after load test.
Remarks:
Replace Parts:
Sr. No. Part Description Qty. WORN OUT / DEFECT OBSERVED
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Ladder Checklist - MS made single straight

ladder
Job No: Date:
Location of ladder
Check Points: WRITE Y: YES, N: NO & N.A: NOT APPLICABLE
Is the base (Ground) where ladder would be placed are plane /solid/rigid ?
Any physical defects found in ladder(Torn/crack/Joint etc) ?

Are Rungs / Stiles free from grease oil or slippery materials?
Are rungs of ladder in working condition ? Are Joints at rungs and stiles ok?
No broken or missing of rung observed ?are the gaps between two

successive rungs uniform ?
Are Solid /rigid handrail provided in both side of ladder ?
Is the ladder installed within 75Degree (Max.) angle with the ground/base
(4:1::height:base) ?
Is the hand rail of the ladder extended upto 1meter from the upper edge of
contact ?
Are the upper portion of the ladder griped /holed to resist its slip
/inclination ?
Is it being properly stacked when not in use ?
Is safe /unsafe tag used on ladder ?
RESULT (A: ACCEPTED ,R : REJECTED )
Remarks
Supervisor Contractor Safety Officer TUV Safety
Signature:
Name:
Date:
0
FTO-11 PROJECTS
Bar Bending Machine

Contractor: Report No
Job No: Location :
Work Description Date:
S No. Description Yes No Remarks
1 Condition of the machine base (Floor levelled )

2 Presence of the cutting machine emergency stopper
3 Provided body earthing (System earthing and body earthing)
4 Machine weather protection (Shed)

5 Condition of machine operating lever and cutting blade.
6 Presence of all rotating guards (Belt, pulley and motor)
7 Condition of terminal box and doors.
8 Condition of the warning devices &gauges.
9 Condition of the Limit cut off switch.
10 Any oil leakage from the oil tank & pipes
11 Display the SOP (safe Operating Procedure).
12 Operator fitness with trained
13 Machine base rest *(provided solid foundation)
NOTE:- Ensure barricading on both sides of the when the machine is in operation
Remarks
Contractor's
Contractor Safety Officer TUV HSE
Representative
Signature:
Name:
Date:
Inspection of Hand Tools

Job No: Date:
Sr No. Check Point/Deficiency Yes No Remarks
1.0 Hammer
1.1 Condition of head (mushroomed)
1.2 Is the Handle in smooth finish and securely fixed?
Handle not properly seasoned & giving good grip. (If handle is replaced
1.3
than original).
1.4 Is the Handle firmly fixed with the head?
2.0 Screw Driver
2.1 Tip is not properly ground to fit the slot in the screw head.
2.2 Tip is not twisted.
2.3 Handle is not sound & smooth.
2.4 Screw driver is not being used for electrical work with insulated handle.
3.0 Punch/Chisel
Head is mushroomed. (A slight taper ground round the periphery of the

3.1
heads to reduce the tendency towards mushrooming).
3.2 Cutting edge is deformed

3.3 Re sharpened chisel not suitably hardened & tempered
4.0 File & Rasp
4.1 Handle is not fixed securely.
4.2 Teeth is worn or clogged.
4.3 Stored not each one wrapped in a piece of cloth or paper.
5.0 Hacksaw
5.1 Blade is not securely tied with frame & in good condition.
5.2 Teeth of blade damaged.
6.0 Wrench/Spanner
6.1 Opening of jaw is deformed.
6.2 Sign of deterioration.
6.3 Physical damage
6.4 Threads damaged.
7.0 Any Other (please specify)
Contractor's
Contractor Safety Officer TUV HSE
Representative
Signature:
Name:
Date:
0
FTO-11 PROJECTS
CHECKLIST(PRE ENTRY) FOR DRILLING MACHINE
DATE OF CHECK- CONTRACTOR NAME- Doc No.:
SL N0 CHECK ITEM PHOTOS Y/N SL N0 CHECK ITEM PHOTOS Y/N
whether Fore whether Double insulation

