Camp Inspection

LARSEN & TOUBRO LIMITED
Power Transmission & Distribution (UAE)

Construction, Supply, Installation, Testing and Commissioning
of UMMDAMAN 132/11kV Substation and Associated works
PROJECT HSE PLAN –All EHS Formats Page 1 of 76
Page
Sl. No. Description Format No
numbers
1 First Aid Kit Checklist EHS-L&T-F001 3
Monthly Plant & Equipment & MEWP
2 EHS-L&T-F002 6
Inspection
Daily Plant & Equipment & MEWP Inspection
3 EHS-L&T-F003 7
Checklist
4 Fire Equipment EHS-L&T-F004 8
5 Crane Site Inspection EHS-L&T-F005 9
6 Site EHS Inspection EHS-L&T-F006 10
7 Sharp Hand tools & Tools Registries EHS-L&T-F007 12
8 Power Tools Inspection EHS-L&T-F008 13
9 Fall Protection EHS-L&T-F009 14
10 Lifting Equipment, Gears EHS-L&T-F010 15
11 Ladder Inspection EHS-L&T-F011 16
12 PPE EHS-L&T-F012 17
13 Scaffolding Inspection EHS-L&T-F013 18
14 Electrical Board & Extension Cables EHS-L&T-F014 19
15 Edge, Hole Protection EHS-L&T-F015 20
16 COSHH Assessment EHS-L&T-F016 21
17 Electrical Safety Inspection EHS-L&T-F017 24
18 Working at Height EHS-L&T-F018 25
19 Full Body Harness Inspection EHS-L&T-F019 27
20 Camp Inspection EHS-L&T-F020 28
21 Induction EHS-L&T-F021 31
22 Job Safety Task Instruction EHS-L&T-F022 33
23 Incident Preliminary Report EHS-L&T-F023 34
24 Incident Follow up form (Part 1&2) EHS-L&T-F024 35
25 Incident Investigation Personal form EHS-L&T-F025 37
26 Hot work Permit EHS-L&T-F026 38
27 EHS Training Attendance EHS-L&T-F027 39
Sl. No. Description Format No
28 STAR CARD EHS-L&T-F028 40

29 Formation Site HSE Committee EHS-L&T-F029 41
30 Minutes of HSE Meeting EHS-L&T-F030 42
31 Tool Box Talk Meeting EHS-L&T-F031 44
32 PTW for Testing & Commissioning EHS-L&T-F032 45
33 Risk Assessment Register EHS-L&T-F033 47
34 Action Notice EHS-L&T-F034 48
35 Lockout-Tag out Permit EHS-L&T-F035 49
36 Customer Satisfaction Feedback EHS-L&T-F036 50
37 Legal Register Format EHS-L&T-F037 51
38 Waste Management EHS-L&T-F038 53
39 Other Requirement Checklist EHS-L&T-F039 53
40 Health Checkup Format from EHS-L&T-F040 55
41 Confined Space Permit EHS-L&T-F041 56
42 Lifting Permit EHS-L&T-F042 58
43 Chemical Inventory Register EHS-L&T-F043 59
44 Drinking Water Filter Changing Schedule EHS-L&T-F044 60
OH&S Key performance indicators for
45 EHS-L&T-F045 61
Contractors
46 Workmen Screening form EHS-L&T-F046 62
47 Floor Opening Permit EHS-L&T-F047 64
48 Excavation Permit EHS-L&T-F048 65
49 Working At Height Permit EHS-L&T-F049 67
50 Emergency STOP Switch Check Sheet EHS-L&T-F050 68
51 Housekeeping Inspection Checklist EHS-L&T-F051 69
52 Diesel Generator (Dg) Inspection Checklist EHS-L&T-F052 71
53 Cable Riser Work Permit EHS-L&T-F053 72
Permit to Work in T&C Area (Civil , Electrical
54 EHS-L&T-F054 73
MEP Works)
REF.: EHS-L&T-F001
FIRST AID KIT CKECKLIST – PROJECT SITE /HIGH RISK AREAS
Inspection Date _______________ # of person using:______________ Job #:______________
Kit In-charge: ______________________________ Signature: ___________________
Inspected By: _______________________________ Signature: ___________________
Exp No
S/ Qty Jan Feb Mar Apr May Jun Jul Aug Sep Oct
v
Dec
Item Date
N
STATUS
1 Guidance Card 1
2 Sterile Band Aid 40
Adhesive Tape : 1/2" x
1
10 yds
3
: 1” x
1
10 yds
Antiseptic Solution 250
4
ml
Gauze Bandage : 1
5 2
inch
:2 inch 2
:3inch 2
6 Gauze Pad 3” x 3” 4
Absorbent Sterile 250
7
Cotton Wool gms
8 Oval Eye Pad (Sterile) 15
Wrapped Sterile
9 2
Triangular Bandage
10 Disposable Gloves 3 Pairs
Wrapped Sterile
10
Unmediated Wound
11 Dressing : app. 12 cms
x 12 cms : app. 18 cms 3
x 18 cms
Individual Wrapped
12 4
Moist Cleaning Wipes
Cotton Tipped
13 20 pcs
Applicator(approx6”)
Eye Wash 250
14
ml
Resuscitation(CPR)
15 3
Training First Aid
16 Safety Pins 1 doz
17 Surgical Scissors 1
Signature & Date
REF.: EHS-L&T-F001 A
FIRST AID KIT CKECKLIST – FOR VEHICLE
Exp No
v
Dec
Item Date
N
STATUS
1 Guidance Card 1
1
10 yds
3
: 1” x
1
10 yds
4
ml
Gauze Bandage : 1
5 1
inch
:2 inch 1
:3inch 1
7
Cotton Wool gms
Wrapped Sterile
9 2
Triangular Bandage
Wrapped Sterile
6
Unmediated Wound
11 Dressing : app. 12 cms
x 12 cms : app. 18 cms 1
x 18 cms
Individual Wrapped
12 4
Cotton Tipped
13 20 pcs
Applicator(approx6”)
Eye Wash 125
14
ml
Resuscitation(CPR)
15 2
Training First Aid
Signature & Date
REF.: EHS-L&T-F001 B
FIRST AID KIT CKECKLIST – LOW RISK - OFFICE
Exp No
v
Dec
Item Date
N
STATUS
1 Guidance Card 1
1
10 yds
3
: 1” x
1
10 yds
4
ml
Gauze Bandage : 1
5 1
inch
:2 inch 1
:3inch 1
7
Cotton Wool gms
Individual Wrapped
10 4
Signature & Date
REF.: EHS-L&T-F02
Monthly Plant, Equipment, Vehicle & MEWP Checklist
Unit Name: __________________ Plate number: _____________________ Job #:_____________
Unit Model: __________________ Serial number: _____________________ Month Colour Code: _____
Operator / In-charge: ______________________________ Signature: ________________
Inspected by: __________________________________Signature: ________________
Date of Inspection: ___________________ Next Date of Inspection: _______________
SATISFACTORY
S/N ITEMS N Correction Remarks
YES N/A
O
1 Operator Driving license
2 Operator Third party Certificate
3 Medical Fitness certificate
4 Health Insurance
5 Vehicle License (Mulkiya)
6 Vehicle Third party Certificate
7 Maintenance Inspection Logbook
8 User manual
9 Seat belts
10 Air conditioning
11 Telescopic boom condition
12 Condition of outrigger / pads
13 Head light & indicators
14 Beacon light / Additional Lights
15 Reverse Alarm
16 Horn
17 Coolant water, brake oil, engine oil, etc.
18 Plant / Equipment Earthing
19 Tires
20 Gauges & warning devices
21 Clutch / Brakes
22 Mirrors (center and side)
23 Unusual damage
24 Unusual noise
25 Leakages on oils, fuel etc.
26 Guards / Covers / Doors
27 Fire Extinguisher
28 First aid box
29 Warning Triangle
30 Others:-
REF.: EHS-L&T-F03
Daily Plant, Equipment, Vehicle & MEWP Checklist
Unit Name: __________________ Plate number: _____________________ Job #:_____________
Unit Model: __________________ Serial number: _____________________ Month Colour Code: _____

Date of Inspection: ___________________ Next Date of Inspection: _______________
S/ Month: ______________________________________________
ITEMS 3 3
N 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
0 1
Operator Driving
1 license
Operator Third
2 party Certificate
Medical Fitness
3 certificate
4 Health Insurance
Vehicle License
5 (Mulkiya)
Vehicle Third party
6 Certificate
Maintenance
7 Inspection logbook
8 User manual
9 Seat belts
1 Air conditioning
0
1 Telescopic boom
1 condition
1 Condition of
2 outrigger / pads
1 Head light &
3 indicators
1 Beacon light /
4 Additional Lights
1 Reverse Alarm
5
1 Horn
6
Coolant water,
1 brake oil, engine
7 oil, etc.
1 Plant / Equipment
8 Earthing
1 Tires
9
2 Gauges & warning
0 devices
2 Clutch / Brakes
1
2 Mirrors (center and
2 side)
2 Unusual damage
3
2 Unusual noise
4
2 Leakages on oils,
5 fuel etc.
2 Guards / Covers /
6 Doors
2 Fire Extinguisher
7
2 First aid box
8
2 Warning Triangle
9
3 Others:-
0
REF.: EHS-L&T-F004
Fire Equipment Inspection Checklist
Inspection Date: ________________ Month Colour Code: ________________ Job #: _______________
Inspected by: ____________________ Designation: __________________ Signature: _______________
Area In-charge: ___________________ Designation: __________________ Signature: _______________
Next Date of Inspection: ______________________________
Gauge
SI. Type of 3rd party Pressure Hose "NO" Seal Tank "NO" "NO"
I.D.# Location Capacity Remarks
No. Extinguisher Expiry (GREEN) Damage Intact Damage Corrosion
10
11
12
13
14
15
REF.: EHS-L&T-F05
Crane Site Inspection
Crane ID & Registration #:__________________ Job #:________________
Crane Capacity:__________________ Inspection date:________________
Colour Code: ______________________________
Sr. SATISFACTORY
No ITEMS Remarks
. YES NO N/A
Operator competency (TP & Fitness) certificate and
1
license validity
2 TPI certificate validity
3 Maintenance registry
4 Lifting Gears TPI Certificate
5 Engine Start-up Condition
6 Seat Belt
7 Wire Rope, Slings, Anchored, &Chain Condition
8 Hydraulic condition (leakage and damages)
9 Lubrication
10 Emergency Stopper
11 Tires Condition & Pressure
12 Stability of Crane
13 Swing, Propel, Hoist, Boom Brakes & Locks
14 Over Load Indicator, lights and alarm
15 Hoist Limit Switch and Hook Latch Condition
16 Engine Oil Leakage
17 Unwanted Sound
18 Engine Oil Level at Indicator
19 Fuel Level at Indicator
20 Outrigger condition
21 Crane load graph
22 Boom Condition
23 Boom length, angle indicator
24 Boom Switch & cut off Switch
25 Warning back lights & Horn

