Inspection Check List-Pursuant to Clause 22.

2 H&S Plan (1st Revision 2018)

MONTHLY INSPECTION CHECKLIST

Date: Number of Page 1 of 6

MARKING SYMBOLS  Satisfactory  Needs Improvement Not Applicable

WORKPLACE SAFETY
Mark Description Corrective Action/Remark
Workplace is clean and orderly maintained
Employee’s work areas are adequately illuminated for late night
Work.
Employees are not engaged ergonomic hazard, e.g. awkward
Posture, prolonged repetitive motion, contact stress, etc.
Exits are cleared of obstructions and accessible
Stored materials are secured and limited in height to prevent
Collapse
Employees are not engaged in unsafe acts, e.g. using chairs or
Tables as step stools etc.
Are ladder in good condition; free from defects
Are safe step stools and ladders available when necessary and
Are they properly used
Is air passes is good in working area, it is not suffocative

Are chemical products properly used, labeled and stored

Are Health and Hygiene is in practice? Nobody eating at work
Place.
Is the Company Safety Policy posted up-to-date?
Are routine Workplace Safety Inspection being conducted and
Recorded in file?
Are unsafe/unhealthful report forms readily available to
Employees?
Are AHA’s readily available at work center?

Is MSDS available at work site?

Are manhole and ditches are safely covered or barricade?

HOUSEKEEPING
Mark Description Corrective Action/Remarks
Are walkways correctly maintained and clear

No evidence of possible tripping hazards

Floors dry – not slippery

Cords are not stretched across aisles or under carpets

Floors are clean and free from slippery

Entrance Is properly marked, lighted for night

Access and egress are free from hazards

Toilets and baths clean and well ventilated

 Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

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Construction materials are in correct place in proper order.

Electrical cables, water pipe line are not crossing walkways

Cement bags are not stack as brick style not more than 10 bags
In height
Bricks are stacking less than 6’ height with proper space in layer

Timbers and logs are managed properly after concrete aged

Steels are properly covered the sharp tips with red cloths

Constructions equipment are cleaned and are in proper place

Scaffolding pipes and clamps are safe keeping

While curing water is not access to the sensitive area

While storing material ensure about emergency access

Fuel storage is free from ignition source

STAIRWAYS, STORAGE ROOMS, EMERGENCY EXITS, FIRE EXTINGUISHERS, KITCHENS

Mark Description Corrective Action/Remarks
Adequate lighting in stairway, aisle, or storage room

Rooms are clean and good condition

Stairways are clear of materials and equipment – not cluttered
Emergency exits are clearly marked and accessible

Fire extinguishers are accessible and fully charged

Stairways are provided with anti-slip treads and in good condition

Fixtures and signage securely fastened to the walk

Supplies and materials stored properly on shelves

Does storage layout minimize lifting problems

Heavy storage shelves are fastened to the wall

Trolleys/dollies available to move heavy items

Racks and shelves properly installed and good in condition

Electrical outlet and switch are safe distance for material

Storing on shelves heavy items are on bottom and light on top

MSD are maintained for each sensitive item stored

Spill control measure are in places

Fire extinguisher is available at store and is in good condition

Emergency handling equipment and material available

 Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

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Access and egress is not blocked and those are marked

Unauthorized person are not entering at store

Material on shelves are not overloaded

Designated staff is attending on the store (storekeeper)

Store staff is using mandatory PPE

First AID box is available near the working area

Emergency number and route map is fixed on the wall

Store staff know how to handle emergency situation

Employee are familiar on assembly point and escape procedure

Everyone are familiar to emergency program, kits

ELECTRICAL SAFETY AND LIGHTING

Mark Description Corrective Action/Remarks
Electrical outlets are not overloaded

Equipment is properly grounded

Electrical cords and plugs are in good condition

Extension cords are not being used for permanent wiring

Clear access to electrical panels and switches

Sockets and switches are in good condition

Lighting levels adequate for the work area

Work areas free from glare or excessive lighting contrast

Task lighting provided in areas of low light or high glare

Power strips and extension cords UL-Approved

Electrical cords arranged in such a way as to not create tripping
or other hazards
Electrical cords kept out of doorways or isles
Breaker boxes and junction boxes securely covered
Heat-producing appliances plugged directly into a hard-wired
Outlet, not extension cords
Electrical panel boxes closed and lock properly