1 handle is good & in 2 provided for the equipment
operating condition (written in the machine body)
whether Equipment
are free from any
whether Magnetic base is in
3 defect like broken 4
charged condition
Handle, broken
parts etc
whether Presence
of Cord strain whether Fuse is available & in
5 6
reliever (glands) good condition
are available.
whether Presence
of Drilling trigger whether Electric wire having any
7 8
switch lock in cuts and joints.
working condition.
whether Drilling
whether Condition of the presence
9 Bit in good 10
On/off switch is ok.
condition.
whether Presence
of dust cleaning ELCB & the presence of industrial
11 brush near the 12 plug/three pin plug available and
equipment is has been checked.
available.
NAME SIGNATURE DATE

Checked by contractor safety in
charge
NAME SIGNATURE DATE

Checked by TUV HSE
FTO-11 PROJECTS
PRECHECKLIST FOR SCISSOR LIFT
Project Name :
Contractor Name : Remarks

Date-
Date-
Date-
Date-
Date-
Date-
Date-
1 SWL marked on bucket
2 Platform safety door in good condition
3 Toe guard provided to Boom lift platform

4 No Damage in Tyre ( Crack, Cut, etc.)
5 Emergency switch is in working condition.
Emergency rescue system is in working condition.

6
(When Engine fails)
7 No oil leak ( Hydrulic parts,Engine and fuel tank )
8 Machine Marching alarm in working condition
Boom structure condition while full expansion

9
( Damage,crack and jamming while extending )
10 Fire Extinguisher availability

All limit switch is in working condition ) over
11
loading ,over reaching)
12 Ensure break system is in working condition
13 Vehicle Information Sheet displayed on Boom lift
14 Emergency contact numbers displayed
15 Do’s and don’ts displayed

16 Warning Lamp is in working condition
17 Display the instruction of operating
18 Required PPE'S displayed on bucket
19 DOCUMENTS :
19.A Third party certificate
19.B Vehical valid insurance
19.C Operator Valid License
19.D Operator Experience Certificate
Checked By Boom Lift Operator
Checked By Site Supervisor
Checked by contractor Safety in charge
Inspected By TUV HSE

Daily Pre-Start Risk Assessment & Safety Talk Page 1 of 2
Contractor: Supervisor name: Date:
GOAL
What is our Goal for today?
REALITY
What is our task for today?
Task: Work Area Location:
Covered by a valid Permit to Covered by a Risk

What are our critical task steps?
Work at hand? Assessment/JSA at hand?
STEP 1: yes Permit no. _______ yes
What can happen during the task - What can go wrong?
STEP 1:
STEP 2:
STEP 3:
STEP 4:
STEP 5:
STEP 6:
OPTIONS & WILL

What actions are we going to take to prevent the above and to address the identified hazards?
STEP 1:
STEP 2:
STEP 3:
STEP 4:
STEP 5:
STEP 6:
D0114401-V-CE-00-CM- D0114401
CHK-035
Daily Pre-Start Risk Assessment & Safety Talk Page 2 of 2
Pre-Start Inspection
In case of a "No" answer, take appropriate action before start of work! Action required?
Risks from/for other persons working nearby, above or below addressed? n/a yes no
Change of conditions from previous shift/day addressed? n/a yes no
Incidents and unsafe situations from previous work shift or day addressed? n/a yes no
Crew fit for work, trained and qualified as required? n/a yes no
Area cleaned prior to task? n/a yes no
Waste disposal bins accessible? n/a yes no
Spill kit available? n/a yes no
Fire extinguisher available? n/a yes no
Tools and equipment inspected and in date? n/a yes no
Protection against falling from height in place (PPE, covers, guardrails, barricades etc.)? n/a yes no
Falling objects prevented (tool lanyards, toe boards, safety nets, covers etc.)? n/a yes no
Hazardous area barricaded (for lifting, mobile elevated work platforms, scaffolding etc.)? n/a yes no
PPE available, suitable and in good shape? n/a yes no
Emergency & rescue procedures known by work crew (alarm, escape, rescue, muster point, phone no.) n/a yes no
CONFIRMATION
By signing/putting initials below, you confirm you have communicated the task, hazards and control/mitigation measures contained on
this BeSafe Daily card.
Supervisor name: Initial:
ACKNOWLEDGEMENT
By signing/putting initials below, you acknowledge you have understood the task, hazards and control/mitigation measures contained on
this LMRA Last-Minute-Risk-Analyse.
Print Name Initial