26 Fire Extinguisher
27 Guard of moving & Rotating Parts
Construction, Supply, Installation, Testing and Commissioning of UMMDAMAN 132/11kV Substation
and Associated works
PROJECT HSE PLAN- EHS Formats Page 11 of 76
Site EHS Inspection REF.: EHS-L&T-F006
Area responsible: ________________ Location: ________________ Job #: _______________
Date of Inspection: __________________________________ Time: _______________
SI. SATISFACTORY CORRECTED ACTION

NO ITEM CORRECTIVE ACTION REQUIRED REMARKS
YES NO N/A BY/ TITLE TARGET DATE
.
1 Approved MSRA
2 Full Time Supervision & Competency
3 Signs & Barricade
4 Watchman/Security Requirements
5 House Keeping / Hygiene
6 Welfare Facilities
7 Workplace Ventilations
8 Monthly Inspections of M/c, tools &Equip’t
9 Floor Opening Protections
10 Physical Safety Power Tools/Electrical Equip't
11 Fire Fighting Equipment
12 Physical condition of Hand Tools
13 Ladder & Working Platform Safety

Construction, Supply, Installation, Testing and Commissioning of UMMDAMAN 132/11kV Substation
and Associated works
SI. SATISFACTORY CORRECTED ACTION

NO ITEM CORRECTIVE ACTION REQUIRED REMARKS
YES NO N/A BY/ TITLE TARGET DATE
.
14 Access, Egress & Emergency Exits
15 Storage Area
16 Permit Requirements
17 Scaffolding Requirements compliance
18 Crane Requirements / Operators Competency
19 MEWP Requirements / Operators Competency
20 Forklift Requirements / Operators Competency
21 Testing & Commissioning compliance
22 Lock-out / Tag -out Procedure
21 Lifting Gears Requirements
22 Personal Protective Equipment (PPE)
23 Transport and Road Safety
24 Working at Heights Requirements
25 Miscellaneous
Inspected By : Signature:
Construction, Supply, Installation, Testing and Commissioning of
UMMDAMAN 132/11kV Substation and Associated works
REF.: EHS-L&T-F007
Sharp Hand tools & Tools Registries
Assigned To: ________________ Signature:________________ Job #: _______________ Color Code: ______________
Inspected By: _____________________ Signature:________________ Date of Inspection :___________________________
MONTH: ____________________
Sr. Identification
Description Usage / Purpose
No Mark / Serial # 1 2 3 4 5 6 7 8 9 10 11 12
10
11
12
13
14
15
16
17
18
19
20
REF.: EHS-L&T-F008
Power tools inspection checklist

Inspection Date: ________________ Colour Code:________________ Job #: _______________
Inspected By: ______________________Signature:________________ In-charge: __________________________ Signature:________________
SI. Cable Physical

Description I.D. / Tool # Socket Function Others Corrective Action Remarks
No. s Appearance
REF.: EHS-L&T-F009
Fall Protection Checklist

Inspected by: ___________________ Signature: _______________ In-charge: ___________________Signature:________________
MISSING
Sr. No. ITEMS ID MARKS CERTIFICATE # BROKEN CUTS CORRODED DIRTY SWL FINAL STATUS
PARTS
1
10
REF.: EHS-L&T-F010
Lifting Equipment& Lifting Gears Checklist
Inspection Date: ________________ Monthly Colour Code: ________________ Job #: _______________
Inspected by: _____________________ Signature: ___________ Site In-charge: _________________Signature:____________
Sl. Certificate Missing

No.
ITEMS ID MARKS Broken Cuts Corroded Dirty SWL Remarks
Expiry (date) Parts
10
11
12
13
14
15
REF.: EHS-L&T-F011
Ladder Inspection Checklist
Inspected by: ____________ Signature: ___________ In-charge: __________Signature:____________
"NO" "NO"
"NO" GOOD "NO" Corrective
Sl No. TYPE OF LADDER ID MARKS Missing Dirty or Remarks
Paint Rung Cracks Actions
Parts Oil
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
REF.: EHS-L&T-F012
Personal Protective Equipment (PPE) Inspection Checklist
Date of Inspection: __________________________________ Job: _______________

Inspected By: ______________________ Signature: ________________
Sl. Safety Reflective

NAME Designation Helmet Goggles Gloves Others Sign
No. Shoes Jacket
10
11
12
13
14
15
16
17
18
19
20
Reported to: Engineer / Manager
___________________________________________________
REF.: EHS-L&T-F013
Scaffolding Inspection Checklist
Erector Name / Company: _________________________ Scaffolding Tag number: ____________ Inspection Date: _________
Location:_________________________________________________________
In Charge: _____________________________ Signature: _______________
Inspected By: ___________________________ Signature: ________________
SATISFACTORY
S/N ITEMS Correction Remarks
YES NO N/A
1 Build by Competent Person
2 Tag Available / Green Tag / Red Tag
3 Sole board
4 Base Plate
5 Upright / Standard
6 Runner
7 Bearer
8 Diagonal Bracing
9 Cross Bracing
10 Mid Rail (47 cm from toe board top end)
11 Top Rail (95 cm from mid rail top end)
12 Toe Board (15 cm width)
13 Transom
14 Planks (No space in between)
15 Plank clamps
16 Outrigger
17 Tie
18 Tie Clamps
19 Ladder
20 Ladder clamps
21 Adjustable Leg / Scaffolding Level
22 Castor / Wheel
23 Tie ratio 4:1 height to base
24 Scaffold ratio 3:2 height to short base
25 Loose parts
26 Frequency of inspection
27 Ladder safety hatch
28 Ladder safety gate
29 (Others)
REF.: EHS-L&T-F014
Electrical Boards & Extension Inspection Checklist
Monthly Colour Code: ________________ Date of Inspection:________________ Job #: _______________
Inspected by: ____________ Signature: ___________ In-charge: __________ Signature:____________
CONDITIONS (√, X or N/A)

SI. Lock / Trippin Corrective Remark
Description I.D.# Incharge Physical
No Key Cable g Terminal Terminatio Other Action s
Informatio Sockets Appearanc
Controlle s Device s n Quality s
n e
d Testing
REF.: EHS-L&T-F015
Edge, Hole Protection Inspection Checklist

Date of Inspection:________________ Job #: _______________
Inspected by: ____________ Signature: ___________ In-charge: __________ Signature:________________
CONDITIONS (√, X or N/A)

SI.
Description Location I.D.# Corrective Action Remarks
No. Toeboard Mid Rail Top Rail Covered Others
1
2
10
Control of Substances Hazardous to Health (COSHH) – Risk Assessment Sheet

Contract No: Contractor:
Describe the activity or work Process.

(Including how long and how often is
carried out and the quantity of
substance used)
Location of process being carried
out?
Identity the person at risk: Employees Sub-Contractor Public

(Including trainees)
Name of the substance involved in the process and its
manufacture.
(A copy of a current safety data sheet for this substance
should be attached to this Assessment)
Classification (state the category of danger)
Very Toxic Irritant Extremely Flammable Other Notes:
Toxic Sensitising Highly Flammable
Corrosive Biological Flammable
Harmful Oxidising Environmental
Hazard Type
Gas Vapour Mist Fume Dust Liquid Solid Other(State)
REF.: EHS-L&T-F016
Route of Exposure
Inhalation Skin Eyes Ingestion Other (State)

Workplace Exposure Limit(WELs)Please indicate n/a where not applicable
Long Term exposure Level (8hr TWA)
State the Risks to Health from Identified Hazards
Control Measures: (for example extraction, ventilation, training, supervision) Include special measures for vulnerable groups, such as disable people and pregnant workers. Take account of
those substances that are produced from activities undertaken by other employer’s employee.
Is health surveillance or monitoring required Yes No
Personal Protective Equipment (state type and standard) Notes:
Dust Mask Visor
Googles
Respirators
Gloves Overalls
Footwear Others
First Aid Measures

Storage
Disposal of Substance & Contaminated Contains
Hazardous Waste Skip Return to Depot Return to Supplier Other
(If Other Please State)………………………………………………………………………………………………………………………………………………………………………………….
Is exposure adequately controlled? Yes No
Risk Rating Following Control Measures
High Medium Low
Assessed by: Date: Review Date:
Approved By:
…………………………………………………………………….
Project Manager’s Name & Signature
REF.: EHS-L&T-F017
Electrical Inspection Checklist
Location: ________________ Job #: _______________

In Charge: __________________________________ Signature: _______________
Date of Inspection: ______________________________
EVALUATION
SI.
Description Corrective Action Remarks
No. Satisfactory Failed N/A
1 Earthing
2 Neutral earthing
3 ELCB
4 Insulation
5 Cable Layout
6 Protection From Water
7 Lightning Arrestor
8 Plug Tops & Cable Joints
9 Installation Cover & Seals
Electrical safety at
installations containing
10
Inflammable & Explosive
substances
11 Safety guards
12 Metal Stand
REF.: EHS-L&T-F018
Working at Height Inspection Checklist
Location: ________________ Job #: _______________Date of Inspection: _____________
EVALUATIO
N
SI. Corrective
Description
Satisfy
Failed
No. Action
N/A
Points
1. Scaffolding Tag available/ MEWP Certified
2 All the workers have been explained safe work-procedures?