Emergency light is in operational

NOISE
Mark Description Corrective Action/Remarks
 Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

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Feasible engineering controls is in place

Hearing protection provided where sound levels exceed

Hazardous noise areas identified and marked

TOOLS EQUIPMENT AND MACHINERY

Mark Description Corrective Action/Remarks
Lockout procedures in place

Tag out procedures in place

Guards cover and safety devices on equipment

Tools grounded or double insulated cords are in use

Load rating on the equipment and power supplied marched

Equipment clean and free from defect

Operator’s service manuals available for the equipment

Electrical cords in good condition with proper grounding, GFCI
Emergency stop buttons is operational

Area adequately ventilated

Appropriate PPE (Safety glasses, gloves, hearing protection,
respirators, etc. ) available.

EMERGENCY PREPAREDNESS & HANDLING

Mark Description Corrective Action/Remarks
Emergency response plan in place for work area

Emergency response team is formed and are trained

Personnel aware of what number to call for emergencies and
reporting procedures
Assembly point clearly visible, unobstructed
Do personnel know who their safety Rep/Camp Warden

Alarm system is established

Access/egress safe for employees and visitors

Emergency Kits are in place

Wheel barrow for emergency use

Personnel trained in the handling of HAZMAT

Containers containing chemicals properly labeled

Containers of non-hazardous chemicals also labeled to avoid
confusion
Current MSDS readily available for each HAZMAT
 Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

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Inventory of all HAZMAT maintained

Appropriate PPE worn when required

Gas cylinders properly supported and stored

Flammable materials are stored properly and ventilated

Decanted flammable liquids vessels are also properly

NO HAZMAT store above or next to sinks

Employees have completed hazard communication

Fluorescent light tubes properly disposed

Hazard warning signage with emergency contact names and
numbers posted on entry door
Eyewashes available, accessible and functional
Personnel trained in proper spill clean-up

Emergency contact Number

Emergency evacuation Route

Emergency contact number for key personnel

Nearest Hospital contact number

Social Mobilizer’s contact Number

Emergency response plan

PPE
Mark Check Points Remarks
Eye Protection applied correctly to protect eye from flying
particles and corrosive substances?
Are gloves using at the site as per job nature on the sites?

Are provided Hard Hat applying by Workers?

Are Hard Hat being checked its shell and suspension system?
Are foot protection using to protect from corrosive, poisonous
substances, cursing and penetration?
Are provided respirator regularly using by workers and staff?
Are ear plug, ear-muff using by workers working at the noisy
workplace?
Are provided PPE have been inspected, cleaned and sanitized?

WALK-WAY
Mark Check Points Remarks
Are wet and slippery surface guarded and signs put to warn road
users?
 Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

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Are holes in floor, sidewalk or other walking surface repaired

properly, covered or made safe?
Are floor opening guarded by cover?
Are toe-board installed around the edges of the permanent floor
opening?
Are unused pits are guarded or covered?
Are signs posted, when appropriate, showing the elevated
surface load capacity?
Is material piled, stacked or racked in a manner to prevent it
from tipping, falling or rolling?
Are emergency exit clear free from obstruction?
Are special precaution taken when carrying construction
material to the worksite in walk way?

LADDER
Mark Check Points Remarks
Are all ladder checked and maintained?
Are rungs and steps are free from greasy substances?
Are those free from defects, while it is being used, is it
positioned correctly?
Are workers and staff oriented for the use of particular ladder?
Are the rungs of the ladder uniformly spaced at 24” and is
perfectly centered.
Are ladder keeping in safe place to protect from weathering?

HAND TOOLS AND EQUIPMENT

Check Points Remarks
Are all tools and equipment used by workers at workplace in
good condition?
Are hand tools, chisel, punches, having mushroomed heads
during use and replaced as necessary?
Are broken or fractured handles on hammers and similar
equipment corrected promptly?
Are worn and bet wrenches replaced regularly?
Are safety glasses, face shields, and similar equipment used
while using hand tools or equipment?
Are tool handle wedges tightly in the head of all tools?
Are tools stored in dry, secure location where there won’t be
tampered and rusted?

INSPECTION TEAM
NAME POSITION SIGN DATE
Inspection Check List-Pursuant to Clause 22.2 H&S Plan (1st Revision 2018)
MONTHLY INSPECTION CHECKLIST

Date: Number of Page 7 of 6