Check List for Batching Plant

Job No: Loc
Checked
POINTS Ok/No/NA Remarks
Plant boundary is demarked to avoid hazards arising out of unintended operations OR

1
Unauthorized entry.
2 Plant supports are as per the design drawing.
3 Is there any defect or damage in plant machinery?
4 Demarcation of working area and vehicles movement available?
5 Opening and cut-outs are properly guarded.
6 Batching plant is in safe condition and inspected by competent person frequently as per
schedule.
7 All rotating parts are adequately guarded.
8 Emergency stoppers for moving conveyers & plant are provided at accessible areas.
Doors of the moving parts are interlocked by using limit switches to avoid unauthorized
9
operation during plant running.
10 Adequate accesses are provided to reach all working locations.
11 Delay start mechanism is installed with hooters/sirens.
12 Safety of the Loading ramps is hard barricading provided & Ground Condition of ramp is
good.
13 Protection against entrapping of peoples in the loading hoppers.
14 Maintain all equipment, including dust/particulate collection equipment, according to
manufacturer’s recommendations to prevent leaks.
Use a totally enclosed system for the loading,unloading, handling, transfer or storage of
15
cement, pulverized fly ash or other dusty raw materials.
16 Adequate illumination is available.
17 Appropriate Earthing is provided.
18 Environment Protection measures implemented.
19 Lightening arrestors are provided.
20 Aviation lamp is installed.
21 Daily check procedure is followed.
22 Operator Fitness & Experience certificate available.
23 LOTO system implemented and in working condition.
24 Effective functioning of pressure relief arrangement in silos done.
25 Permit system is followed regularly during maintenance activities.
26 Adequate Fire Protection & Fire Fighting arrangement is done.
Vent all cement/fly ash storage silos and weigh hoppers to a fabric, bag house or
27
cartridge filter system.
REMARKS
Contractors Representetive TCE Representetive Clients Representetive
Signature:
Name:
Date:
Remarks
Representetive
Labour Camp Checklist
0

Job No: Loc
Checked
Sr. No. POINTS Remarks
Ok/No/NA
1 entry roads/walkway/passages to Labour camp are Neat & clean
2 Illumination level OK in access/egress?
3 Sufficient number of dustbin / garbage bins provided?
4 Generated garbage being disposed off on regular basis?
5 Drinking water facilities adequate in the camp
6 Fire Extinguishers & Fire Buckets available and maintained regularly?
7 First-aid facilities available?
8 Disinfection activities carried out on periodic basis?
9 Cement Flooring provided?
10 Condition of the Side walls / Roof Sheet strong enough to with stand wind pressure?
11 Ventilation of the rooms adequate?
12 Illumination of the rooms adequate?
13 Doors and windows in good condition?
14 Kitchens kept clean and tidy?
15 Water supply adequate for cooking?
16 Utensils are being cleaned on regular basis?
17 Gas cylinders & other flammable materials kept in safe area (away from fire)?
18 Fire extinguishers kept outside kitchen?
19 Adequate toilets available
20 Toilets are being cleaned on regular basis
21 Adequate water facility available for toilet and bath
22 Septic tanks and soak pit working properly
23 Area around bathrooms cleaned & kept dry and non-slippery
24 Proper drainage provided?
25 Water tank tap not leaking?
26 Water tank cleaned regularly?
27 Serviceability of light fittings
28 Adequacy of lighting
29 Serviceability of power outlets/leads
30 Adequacy of power outlets (qty & ratings)
31 Accessibility of main switch/circuit breakers
32 Labeling of switches/fuses/circuit breakers
33 Electrical shock resuscitation drill, notices instructions
REMARKS
Signature:
Name:
Date:
D0114401-V-CE-00-CM-CHK-001 Check List for DG Set
Job No: Loc

Checked
POINTS Remarks
Ok/No/NA
1 Guard provided for any rotating parts.
2 Hot surface is provided with guard.
Rubber mat is provided in operator standing area.