An established communication system have been established and explained to
3
the workers.
4 Adequate illumination has been ensured
5 Work-area inspected prior to stating of the job.
6 Area below the workplace barricaded, especially below hot-works.
7 Workmen provided with bag / box to carry bolt, nuts and hand tools.
8 Arrangement for fastening hand tools made.

All workplatforms ensured to be of adequate strength and ergonomically
9
suitable.
10 Work at more than one elevation at the same segment is restricted.
Access / Egress
11 Walkways provided with hand-rail, mid-rail & toe guard ?
12 All chequered plates, gratings properly welded / bolted?
13 Are ladders inspected and whether they are maintained in good condition
14 Are ladders spliced
15 Are ladders properly secured to prevent slipping, sliding or falling
16 Do side-rails extend 36” above top of landing
17 Are built up ladders constructed of sound materials
18 Rungs and cleats not over 12” on centre
19 Metal ladders not used around electrical hazards
20 Proper maintenance and storage

21 Ladders placed at right slope
22 Ladders, staircases welded/bolted properly
23 Any obstruction in the stairs
24 Are landings provided with handrails, knee-rails, toe-boards etc.
25 Whether ramp is provided with proper slope
26 Proper hand-rail/guards provided in ramps.
Housekeeping
27 Walkways & all overhead workplaces cleared of loose material.
28 Flammable material, if any, are cleared
29 All shuttering materials are removed after de-shuttering is done.
30 Platforms and walkways free of oil / grease or other slippery spillage

Collected scrap are brought down or lowered down and not dropped from
31
height.
General
32 Use of safety helmets, Safety belts ensured for all workers.
33 Anchoring point provided at all places of work.
34 Common life–line provided wherever linear movement at height is required.
35 Safety nets are in use wherever required.
36 Proper fall arrest system is deployed at critical work places.
37 Crawler boards / Safety system for work on fragile roof are used
REF.: EHS-L&T-F019
Full body Harness Inspection Checklist
Storage Location: Date of Inspection:
Month: Year: Color Code:
Webbing Hardware Stitching

identification no.
identification no.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
of harness
of lanyard
Back Pads /
Serial /
Serial /
Upper back
Lower back
Upper back
Lower back
Lower front
Upper front
Lower front
Upper front
pelvic side
pelvic side
pelvic side
pelvic side
snap hook
chest side
chest side
chest side
chest side
(front side
Absorber
D - rings
Keepers
Lanyard
Lanyard
Lanyard
Buckles
Locking
Remarks
Double
Plastic
Shock
chest)
Inspected by: Report verified by:
Name: Name:
Signature: Signature:
Date: Date:
REF.: EHS-L&T-F020
Camp Inspection Checklist
Location: ________________ Job #: _______________Date of Inspection: _____________
Inspected By: ______________________ Signature:________________

EVALUATION
SI. Corrective
Satisfy
Failed
Description
N/A
No. Action
ACCESS & EGRESS
Are the entry, exit roads / walkways / passages to camp kept clear from
obstruction/ un safe?
Are the walkways & roads are even and free from water logging?
Is the entry inside workmen camp restricted? Documented?
Is Illumination level adequate in access / egress?
Is Security provided adequate in the camp?
Is there emergency exit located in the fence?
Is there adequate fire training to the security guards?
GENERAL
Is there designated camp boss available in the camp?

Is the complaint registered & Monitored?
Are dustbin / garbage bins allocated for each barracks?
Is the garbage being disposed off on daily basis?
Are the cool & Hot drinking water facilities adequate in the Workmen camp?
Are the water filters, coolers cleaned on weekly to maintain the hygienic
condition?
Is there laundry available in the camp?
Is the area provided to drying the cloth is adequate?
Is there any emergency communication system established?
Is there fire siren?
Are the Workmen camp all facilities constructed with Non-Fire Hazard
Material?
Are Fire Extinguishers & Fire Buckets available and maintained regularly?
Are locations of Fire Extinguishers & Fire Buckets listed out & displayed?
Is there any trained Fire fighter in the workmen group?
Is there any assembly point identified and communicated?
Availability of emergency vehicle at the camp? With 24 hrs driver?
Is there an adequate emergency light in the camp surroundings?
Is there an identified area for fuel storage?
Are there DG sets provided for power supply with acoustic insulations?
Are First-aid facilities available? Periodically inspected?
Is there any qualified Male Nurse available in the Camp?
Whether disinfection activities carried out on weekly basis?
Is there Prayer hall provided in the camp?
SI. Description EVALUATION Corrective

Satisfy
Failed
N/A
No. Action
LIVING AREA
Is the flooring free from patches, holes etc.?

Is Adequate Air conditioning provided and maintained?
Are all electrical fittings safe?
Are the cots and matters good not smelling?
Is there periodic disinfections, pest control & bed bug sprays done?
Whether the electrical connections provided are safe?
Are the ventilation of the rooms adequate?
Are the illumination of the rooms adequate?
Are the doors and windows in good condition?
Is the general hygienic condition of the rooms adequate?
Is the head room adequate to keep workmen free from incident contact?
Is there adequate safe area provided to keep their valuables / belongings?
Is the power sockets safe to use and adequate?
Are the residents aware of fore emergency?
KITCHEN
Are kitchens kept clean and tidy?

Is there any medical checkup for the cook and food handler?
Is the cook and food handlers are provided with disposable gloves?
Is the water supply adequate for cooking and safe?
Is the garbage of kitchen being disposed off every day?
Are the utensils being cleaned on regular basis?
Is there all gas lines protected from heat and damages?
Are gas cylinders & other flammable materials kept in safe area (away from
fire)?
Are suitable regulator, Connecting tube & connections with the cylinder
Are right fire extinguishers kept outside kitchen?
Is Disinfection in kitchen takes place regularly?
Is there ate exhausts clean & free from oil, dirt etc?
Are all electrical points covered and inspected?
Are kitchens Well ventilated free from sinking smell?
Is all spider nets, etc. removed? Are walls cleaned?
Are all food items closed properly?
Are all containers in the kitchen reasonable clean and hygienic condition?
DINNING AREA
Are all doors and windows having proper locking studs, hooks?
Are the doors and windows provided with fly mashes?
Are there all doors and windows cleaned regularly?
Are the floors cleaned daily and non-slippery?
Is there an Adequate sitting arrangement for camp members?
Are all furniture good?
Are there fly catchers provided?
Is there adequate ventilation and distribution counters?
FOOD STORAGE AREA
Are adequate shelves and containers provided in the store area?

SI. Description EVALUATION Corrective
Satisfy
Failed
N/A
No. Action
Are all Food items kept on wooden pallets above the ground?
Is the Temperature maintained in the freezers to preserve the food?
Are specified brand of food ingredients purchased / stored?
Are Pest control arrangements adequate?
Is adequate ventilation & Room temp maintained in the food stuff storage
area?
Is the expiry date displayed and followed in the storage area?
Is Disposal of expired products, non-complyingproducts are documented?
Are All food stuff materials stored in reachable area?
Is General cleanliness in the storage area maintained?
UTILITIES AREA
Is the Wash area - Water tanks constructed as per the Design Drawing?
Are adequate toilets available?
Are the toilets, floors being cleaned on regular basis?
Is there adequate water facility available for toilet and bath?
Are the septic tanks and soak pit working properly?
Is area around bathrooms cleaned & kept dry and non-slippery?
Is proper drainage provided?
Is there cleaning schedule followed?
Is there all taps free from leak, damage?
Is there adequate mirrors provided for face washing, shaving? Maintained?
Are there locking pads, tower bolts in the toilets/ bath rooms?
Is there any shoe racks provided to keep them in order?
Is there any cooking takes place outside the kitchen area?
Any Other Information
Stairways , handrails conditions

Is there any supermarket in the premises?
Is there any doctor in contact for treatment?
Is there the night emergency used?
Is there any mock up drill to overcome emergency?
Is area having adequate lighting?
Is the entertainment facility adequate? Maintained?
Is there any compliant from the resident attended?
HSE Induction Training Form REF.: EHS-L&T-F021

Training Location: _____________________ Project: _______________________ Company / Contractor: _________________
Conducted by: ______________________________ Signature: _______________ Date: __________ Time From: _____To:____
SI. SI. STATU

SUBJECT COVERED STATUS SUBJECT COVERED
No. No. S
1 Project Overview 13 Waste Disposal & House Keeping
2 Client, Consultant & L&T Policy 14 Scaffolding & Ladders
3 L&T Project Objectives 15 Working at Heights
4 Scope of Work 16 Fire Protection and Prevention
5 EHS Organization & Responsibility 17 Transport of Materials
6 Enforcement Guidelines 18 Lifting Operations
7 Work Start Requirements 19 Manual Handling
8 Emergency Protocol 20 Electrical Safety
9 Reporting Emergency Protocol 21 Permit Systems
10 Occupational Health 22 Tag-out / Lock-out Procedure
11 Personal Protective Equipment (PPE) 23 Floor Openings & Protection
12 Heat Stress and summer working plan 24 Covid-19 prevention
25 Method of statement, Risk assessment
26 (Others) -
WORKERS / TECHNICIANS
1. Obey company / traffic rules, regulation to drive safely all the times.
2. Use all personal protective equipment all the time.
3. Before starting the work check all guards, fencing, safety devices and equipment etc., and follow safe method of working .It will be checked even
after the closure of work.
4. Keep working / surrounding place clean and without obstruction.

