Not

No Description OK N/A No Description OK

Ok
1 Work Permit 7 Man Basket

Work permit available & valid Have valid 3r° party certificate

Work permit relevant to the

Door latches are perfect
job
D Shackle/ Sling attached to
Work permit signed by all the basket are free from
defects.
Personnel are hooking the
Tool Box Talk Meeting harness to the overhaul ball
hook of crane.

Trial lift was done with man

Personal protective
2 basket with 110%of anticipated
equipment
load for each location.

PPE provided and its use is

Portable Generator
enforced
PPE properly maintained 8 ELCB ( 30mA rating) provided
PPE of approved make ELCB is functioning
Used for intended purpose Fuel tank covered
3 Excavation and Trenching Grounded properly

Shoring / Sloping / Stepping Pluck/receptacles good

Trench box Provided condition

Soil Clearance Maintained Safety Certificate validity

Barriers, Lights, Signs Fire Extinguisher with valid
Installed certificate

Safe Access /Egress Provided Guards are in position

Crossover Provided Condition of cable

Validity of Excavation
Cables are laid safely
authorization
Identification of existing
9 Gas/ Electric welding
facilities
4 Scaffolds Gauges / hoses condition
Scaffold tag system in place/ proper acetylene pressure
Valid maintained
Condition of welding / earth
Base and sole plates provided
returns cables.
Secured Proper earthling
Toe boards , guard rails
Operator's PPE
provided

Safe access ladder provided Fire extinguisher available

 All ladders are secured
properly
workers are working in
approved scaffold structure
Power
5 ECLB is available /working
tool/machines/equipment
Free from defects/guarded
Dead Man switch
Suitable for job
Extension cords good
condition
Cables are laid neatly
Cable connectors good
condition
Cable connections properly
secured
Extension cables are armored
type
6 Temporary Electrical
ELCB/GFCI used
Condition of Receptacles /
plugs
Condition of cables
Grounding
Warning signs
12 Firefighting equipment
Fire extinguishers are available
Are the certificates are valid
Gage pressure
13 House keeping
Materials properly stacked
Vehicle access ways are clear
Walk ways are clear/ free from
obstructions.
Combustibles protected/cleared
Spark Contained with approved
drapes
Compressed Gas
Proper storage (shade /
10
separation)
Protective caps in place
Cylinders in upright position
&secured on trolley
Flash back arrestors
Proper colour coding
Regulators conditions
Crane & Lifting devices
11 Valid TP certificate/ safety
certificate
Load Radius indicator & safe
load charts
Condition of wire ropes and
safety latches
Tag line used
Certified rigger in position
Load drop area barricaded
Outriggers are placed safe
distance from the edges of
excavation.
Free from hydraulic oil leakage
Office Facilities
15
All electrical panels are covered
Electrical appliances are approved
for use.
All ELCBs are functioning
Fire extinguishers with valid
certificate are available
Flammable material not stored
inside office or under the cabins
Smoking prohibited
All plugs/ receptacles in good
condition
Good housekeeping maintained.
First aid kit is available
 Waste collection bins are
Office is properly earthed
available
Secured ladders are provided on Emergency telephone nos are
the slopes. displayed.
Trash bins are available and cleared
Overall condition
regularly.
14 Miscellaneous
Drinking water available
Fuel is stored in approved
containers
Fuel can keep closed / kept in
safe location.
Safe refueling practice is
followed.
All pipes are secured on the
supports
/foundations with wedges or
stoppers.
All erected pipes are secured
I
Highlight & Points need immediate action :

Signature
Not
N/A
Ok