3
(In front of operator panel of the DG)
4 Proper access to the D.G control panel.
5 Wheel stopper in case of vehicle mounted DG.
6 Fire Extinguishers & Fire Buckets available and maintained regularly?
7 No oil leakage from the oil tank & other parts of the M/C.
8 Dip tray for any oil leakage.
9 Exhaust smoke pipe faced upwards & outside of DG shelter.
10 Adequate ventilation in case of indoor generator.
11 Drive belt is in good condition (any cut,bent or damage).
12 Presence of fire extinguisher (ABC type).
Presence of damage free operating switch,Voltage and temperature meter,

13
circuit breaker, Oil level indicator, Emergency switch.
In case of mobile gen set, confirmation of inbuilt acoustic system.( If sound is
14
more than 85dbi)
15 Earthing is provided with standard earthing pit.
REMARKS
Contractors
TCE Representetive Clients Representetive
Representetive
Signature:
Name:
Date:
DV INFRA & PROJECTS
DAILY CHECKLIST FOR TOWER CRANE 0
Name of Contractor:- Date:-
Job No:- Location:-
Registration No. :- frequency:- DAILY
OBSERVATION DAY
Sr. No. POINTS
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
1 Wire Rope(Hoist)
2 Boom Rope Drum
3 Boom Rope Pulley
4 Boom Rope Condition
5 Bottom Hook
6 Bottom Hook Safety Latch
7 Boom Angle Limit Switch
8 Slewing Limit Switch
9 Hoisting Limit Switch
10 Hoisting Rope
11 Boom Buffer Block
12 Hoisting Overload Cut off Switch
13 Aviation Lamp(Red Colour)
14 Hoist Breaking System
15 Boom Breaking System
16 Automatic safe load indicator

17 Earthing
18 Ladder Condition
19 Hoisting Rope End Clamping
20 Hoisting Rope Clamps
21 Boom Rope Clamps
22 Operators Cabin Condition
23 Electrical Panel Condition
24 Quarter Pins Provision
REMARKS
Contractors Representetive TUV Representetive DRL Representetive
Signature:
Name:
Date:
DAILY CHECKLIST FOR EARTH MOVING EQUIPMENT
0
Name of Contractor:- Date:-
Job No:- Location:-
Registration No. :- frequency:- DAILY
OBSERVATION DAY
Sr. No. POINTS
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
1 Operator's Valid driving license
2 Certificate of Registration(RC Book)Form 23 Rule 48
3 Certificate of Taxation (Tax Receipt)
4 Certificate of Fitness
5 Goods Carriage Permit Form P.Gd.C. Rule-72
6 PUC - Validity
7 Insurance copy- Validity
8 Age proof of equipment helper/banks man/cleaner
9 Hydraulic System
10 Guards / Covers / Doors
11 Fastener locks pins / Keys.
12 Horn / Reverse horn / Lights
14 Indicators / Wiper Blades
15 Ear Plug /Dust Mask for the operator
16 Condition of Battery and Lamps
17 Operating levers
18 Fire extinguisher Provided
19 Rear View Mirror
20 Seat Belt
Signature
REMARKS
Signature:
Name:
Date:
DV INFRA & PROJECTS
EMERGENCY CONTACT NUMBERS
SL.NO NAME OF THE EMPLOYER DISIGNATION CONTACT NUMBER
1 K.SESHIBHUSHAN GENARAL MANAGER 7702018751
2 P.V.S.N.MURTHY PROJECT MANAGER 9441893335
3 K.SYAMA SUNDHAR RAO Q.C 8500339871
4 P.GANESH HR 9550743822
5 SK.MOFIJUL ISLAM SURVEYOR 9989329670
6 P.NARASINGA MURTHY SAFETY OFFICER 8555011783
7 K.SATHYANARAYANA SITE.ENGINEER 8074722528
8 K.S.NANTHA KUMAR JR.ENGINEER 9626271826
9 K.KIRAN KUMAR JR.ENGINEER 8886070990
10 P.RAMA KRISHNA JR.ENGINEER
11 G.RAMA KRISHNA STORE INCHARGE 7659031802
12 G.MURALI MOHAN ACCOUNTS
13 J.CHANDARA RAO SUPERVISIOR
14 P.RAMA KRISHNA SUPERVISIOR 7032700450
15 U.RAJA SHEKHAR ELECTRICIAN 7680837209
16
17
DV INFRA & PROJECTS
SUB CONTRACTOR WORKMEN DETAILS
NAME OF THE CONTRACTOR