5. Report malfunction or defect of machinery, equipment etc.
6. Not to make safety appliances or guard inoperative or defective.
7. Not to do any unauthorized work.
8. Cooperate in case of emergency.
9. Not to use toxic substances, which will affect safety of vehicle and personnel
DRIVER / OPERATORS
1. Obey company / local traffic rules, regulation to drive safely all the times.
2. Use all personal protective equipment all the time.
3. Keep ready the driving license and vehicle legal documents to show the authority.
4. Check and maintain all the points related to vehicle fitness as well as safety before coming on road.
5. Not to use toxic substances, which will affect safety of vehicle and personnel
6. Not to allow unauthorized personnel to sit inside the vehicle.
LINE MANAGEMENT EMPLOYEES
1. Constant watch over safe conditions and actions for accident free production. Teach safety through behavior.
2. Train worker for safe work practices and problem solving.
3. Ensure use of required personnel protective equipment all the time.
4. Put attention on good maintenance of machines, materials, tools, and also on good
Housekeeping.
5. Report all accidents and defects to the management and carry out their investigation for the purpose of stopping its reoccurrence.
6. Matters out of control will be report to the higher officials, meanwhile make temporary safety arrangement.
7. Carryout compliance of safety measure suggested by safety dept. and other authorities.
“I, hereby acknowledge / accept that, the subject matter HSE communication which was made by the
trainer during HSE Induction / Awareness session / Tool box / Training session, has been fully understood
by me and was found suitable and sufficient as per subject / agenda of HSE Induction, Awareness session,
Tool box, Training session. I will comply the same HSE communication / guidelines during my work /
activities in the project”
Emirates ID # /
S.I. Name Designation Contact # Signature
Company ID #
10
11
12
13
14
15
JSTI (Job Safety Task Instruction) REF.: EHS-L&T-F022

DATE: TIME: LOCATION OF WORK:
Assessed by (Name of Supervisor/Engineer)
Activity :
Sequence of Tools/Equipment/Material to Potential Hazards Hazard Elimination/Control
work: be used measures in place
1  work at height  Exclusion Zone

 Hand tools  Competent operatives
 Power tools  working with  Permit to work in place
2 moving plants  Competent supervision
 Vibrator  Inspected tools/plants used
 Working in
3  Competent operators
 Ladders Excavation
 Guards/barricades in place
 Scaffolding  Lifting operation
4
 Skid loader  Fire  Banks man/flag men in
place
5
 Wheel loader  Electricity
 Fall prevention
 Poor Air quality system in place
6  Excavator  MSDS in place
 Flying particles
 Compactor  Health hazards
 Fire Extinguishers in place
 Use of COSHH
 Crane/lifting Eqp.
material  Fire watch assigned (Hot
 Welding machine work)
 Confined space
 Compressor /pneumatic work  Task specific PPE
tool issued/used
 Air Blowers  Segregation of traffic/pedestrian
 Vibration
 Cement/Concrete route
 Radiography
 Asphalt/Bitumen  Good House keeping
7
 Contact with Hot Others
 COSHH Material
bitumen/ asphalt/wet  First Aid
 Reinforcement concrete/rotating parts
 Shuttering material  Safe Access/egress
 Manual handling  Dust suppression in place

 Generators
 Hot work
 Floor/ Wall/ Confined space
 Compressed Gas
protection.
 Floor /Wall/  Others
Opening
 Others
Pre-Task Safety Checklist/verification Yes No N/A
Does the crew inducted, briefed on M/S, R/A….etc.
Are all utility protected, checklist completed and permit in place to work at or near utility corridor
Is the Waste removed/loose material secured against wind
Are all the floor openings and confined space opening secured properly?
Are all ladders and scaffolds, working platform being used, and inspected and safe for use?
Is the work permit such as HOT Work, Excavation//LOTO/confined space/lifting, Floor Opening
permit etc. in place?
Other issues Identified/discussed
Name of supervisor: Signature:
REF.: EHS-L&T-F023
Incident Preliminary Report Form
PRELIMINARY REPORT
Incident No
INCIDENT (ACCIDENT / NEAR MISS) (To be filled H&SS DEWA)
(CONTRACTOR STAFF)
To: Manager – Safety/Health, H&SS,DEWA
From: Contractor………………….. Signature & Date………………
Contract No………………………
Thru: a) Consultant……………… Signature & Date………………
b) Executing department……………….. Signature & Date………………
1a. Name, ID No. & Designation of the Victim/ involved with Accident /Near Miss: …………………………………...
……………………………………………………………………………………………………… …………………………………….
1b. Equipment / Machinery / Vehicle etc. Involved in Accident / Near miss: ……………………………………………………………
2. Date, Time & Spot of Accident /Near Miss: ……………………………………………..……………………………………………..
3. Name, Designation & Tel. No. of Direct Supervisor: …………………………………………………………………………………
4. What Happened? :…………………………………………………………………………………………………………………..……
5. How It Happened? :………………………………………………………………………………………………...……………………
6. Area / Location / Place of Happening:……………………………………………….
7. Name of witness: ……………………………………………….
8. Present Status of the Victim (Sick Leave/ Police Custody/ Hospitalized / Resumed Duty): …………………………………………...
9. Risk Assessment carried out for the activity (If yes, pl. attach the copies) Yes / No:
NB:
 Please Fax to 2857415 Within 24 Hours of The Occurrence through DEWA Executing Department
 Preliminary Form- Contractors-H&SS, DEWA/2014
* Document from DEWA SP-06 Annexure IV-A
REF.: EHS-L&T-F024
Incident Follow up Report Form
FOLLOW UP REPORT
INCIDENT (ACCIDENT / NEAR MISS) Incident No
(To be filled H&SS
(CONTRACTOR STAFF)
PART 1:To be filled by Contractor, Consultant & DEWA executing dept.as applicable.
To: Manager – Safety/Health, H&SS, DEWARef. No………………..
CC: SM- H&S Date………………
Contract No/ Contractor ……………………… DEWA Dept………………..
Name of Person Involved ……………… ID No…….. Designation………………
Description of Incident (Additional sheet may be attached if required)
a) Immediate Supervisor of Contractor b)Supervisor / Engineer of DEWA

b)
Name…………………….. Tel No…………….. Name…………………….. Tel No……………..
Signature & Date ………………………. Signature & Date ……………………….
Comments & recommendation (Additional sheet may be attached if required)

a) Contractor________________________________________________________________
_______________________________________________________________________
Name……………………… Signature & Date……………………… Tel………………………..

B) Consultant:_______________________________________________________________
________________________________________________________________________
Name………………………… Signature & Date………………………….. Tel………………………..
b) Sr. Manager(DEWA):__________________________________________________________
_______________________________________________________________________
Name……………………… Signature & Date………………………….. Tel………………………..
Incident Follow up Report Form

FOLLOW UP REPORT
INCIDENT (ACCIDENT / NEAR MISS)

(CONTRACTOR STAFF)
TO: DEWA Exec. Dept. Incident No:……………
CC:SM- H&S Date:……………….

Investigated By: (To be filled by H&SS,DEWA) Designation: Sign & Date
…………………………………………………………… …………………….. ………………….
PART 2: Final comments & recommendation of Manager – Safety ,H&SS,DEWA:
Name:………………………………………………… Signature & Date……………………………..
PART3: Status on Implementation of corrective action taken by the contractor concerned to be sent to H&SS,
DEWA with 15 days of receipt of above mentioned recommendation (s) from M- Safety, H&SS, DEWA.
CORRECTIVE ACTION REPORT

TO: Manger – Safety/Health,DEWA Exec. Dept.Ref. No:…………………………….
CC : SM – HSE Date:……………………
………………………………………….. …………………………………….
Contractor Sign &dt Consultant & Sign &dt
Endorsed By: Date:

…………………………………………………
SM / M – Concerned Project Executing Dept.
Follow Uo Form – Contractor – H&SS/2014
* Document from DEWA SP-06 Annexure IV-B
REF.: EHS-L&T-F025
Incident investigation personal information Form
(To be filled by HSE, DEWA staff / investigator)
INCIDENT (ACCIDENT / NEAR MISS) INVESTGATION

PERSONAL INFORMATION FORM
1. Name of contractor:
2. Contractor no:
3. Consultant
4. DEWA Executing Dept.:
5. Details of Person (Victim) a) Name…………………………………….
b) Designation……………..ID#..................
c) Age……… Dt of Joining……………….
d)Nationality……………………………….
6. Date, Time & Place of Accident /Near Miss:……………………………………………
7. Name & Designation of Supervisor……………………………………………………
8. Result of Accident (Please Tick on) Death / Injury. If Injury, then
a) Nature of Injury (Please Tick) Bruise / Laceration/ Abrasion/ Fracture/ Burn/ Scald/ Cut/
Profuse Bleeding / Unconsciousness/ Poisoning / Any other…..
b) Part of body part Injured:……………………………………
c) Category of Injury (Please Tick) : Serious / Moderate/ Minor
9. Kind of accident / Near miss: Electrical / Mechanical / Chemical /
Environmental / any other
10. Cause of the Accident: (Please Tick) (Please Tick) Falling / Tripping / Slipping / Fire / Trapped / Shock / Any
other……………………………………………..
11. Use of Personal Protective Products / Equipment: (Please Tick) Safety Shoes / Helmet / Gloves / Belt / Any
other………………………………..
12. Condition of working area: (Please Tick) confirmed / noisy / slippery / not guarded / any other……………………………..
13. Taken any safety measure: Yes / No. If yes then what?......................................................
14. Risk assessment (for the activity has done): Yes / No
15. What medical aid / First Aid given……………………………………………….

16. Name of witness (preferably two)
………………………………………………………………………………………………………
17. When & to whom the accident / near miss was reported………………………………..
18. Total no.of S/L availed:……………………. From…………………….. To……………………………..
19. Accident / near miss occurred during: Normal duty / Over time
20. Any Safety Training / Briefing attended: Yes / No. If yes when……………………………..
Subject…………………………………..
21. Any previous Accident (if yes then date)…………………………………
Filled by:………………………………… Date…………………………………
Investigation Form – H&SS / 2014

* Document from DEWA SP-06 Annexure IV-C
HOT WORK PERMIT REF.: EHS-L&T-F026

Permit No: …………………….. Date: ……………………
Company-L&T/ Subcontractor
Location of the task

Type of Hot Work Welding/ cutting/ grinding/ bracing/ soldering/ heating/thawing/flaming etc.
Type of hot work equipment
Type of Location Outdoor/ indoor/ Others (specify).
Description of item in the hot work process.
Name(s) of the hot work performer
Name of the Fire Watch
Time requested From: Hrs. To: Hrs.
HSE Checklist
Is the hot work performer competent and certified? Yes No
Are the crew briefed about hazards & risks involved in the task Yes No
Competent supervision available at the work location. Yes No
Fire watch posted at the location Yes No
Fire extinguishers & fire blankets available at the location. Yes No
All combustible materials removed from the area. Yes No
The area is barricaded and hazard warning placed. Yes No
Inflammable items removed from the area. Yes No
Hot work equipment inspected and found fully serviceable Yes No
Cables and electrical connection are intact Yes No NA
Welding machine is earthed and ELCB provided in the circuit Yes No NA
Electrical cabling is free from dampness, metal contact, obstructions. Yes No NA
Compressed gas cylinders are kept upright and lashed. Yes No NA
Hoses/ flash back arrestor/ NRV/ couplings are inspected & found fit. Yes No NA
Pressure gauges on the gas cylinders are working and covered. Yes No NA
Voids, ducts, floor openings, wall openings are protected. Yes No NA
Is the floor or wall made of combustible material? Yes No NA
Shield provided to protect others from arc eye. Yes No NA
Are all required PPE available and used? Yes No
Fire watch is trained and know how to use fire extinguishers Yes No
Emergency response number displayed at the hot work area Yes No
Good cable management maintained at the location. Yes No NA
Is there any potential presence flammable gas in the proximity Yes No
Weather condition is suitable for the hot work( wind/ rain /dust) Yes No
If the hot work is in an enclosed area, local ventilation is provided. Yes No NA
Certified that the above quoted HSE precautions are ensured at the hot work location.
Permit Requested By (Foreman/Engineer)
Permit Issued By (Construction Manager)
Verified By (Contractor EHS Officer) EHS Engineer
The work completed safely by (Requester)
Permit Closed by (Construction Manager)
Verified By (Contractor EHS Officer) EHS Engineer
Name Designation Signature with date & time
Permit Validity: From: Hrs. To: Hrs. Permit Closed at: Hrs.
Note:
1. The Fire watch shall remain in the hot work location for 30 minutes after the hot work to watch for any potential fire outbreak.
2. The Permit must be returned to HSE office upon completion of the work.
REF.: EHS-L&T-F027
EHS TRAINING ATTENDANCE
Training Location: Date: Time: Duration: hrs min
Type of Training:  INTERNAL  EXTERNAL  WORKSHOP  PRACTICAL ASSESSMENT
Topics Covered:
“I, hereby acknowledge / accept that, the subject matter HSE communication which was made by the trainer during HSE
Induction / Awareness session / Tool box / Training session, has been fully understood by me and was found suitable
and sufficient as per subject / agenda of HSE Induction, Awareness session, Tool box, Training session. I will comply the
same HSE communication / guidelines during my work / activities in the project”
SL
NO
ATTENDEES NAME ID NUMBER DESIGNATION COMPANY SIGNATURE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Faculty:
Name: _____________________________________ Signature: _____________________ Date:

__________ Time: _______
STAR CARD REF.: EHS-L&T-F028

Safety Training Assessment Reporting (STAR) Card
Name of Observed Person:___________________________________________
ID Number & Signature:___________________________________________
Company Name & Designation:_________________________________________

STAR CARD REFERENCE
Observed Date and Time:_______________________________________________ NO:
Location:_______________________________________________
Observed Safe or Unsafe Practise:
___________________________________________________________________ PROJECT DETAILS:
___________________________________________________________________
___________________________________________________________________
Action Required for Observation:
___________________________________________________________________
NO. Of STARs Received
___________________________________________________________________ Before:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Who raised the Card (Name & Designation):
_____________________________________________________________________
Project Safety Officer and Project Manager Name and Signature with date
____________________________________________________________________
REF.: EHS-L&T-F029
FORMATION OF SITE EHS COMMITTEE
Identity / Name of the Site :PROJECT NAME

Job Number :CODE
Region :
CIRCULAR
Committee
The following safety Committee is constituted with immediate effect:
Chairman : Mr.
Members :
1) Mr.
2) Mr.
3) Mr.
4) Mr.
5) Mr.
6) Mr.
Secretary : Mr.
Periodicity
The committee will meet fortnightly.
Agenda
Secretary will circulate agenda of the meeting at least a day in advance of the schedule date of the meeting.
Circulation
Gist of the meeting will be Minute in the standard format and circulated to the following under the signature of the secretary ---
1. Chairman 3. Invitees
2. Members 4. Country Manager EHS
5. Others concerned
Date: Signed By: -------------------------------

CHAIRMAN
REF.: EHS-L&T-F030
MINUTES OF EHS MEETING
Name of the Job Site: Meeting No.

Business unit: Job No: Date of meeting
Purpose of Meeting: Site EHS Meeting Location of Meeting

MEMBERS PRESENT (L&T) INVITEES MEMBERS ABSENT (L&T)
REPORT SENT TO
No. of No. of No. of
Name / Dept. Name / Dept. Name / Dept.
Copies Copies Copies
Prepared By: Location: Date:

Item
Description of Discussion Action By Target Remarks
No.
Complaints received from Clients and

1
corrective and preventive action
2 Review of MOM of previous meeting
3 NCR's / Observation from third party
First - Aid cases / Reportable accident

4
cases
5 Future jobs and specific requirement
6 Status of implementation of Safety plan
7 Sub-contractor performance
8 Analysis of first-aid cases
Need for any specific system / training /

9
PPE's / resources
Observation of EHS committee during last

10
walk down
Next meeting is scheduled on:
REF.: EHS-L&T-F031
TOOL BOX MEETING
Date: Time: Location

Topics Discussed:
Safe access and egress Work at height Safety Hot works & Fire safety Excavation Safety Electrical Safety
Confined Space safety Chemical Safety Power tools Safety Hand tool safety Importance of PPE
Floor opening Adverse weather Manual handling working with moving plant Safe Lifting works
Compressed Cylinder Health Hazard Emergency Procedure Carpentry work safety Steel work safety
Masonry work Safety Housekeeping Scaffolding safety Others:-
“I, hereby acknowledge / accept that, the subject matter HSE communication which was made by the trainer during
HSE Induction / Awareness session / Tool box / Training session, has been fully understood by me and was found
suitable and sufficient as per subject / agenda of HSE Induction, Awareness session, Tool box, Training session. I will
comply the same HSE communication / guidelines during my work / activities in the project”
SL
ATTENDEES NAME ID NUMBER DESIGNATION COMPANY SIGNATURE
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Conducted By: Signature: Date & Time:
Note: Attach the detailed topic (If applicable)

PERMIT TO WORK FOR TESTING /COMMISIONING
Permit Number: _______________________ REF.: EHS-L&T-F032
Name of Applicant:__________________________________ Contact Number:__________________
Designation of Permit Applicant: ____________________________Company / Dep.____________________
Equipment Name and Number :_______________________________ Location:_________________
Description of the Job:_______________________________________________________________
__________________________________________________________________________________
Permit Requested from (date) _______ (time) _______ hrs. To (date) _________ (time) _________hrs.
Job carried out by (No .of persons):_______________________ (Attached TBT record)

Y- YES, N- NO, NA – Not Applicable, Tick ( ) whichever is applicable
Checklist
Description Y N NA Description Y N NA
1. Testing / Commissioning Checklist available as per 8. Insulated Ladder /fibre glass ladder
MSRA? available?
2.Area barricading & Warning sing available? 9. Fire extinguisher available
3. Testing equipment / apparatus / kit calibration 10. Tool box meeting conducted to the
certificate available? workforce safety precautions necessary for this
work is communicated.
4. Testing equipment / apparatus/ kit inspected and 11. Is it required to channel other permits in
tagged for the month of done? the testing area/room? (Work stoppage)
5. Fully insulated had tools available? 12. Lock out tag out done (where required)
6. Use of face shield/leather hand gloves/electrical Specify Locations (panel name/identification
insulated gloves/goggles/Electrical resistance Safety no. etc.)
Shoes/Body protection (flash proof Apron if i.
required) /ear protection available as per Risk ii.
Assessment /task? Other PPE specify: iii.
7. Rubber mats /security guards /door available?
13. Any special instruction to the applicant:
AUTHORISED SINGNATORIES
Comments
I hear by declare that I accept responsibility for carrying out the above said work on the panel /equipment / unit/ plant details on this permit
and it is safe to carry out the specified work during the time mentioned below. All necessary precaution have been taken including Lock out Tag
Out (LOTO)
Authorized Person (Permit Applicant)
Name: Date Signature