CTO SEZ PROJECTS
CHECK LIST FOR DEWATERING MOTOR
Name of Contractor: DATE:-
DUE
TAG NUMBER:-
DATE:-
Sl No.: Check Items Yes No Remarks
1 Is physical condition of motor in good condition ?
2 Protective guard on moving parts ?
3 Power connection made through 30ma ELCB& RCCB
4 Vibrator case and frame / bottom condition ?
5 Is switch On / Off workiing condition ?
6 Healthy needle hose and cuppling.
7 Presence of industrial plug top ?
8 Orther
Remarks
Supervisor Contractor Safety Officer DRL/TUV HSE
Signature:
Name
Date:
DV INFRA & PROJECTS
JOB SAFETY ANALYSIS DETAILS
SL.NO TASK INVOLVED JSA NUMBER'S APPROVED DATE
1 ERECTION OF SCAFFOLD DRL/P/DV/JSA-001 6/21/2023
2 SHEET FIXING WORK AND REMOVING WORK AT PB -5 AREA DRL/P/DV/JSA-002 6/21/2023
3 EXCAVATION WORK DRL/P/DV/JSA-003 6/21/2023
4 LOADING AND UNLOADING OF MATERIALS & PORTA CABINS DRL/P/DV/JSA-004 6/23/2023
5 WELDING WORK LIKE HOT WORK DRL/P/DV/JSA-005 6/21/2023
6 DEWATERING FROM EXCAVATED AREA DRL/P/DV/JSA-006 6/26/2023
EXACAVATION SHUTTERING WOOD CUTTING,REINFORCEMENT STEEL

7 CUTTING,CONCRETING,SCAFFOLD ERECTION,WALL BRICK DRL/P/DV/JSA-007 7/9/2023
WORK&PLASTRING ,WELING WORK'S
8 GRAVEL & SAND FILLING WORKS DRL/P/DV/JSA-008 7/27/2023
9 STEEL FIXING AND RCC DRL/P/DV/JSA-009 7/27/2023
10 GROOVE CUTTING /SAW CUTTING ON ROAD DRL/P/DV/JSA-010 7/27/2023
11 LOADING AND UNLOADING OF MATERIALS DRL/P/DV/JSA-011 7/27/2023
12
13
14
15
DV INFRA & PROJECTS
JOB Specific Training
PROJECT NAME :-DRL(CTO-SEZ) PB-05
COUNDUCTED BY:-
TOPIC DISCUSSED:-
SL.NO NAME OF THE EMPLOYER DISIGNATION SIGNATURE REMARKS
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
SHE TRAINER : TUV SIGN : DRL SIGN :

DV INFRA & PROJECTS
ATTANDANCE SHEET
PROJECT NAME :-DRL(CTO-SEZ) PB-05
COUNDUCTED BY:-
TOPIC DISCUSSED:-
SL.NO NAME OF THE EMPLOYER DISIGNATION SIGNATURE REMARKS