I hear by declare that it is safe to work on the above equipment /panel/ unit/ plant to carry out the above specified work during the time
mentioned above. All necessary precaution have been taken including Lock out Tag Out procedure
Permit Issuing Authority (Appointed Person)
Permit Verified by (HSE department)
Permit Validation: DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

Date:
Permit Applicant Sign
Permit Issuer Sign
HSE department Sign
Section IV CLEARANCE
I hear by declare that work for which this permit was issued is now suspended /Completed and that all personnel under my control have been
withdrawn. The area has been cleared and tools have been removed and are safe.
Permit Applicant (Authorized Person) Permit Issuer (Appointed Person)
Name: Name:
Date Signature Date Signature
Section V CANCELLATION
Signature: Permit Issuing Authority
Name: Signature: Date
Comments of cancellation:____________________________________________________________________________________________
NOTE:
1. A permit copy shall be submitted to L&T HSE department before starting the work.
2. Permit has to be renewed / validated on daily basis.
3. It is the responsibility of the permit applicant to ensure all control measures are in place during the work and till closure of work
permit.
4. The applicant has to return the original permit to issuing authority after completion of the job or at the end of working hours.
5. Make sure that each worker on the job understand fully the prescribed conditions and the tool box talk points.
6. Stop working upon hearing fire/emergency siren/alarm or the instruction of the permit issuer or safety officer or fire warden and
assemble in the fire assembly point.
7. Log IN / OUT register shall be placed in each room where electrical equipment is placed. All the entrant should fill in the details.
8. Room door should be locked after the completion of the works and to ensure nobody left out in room.
9. Lone working not allowed in any work areas.
REF.: EHS-L&T-F033
RISK ASSESSMENT REGISTER
Description of Approved Date

RA Number Company Date Submitted Review Date
Activity by Approved
REF.: EHS-L&T-F034
ACTION NOTICE
Prohibitions – Stop Work, immediately notify Supervisor & CM
 IMPROVEMENT  PROHIBITION  POSITIVE  ACT  CONDITION  OTHER
DETAILS
Inspector name Date
Violator Name Time
Resp Engineer S/C Company
Location /Zone Risk Rating H M L
ENVIRONMENTAL
 Noise  Waste Management  Hazardous Material/Waste
 Illumination  Nature/Temp/Wind  Dust & Air Emissions
 Ventilation  Chemicals  Fuel Storage/Spillage
 Radiation  Waste Management  Other
OCCUPATIONAL HEALTH
 Welfare Facilities  Manual Handling  Vibration  Personal /Spitting
SAFETY
 PPE  Scaffolding  Electricity /Energy  Plant / Machinery
 Driving  Fire protection  Confined Spaces  Fall Protection
 Hot Work  Housekeeping  Night Work  Edge Protection
 Access/Egress  Traffic Management  Barricading  Excavation
 Permits / R/A’s  Lifting  Tools Equipment  Work at Height
INCIDENT/CONDITION/OCCURRENCE DESCRIPTION Open /Close
RECOMMENDED IMMEDIATE AND PERMANENT ACTIONS
Legal references if any:

SUB CONTRACTOR /CONTRACTORS SUPERVISOR /ENGINEER IN CHARGE OF AREA/JOB
Notice Print
Receiver Name Sign Date / /
IMMEDIATE & PERMANENT CORRECTIVE ACTION TAKEN Resp.
Person Sign
CM/ Representative re –inspected corrective action & CLOSE OUT

CM/ Print
Rep. Name Sign Date / /
REF.: EHS-L&T-F035
LOCK OUT – TAG OUT PERMIT
This permit is required whenever personnel will work on or near the equipment (Electrical, fluid, mechanical or other) and
could be injured as a result of unexpected release of energy or hazardous material.
Project Name: Permit No.
Specific location of activity: Date of issue:
Time of issue:
Work Description: Name of the contractor:

Name of responsible supervisor
Name of authorized employee
Shift validity
Day  Night  Both 
NAME OF AUTHORIZED COMPANY TELEPHONE NO. LOCK/TAG NUMBER
EMPLOYEE
TYPE OF EQUIPMENT UNIT NUMBER SPECIFIC LOCATION DURATION (Hours, days.

week)
TYPE OF ENERGY:  ELECTRICITY:______________ Volts  Pressure: _________psi Others:
Required Precaution Checklist: Yes No N/a Others

LTP authorized employee appointed   
Authorized employee familiar with DEWA LTP   
Affected employee notification from available   
LTP training card available for each authorized employee   
Engaged equip. has the ability to accept a lockout device   
Lockout/ Tag out devices are provided (Locks, hasps, tags)   
LTP authorization card issued along with lock keys   
Authorized employee have complete PPE   
Important notice: By accepting this work permit the receiver/ undertake to fully comply with the requirements and take full responsibility of the
deviations/ nonconformance caused by him.
Expiry Date: Name of the issuer: Issuer Signature:

Expiry Date: Name of the Receiver: Receiver Signature:
Verified By (Contractor EHS Officer) Name: Signature:

Verified By (Consultant EHS Officer) Name: Signature:
REF.: EHS-L&T-F036
CUSTOMER SATISFACTION FEEDBACK
Name of Site :
Job No. :
Region :
Sl. No. Observation Comments
Understanding your safety requirements while

1
planning and execution
2 Submission of reports in time
3 Effectiveness of review meetings with you
4 Effectiveness of Safety Management at Site
5 Overall Safety performance at Site
6 Any other comments
Signature: ________________ Date: ________
Name & Designation ________________
Company: ________________
REF.: EHS-L&T-F037
LEGAL REGISTER
LAW/DECREE ARTICL ARTICLE ACTIONS

No. LAW/DECREE FEDERAL/LOCAL YEAR
# E DESCRIPTION DONE BY
L&T
Prepared By: - Approved By:
EHS Department Project Manager
REF.: EHS-L&T-F038
WASTE GENERATION REPORT
Project & Location Reporting Month : Report Date :
Non-hazardous Waste Hazardous Waste

Year / Other
Month Gen Paper& Wastes
Con Wood Food Metal Plastic Sewage
-eral Board Solid Liquid
-crete waste Waste Waste Scrap Waste Water
waste Waste
(in
Unit (in kgs)
gallons)
(in kgs) (in gal)
JAN
FEB
MAR
APR
MAY
JUN
JULY
AUG
SEPT
OCT
NOV
DEC
Total
Remarks :
Accounts & Administration

EHS Engineer Construction Manager Project Manager
In charge
Prepared by Reviewed by Reviewed by Approved by
REF.: EHS-L&T-F039
Other Requirement Checklist
EHS Manager / Engineer: ________________ Project Manager: _______________
Signature: _____________________________ Signature: ________________

Date: ____________________Date: ________________
Sr. SATISFACTORY
ITEMS Remarks
No. YES NO N/A
CONTRACTUAL REQUIREMENT
1 Approval for L&T EHS Representatives
2 Approval of L&T EHS Plan
3 Sub-Contractor Approval
4 Sub-Contractor Approval for EHS Representatives
5 Sub-Contractor Approval for EHS Plan
ENGINEERING REQUIREMENT
6 Risk Assessment prepared for all activities
7 Risk Assessments are signed
8 All Activities have Method Statement
9 Approval of Method Statements
10 All Activities have work notification
11 Approval for Work Notifications
WORK REQUIREMENT
12 Approval of Client's NOC
13 Approval of Water & Electric Authority Work NOC
14 Approval of Water & Electric Authority Trial Pit NOC
15 Approval of Water & Electric Authority Excavation NOC
16 Approval of Town planning Authority NOC
17 Approval of Central Military Command
18 Approval for Municipality Work Permit
19 Approval for Etisalat/DU Work Permit
20 Approval for Agri Department Work Permit
21 Approval for RTA Permit
22 Approval of Electric Authority NOC for Sub-Station
23 Approval for Hot work Permit
24 Approval for Excavation Permit
25 Approval for Confine Space Permit
TRAFFIC REQUIREMENT
26 RTA / Client Signage's Standards
27 RTA / Client Barricade Standards
28 RTA / Client Lighting Standards
TRAINING REQUIREMENT
29 EHS Induction
30 EHS Plan Orientation
31 Supervisor's Training
32 Control Measures Toolbox Meetings
FIRE PREVENTION REQUIREMENT
33 Fire points available with fire extinguishers
34 Fire exit are cleared

35 Assembly points available
SPECIAL EHS TEAM REQUIREMENT
36 EHS Committee
37 Emergency Team
38 Waste Disposal Team
WELFARE REQUIREMENT
39 Ratio of Toilets, Urinal and Etc.
40 Prayer Rooms
41 Eating Areas
42 Water Cooler Availability
43 Water Jar Supply
REPORTS REQUIREMENT
44 Monthly Statistical Report
45 Accident/Incident Reports
46 Other
OTHERS
47 Pass - Entry and Exit
48 Anemometer Test
49 Thermometer Test
50 Oxygen Meter Test
51 FOD Control (Foreign Object Debris)
52 Rain and Water Flooding Control
53 Competency Certificate for the MEWP Operator
54 Competency Certificate for the Supervisor In charge
51 Certificates (Load Test, Calibration and etc.)
REF.: EHS-L&T-F040
HEALTH CHECKUP PROGRAM
Project No: ________________
Project Name: _____________________________ Date: ________________
Action to be required Details of

Height Weight Blood pressure Blood sugar
SL Name Employee id Result Yes / No If it is follow up Remarks
Cm Kg mm/hg Fbs/Rbs mg/dl
Yes ,Narrate Action action
1
2
3
4
5
Legend Description of Actions Follow up Action

1.√-Normal 1.NOR-No action required 1. F-NR Follow-up not required until next schedule
2.↑BPHigh BP 2.KOB-Keep under observation 2.F-R Follow up Required
3.↓BPLow BP 3.ITR-Immediate treatment required
4.ARC-Health education &Adviced regular
4.↑RBS/FBS-High Sugar
checkup
5. ↓RBS/FBS-Low sugar
Male Nurse :
CONFINED SPACE PERMIT REF.: EHS-L&T-F041

Permit Number: ___________________________ Date: ____________
Permit Request
Please permit the confined space entry as per the following details:
Location: …………..………………………… Activity: ………………………………Company: ……………………………
Type of the Confined Space: Trench, Pit, Man-hole, Severe, Flue, Reinforcement cage,  enclosed room, silo,
chamber, tank,  tunnel,  pipe,  others (specify): …………………………………………………………
Number of Crew: ……………………………………………………. Team Leader: ………………………………………………………………
Entrant Name: ………………………………………………………... Attendant Name: …………………………………………………………….
Name of the Requester: ………………………………………… Designation: …………………… Signature: ………………………………
Mobile No: …………………………….. Permit requested from: ………………………………… to: …………………………………………
Potential Hazards in the Confined Space
 Oxygen Deficiency  Flammable gas  Hot/ humid atmosphere  Poor lighting
 Oxygen enrichment  Bacterial agents  Cold atmosphere  Poor ventilation
 Toxic gas/atmosphere  Limited access/ egress  Dust/ fumes High Noise
 Water ingress  Gas/ fuel ingress  Dangerous creatures  Deep narrow entry/ exit
 Limited work place  Presence of sewer  Falling materials  Electrical hazard
 Sharp objects/ surface  Slippery surface  Cave in  Others:
Air Quality Monitoring
Frequency of monitoring: 10/ 15/20 /30 minutes. Note: Log air quality monitoring in attached sheet.
Monitored by: Name:
Details of Gas monitor:
Details of Rescue equipment
Tripod with accessories Yes /  No. Safety/ rescue harness Yes /  No.
Extractor Yes /  No Rescue hauler Yes /  No.
SCBA/ SAR / EBA Yes /  No Rescue stretcher Yes /  No.
Rescue trolley/ pulling device Yes /  No Others(specify):
Means of Communication
Walkie-talky  Yes/  No PA System Yes /  No.
Whistle/ Air horns Yes /  No. Alarm Yes /  No.
Control of Entry & Training
Entry/ exit register available Yes /  No. Task Briefing /TBT given Yes /  No.
Entrants/ attendants are 3rd party trained Yes /  No. Supervisor is competent Yes /  No.
Rescue equipment are inspected Yes /  No. Emergency response known to all Yes /  No.
Site clinic is alerted Yes /  No. Standby vehicle available Yes /  No.
Documents Attached: Method statement/ RA (strike out whichever is inapplicable).
Permit Requested by: (Supervisor /Engineer)
Permit Issued by:
(Construction Manager)
Verified by:
(Contractor EHS Officer)
Work completed safely & Permit returned by:
(Supervisor / Foreman / Engineer)
Permit Closed by:
Verified by:
(Contractor EHS Officer/ Engineer)
Name Signature Date & Time
Permit Closed out: The confined space work has been completed safely:
Name of In-charge: Sig: Date:
Note: 1. The scope of the permit is limited to the location mentioned above. The permit must be returned to the HSE office
upon expiry of the same.
2. Alteration/ correction after the approval will make the permit null & void.
Air Quality Monitoring Log
Frequency
Time Time Time Initial of
Time & Time & Time & Time & Time & Time &
& & & the
Value Value Value Value Value Value
Description Value Value Value inspector
Oxygen %
O2
Carbon
dioxide CO2
Carbon
monoxide CO
Hydrogen
Sulphide H2S
Ammonia
NH4
Other
Respiratory
particles
Atmospheric
Temp.
Relative
Humidity
Entry/ Exit Log Sheet
Entry
Name of the entrant Time - in Time – out Time - in Time - out Time - in Time - out
Attendant
LIFTING PERMIT REF.: EHS-L&T-F042

Permit No: ______________________ Date: ____________ Shift: DAY / NIGHT
Name & Contact Number of the Permit Holder
Mention what material(s) is to be lifted
Location / Area.
Name of the Lifting Supervisor / Foreman.
Equipment Details.
Equipment Custodian / In-charge
Type of the Crane or Lifting Equipment Mobile crane / Tower crane / EOT crane / Chain block / Others:-
Capacity (SWL) & 3rd Party Certificate ref. no:
Maximum load to be lifted
Capacity of the lifting gears
Crane operator’s name & 3rd Party ID
Routine (normal)/ Non-routine (Critical/Heavy Lift/ Tandem lift etc.) Note: Lift
Type of Lifting
Plan required for non-routine lifting operations.
Type of hitch arrangements and condition
HSE Checklist for the Lifting Supervisor/ Foreman/Engineer
Task briefing delivered to the crew. Yes No Verified 3rd party certificates and found OK. Yes No
Visual inspection carried out on lifting Yes No The Crane operator has valid license and 3rd Yes No
equipment and accessories. party ID.
Trained rigger available Yes No The Rigger & the operator know correct Yes No
hand signals.
Outrigger pads are defect free Yes No The ground is compacted and levelled. Yes No
Swing area is barricaded Yes No Hazard warning signage placed. Yes No
Is there any U/G utility below the Yes No Is there any overhead electrical line etc. in Yes No
outriggers the swing area.
The Crane, vehicle, truck parked on road. Yes No NA Traffic control measures taken. Yes No NA
Lifting supervisor is available on site. Yes No Weather condition is satisfactory Yes No
Operator cabin have full visual clearance Yes No Is there any excavation nearby the crane Yes No
positioning area?
The crane is positioned away from Yes No NA If the excavation is deeper than 1.5 mts. the Yes No NA
excavation edge crane outrigger shall be Depth X 1.5 mts.
(2 meters away if depth is 1.5m or below) away from the edge.
Permit Requested by:
(Lifting supervisor / Engineer)
Permit Issued by:
(Construction / Site - Manager)
Verified by: (Contractor EHS Officer)
The work completed safely & Permit returned by:
(Lifting supervisor / Engineer)
Permit Closed by: (Construction / Site - Manager)
Verified by: (Contractor EHS Officer)
Signature with
Name Designation
Date & Time
Note: 1) The permit shall be returned to HSE office on completion of the task.
2) Non-compliance to the permit conditions will lead to stoppage of work.
3) The lifting shall be stopped if the wind speed exceeds 35 Km/Hr. and during other inclement weather conditions
REF.: EHS-L&T-F043
CHEMICAL INVENTORY REGISTER
Hazardous
Chemical Quantity
Chemical Hazardous Property eg. Is the Chemical
S Abstracts Stored Is MSDS Is COSHH
Trade / Non - Toxic/ Labelled and
No. Service – (unit in Available Available
Name Hazardous Flammable/ stored safety?
(CAS No) Gallon )
Explosive
Drinking Water Filter Changing Schedule

Sl No Date Checked by / Changed by Sign Remark
Admin In charge EHS Manager
REF.: EHS-L&T-F044
REF.: EHS-L&T-F045
OH&S Key Performance Indicator for contractor SP06: Annexure X
Contractor: Larsen &Toubro Contract No: Month: DDMMYY
Target
Yearly Achiev
# INDICATOR Targe CONTRACTOR OH&S PERFORMANCE (CUMULATIVE) ement
t Level
(TAL)
Ja Fe Ma Apr M Jun Jul Aug Sep Oct Nov Dec
n b r ay
Ill Health Frequency Rate (IHFR)

No. of ill-health cases X 100,000
1 No. of staff x 8 x no. of working 0%
days
Loss Time Injury (LTI): Number of

2 on-duty injury incident(s) having 0%
sick leave
Loss Time Injury Frequency Rate
(LTIFR) =
Number of (on-duty) loss time 0%
3
Injuries (LTI) x 1,000,000
Man hours of exposure Total (No.
of Staff X 8X No. of Working Days)
Accident Severity Rate (ASR) =
Total man-hour(s) lost due to on-
duty Accident (Total no. of sick
4 0%
leave due to on-duty accidents X
8) x 1,000,000
Man hours of exposure
5 Number of first aid cases reported 100%
Number of Near miss reported to 100%
6
H&S Section, DEWA
Number of new staff attended
7 100%
H&S Induction training
Training hours /staff (Formal
8 100%
training, awareness and TBT)
Average number of staff in the Month: Total number of new staffs joined in the Month:
Total Month hours in the Month: Date:
Target Achievement level (for Positive Trend -Item 6 to8 = 100% + [Actual-Target] * 100%
Target Achievement level (for Negative Trend -Item 1 to5 = 100% + [Target-Actual] * 100%
Safety Officer Project Manager

Name & Sign Name & Sign
REF.: EHS-L&T-F046
Performa for Screening Workmen

Engaged by Contractors / Sub – Contractors
Name of the Contractor / Sub – Contractor: ____________________________