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
DV INFRA WORK SCHEDULE
SL.NO DESCRIPITION EXACAVATION GRAVEL FILLING SOLING PCC REINFORCEMENT SHUTTERING RCC REMARKS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
DV INFRA & PROJECTS
MONTHLY WORK PERMIT DETAILS
DATE WISE PERMIT NUMBERS MONTH:-SEPTEMBER
SL.NO DATE GENARAL PERMIT HOT WORK PERMIT HEIGHT WORK PERMIT EXCAVATION WORK PERMIT REMARKS
1 9/1/2023
2 9/2/2023
3 9/3/2023
4 9/4/2023
5 9/5/2023
6 9/6/2023
7 9/7/2023
8 9/8/2023
9 9/9/2023
10 9/10/2023
11 9/11/2023
12 9/12/2023
13 9/13/2023
14 9/14/2023
15 9/15/2023
16 9/16/2023
17 9/17/2023
18 9/18/2023
19 9/19/2023
20 9/20/2023
21 9/21/2023
22 9/22/2023
23 9/23/2023
24 9/24/2023
25 9/25/2023
26 9/26/2023
27 9/27/2023
28 9/28/2023
29 9/29/2023
30 9/30/2023
DV INFRA & PROJECTS
Checklist on Concrete Mixer (AJAX)

Name of Contractor: DUE DATE:
LOCATION: TAG NO:
7 8
10
11
6 9
4
5
1 2
No Damage in
Number plate
Tire ( Crack,
1 in front and 2
cut, air
back side
pressure etc).
No air leak in Front and

3 4
the air tank. reverse horn.
No oil leak Fire

5 from the diesal 6 extinguisher in
tank. driver cabin.
Brake,Clutch
and
8 accelerator are
in w orking
Head and tail condition
7 lamps (for
night w orking).
Rotating parts
9
fully protected
Rear view Wind shield

10 11
mirror w ith w iper
12.B Operator license (heavy duty).

12.A Vehicle valid insurance
12.C Road tax
Remarks
CONTRACTOR SAFETY
TUV HSE DRL HSE
OFFICER
Signature:
Name:
Date:

TUV Checklist - Master-Rev 0 (4) (2) (Recovered)

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Sr.

Name of Contractor: Report No:

Check List for Non Compliances

S.No Items Photos Y/N S.No Items Photo Y/N

whether Hoist limit

whether Wire rope

whether oil leak in

7 8 whether Front and

Whether windshield Whether the

Whether Fire- Whether the

Supervisor Contractor Safety TUV HSE

Check List for Truck

Whether wheel nuts & Is the Jack &

Is the helper/ co-driver

Checklist for Dumpers #NAME?

Name of Contractor: Report No:

Check List for Non Compliances

List of Issues Identify

Check List for Tractor

Name of Contractor: Report No:

Driver Name Vech. No

Owner Name Date of Insp.

S.No Items Photos Y/N S.No Items Photo Y/N

whether Head light, whether Brake,

whether Lock of the whether Inter

Supervisor Contractor Safety TUV HSE

D0114401-V-CE-00-CM-CHK-005 Check List for Pre Entry Of Hydra #NAME?

Name of Contractor: Report No:

Check List for Non Compliances

S.No Items Photos Y/N S.No Items Photo Y/N

whether Hoist limit

whether Wire rope

whether oil leak in

whether Boom whether Boom

Whether windshield Whether the

Whether Fire- Whether the

Supervisor Contractor HSE TUV HSE

Check List for Crawler Crane

Name of Contractor: Report No:

19-LOAD TEST DETAILS

Name of Contractor: Inspection

S.No Items Photos Y/N S.No Items Photo Y/N

whether ON / OFF knob

whether Welding cables

whether Electrode rod

Inspected By: Sign:

DATE OF CHECK- CONTR NAME-

SL N0 CHECK ITEM PHOTOS Y/N SL N0 CHECK ITEM PHOTOS Y/N

NAME SIGNATURE DATE

NAME SIGNATURE DATE

NAME SIGNATURE DATE

CONTR NAME- DATE OF CHECK-

SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEM PHOTOS Y/N

whether Protective whether Pressure

whether Non return

whether Tight whether Hose free from

whether Cylinder whether Trolley tyre are

NAME SIGNATURE DATE