Full Name of the workmen: _________________________________________
Father / Husband’s Name: __________________________________________
Permanent Address: _______________________________________________
________________________________________________________________
Present Address: __________________________________________________
________________________________________________________________
 Date of birth ________________ Age _______ Years________
Married / Single / Widow / Widower ____________ Number of Children ______
Mother Tongue _______________ Other Languages Known_______________
In case of emergency person to be contacted ___________________________
(With address and Telephone Number if any)
________________________________________________________________
signature or left Hand Thumb impression
of the workmen for identification
Any other identification mark:
Weight: _______________ Height: ________________
Vision: __________________________________________________________
________________________________________________________________
Education:
Examination Passed Year School / Board

PREVIOUS WORK EXPERIENCE

SL. Name of the Contractor Project Site Category Period Salary /
NO. Organization Wage Rate
1.
2.
3.
4.
5.
6.
Referred by / References:
Screened by me. Certificates / Details verified / not verified.
________________________________________________________________
Referred to Mr. _________________ for on the job trial
Suitable for employment as ____________________
Site in charge / Site Engineer

________________________________________________________________
TRIAL REPORT
Seen and briefed the Safety Rules of the Site.
EHS Engineer /EHS Co-ordinator

________________________________________________________________
Approved for employment by M/s. _____________________________________
Project Site ______________________________________________________
PROJECT MANAGER
Employment Card issued and details entered into Register of workmen.
 Time Keeper ________________

FLOOR OPENING PERMIT REF.: EHS-L&T-F047
Permit Serial No---------------- Date -------------------------
FLUSH UP - STAND OTHERS_____________
The person taking permit (permit tee) to fill up:
1. Exact location where the work is being carried out _____________________________________
2. Duration of work. From :______________ To ______________
3. Nature of the Work: ____________________________________________________________
4. Name of the company other than L&T______________________________________________
Points to be checked
Sl. No Details Yes No NA
1. Is the area free from any falling materials?
2. Anybody working in down the floor opening
3. Is required to be wear safety harness and hook right place
4. Is adequate working platform provided with Access?
5. Proper barricades provided with sign boards
6. Are the operatives provided with adequate PPE and explained about open
floor during Tool Box Talk.
7. Any other precautions taken (specify)
8. Is adequate fall protection from basement provided?
9. Is Watcher made available for this job to guard the opening?
Please don’t issue any Floor open work if above points are not complied
Certified that the above quoted HSE precautions are ensured at the work location.
Verified By (Contractor EHS Officer)
The work completed safely & Permit
returned by:
Permit Closed by:
Signature with
Designation
date & time
Permit Validity: From: ______ Hrs. To: ________Hrs. Permit Closed at: Hrs.
After Work Completion (Before Leaving the Location)
The openings have been protected and reinstate safely.
By Permit Requester: Name: Designation: Signature with date & time:
EXCAVATION PERMIT REF.: EHS-L&T-F048

Permit Number: Date:
Permit Request
Please permit the excavation as per the following details:
Length: …………………………………… Width: ……………………………… Depth: …………………………..……… Location: ……………..……………………
Performing Agency: ………………………………..….. Name of the In-charge: …………………………………..……… Designation: ……………………
Signature: ……………………………………..…. Means of Excavation:  Manual /  Mechanical.
Permit requested from: ……………………………………..to: ………………………………………
Details of Underground Utilities: Furnish Details & means of isolation and protection.
Are there any electrical cables/ services present: Yes /  No.
Are there any data cables present: Yes /  No.
Is there any pipe lines (fuel, gas, water etc.) present:Yes /  No.
Are you verified below documents/ drawings/ Approvals?
Method Statement/ RA: Yes /  No. Utility Drawings provided by Authorities Yes /  No.
Is IFC drawing is available Yes /  No. Area clearance obtained by concerned Yes /  No.
HSE Controls and precautions:
The crew undergone excavation safety training Yes /  No. Necessary PPE are available Yes /  No.
The area scanned using CAT scanner Yes /  No Hazard warning signage/ Emergency no. Yes /  No.
displayed.
Area is barricaded with hard barriers Yes /  No Provision of access/ egress Give details:
Welfare facilities available at the Yes /  No First aid box & first aider available. Yes /  No.
location( toilet/ rest shed/ drinking water)
Type of side protection planned: Shoring/ Mention type. Any impact on road traffic. Yes /  No.
benching/ sloping/ shield/ box shield.
Flashing lights are provided near vehicular Yes /  No. Surface encumbrance are removed or Yes /  No.
movement area/ adjacent to road. protected.
Full time supervision is ensured. Yes /  No. Any plant/ equipment positioned Yes /  No.
nearby.
Remarks(if any):
Documents Attached: Method statement/ Risk Assessment/ As built Drawing/ Utility Drawing/ IFC Drawing (strike out whichever is
not applicable
Permit Requested by: (Supervisor
/Engineer)
Permit Issued by:
Verified by:
(Contractor EHS Officer)
Work completed safely & Permit
returned by:
Permit Closed by:
Verified by:
(Contractor EHS Officer/ Engineer)
Name Designation Signature with date &time
Noncompliance to the permit conditions will lead to cancellation of the permit and stoppage of the work.
Cancelled by: Signature: Reason:
Validity of the Permit. From: ………………………………….. To: …………………………………………………….
Note: 1. The scope of the permit is limited to the location mentioned above. The permit must be returned to the HSE office upon
expiry of the same.
2. Alteration/ correction after the approval will make the permit null & void.
EXCAVATION PERMIT VALIDATION FORM
Daily HSE Check by the Supervisor Yes No HSE Engineer’s/ Officer’s Remarks
1) The excavation profile is intact.
2) Sign boards & barricades are in place.
3) No water ingress in the excavation.
4) Safe access/ egress provided.
5) U/G utilities are protected.
6) No plant/ equipment parked at the edge.
7) Workmen given daily toolbox talks.
8) Edge protection is intact.
9) Welfare facilities are provided.
10) Emergency No. displayed & known to all.
11) Good housekeeping is maintained on site.
12) First aid facility is available.
13) No oil leak in the equipment being used.
14) Workmen are using PPE.
15) MS/ RA available on site.
Request for Daily Validation of the Permit (To be filled by the Supervisor).
Date/ Time/ Date / Time/ Date / Time/ Date / Time/ Date / Time/ Date / Time/
Signature Signature. Signature. Signature. Signature. Signature.
Validated by HSE Engineer/ Officer.

Date/ Time/ Date/ Time/ Date/ Time/ Date/ Time/ Date/ Time/ Date/ Time/
Signature Signature Signature Signature Signature Signature
Note:
1) The excavation work shall not commence until validating the permit.
2) Maximum days for validation are for six days. If the excavation is continuing beyond six days
a new permit shall be obtained.
3) HSE Engineer/ Officer to cancel the permit if deviations are observed during the daily
validation.
4) The permit and the daily validation sheet shall be returned to the HSE office upon expiry.
Date of cancelation / expiry:
WORK AT HEIGHT PERMIT REF.: EHS-L&T-F049

TO BE COMPLETED BY REQUESTOR
Location of work: Date:
Contractors. (Company name, supervisor and contact details)
________________________________________________________________________________________________
_____________________________________________________________Tel No: ____________________________
Description of work to be undertaken
Safety Checks Yes No N/A

Due consideration given to eliminate work at heights tasks
All personnel are adequately trained to perform work at heights
Safe Means of access and egress provided
Scaffolding
Scaffold has been inspected and tagged by competent person
Scaffold structure built as per the approved drawing?
Base plates and/or screw jacks in firm position
Edge protection provided wherever there is falling risks
Walkways are properly boarded with planks and secured by clamp
All persons subjected to falling risks are equipped with full body harness
Toe boards properly installed?
Adequate cross bracing & cantilever supports provided?
Temporary Working Platform
Temporary working platform has been inspected and tagged by competent person
Temporary working platform installed as per the approved drawing?
Equipment providing mechanical elevation must be Safety approved
Have sufficient strength to bear the load to be placed on it
Cornice hooks, parapet clamps and thrust-out beams must be secured by tiebacks to a solid
anchor on the building or structure
All persons subjected to falling risks are equipped with full body harness?
Declaration by Requester: I hereby declare that no work other than stated within the relevant method statement and
risk assessment will be carried out, and all precautionary measures referred in risk assessment will be adhered to. The
work at heights described above is in my opinion safe to work. The work at heights described can be carried out,
provided that the precautions above are fully observed.
Permit Requested by: (Supervisor /Engineer)
Permit Issued by: (Construction Manager)

Verified by:(Contractor EHS Officer)

Work completed safely & Permit returned by:
Permit Closed by: (Construction Manager)
Verified by: (Contractor EHS Officer/ Engineer)
Name Designation Signature with date & time
Permit closed and returned to HSE department
Emergency STOP Switch Check Sheet REF.: EHS-L&T-50
Dept/Section:
Workshop Name & Location:
Equipment Name: Equipment ID:

To be checked by Operator To be checked by Operator To be checked by Operator
Date Status Checked by Date Status Checked by Date Status Checked by
Method of Checking:Checking shall be carried out prior to use the equipment at least on daily basis.
Step 1: Switch on the equipment and allow to run fully; Step 2: Stop the equipment using emergency stop switch.
Action: If the running equipment not stopped by emergency switch immediately notify to the workshop in-charge and do not use the equipment
till corrective action has been completed.
REF.: EHS-L&T-51
HOUSKEEPING INSPECTION CHECKLIST
Name of project & Location Reporting Month

Sl. Observation/
Description Remarks
No. Yes / No
Structural Fabrication / Erection Site.
1 Walkways, passages kept clear of material.
Area and roads kept clear for maneuvering of cranes
2
and material handling equipment.
Scrap, cut-pieces, welding electrode stubs, hand-tools
3
kept tidy in work area and disposed suitably.
4 Scrap-bin available at site.
Welding cables, power cables routed properly to avoid
5 run-over by vehicle or tripping hazards and obstruction
to personnel movement.
6 Compressed gas hoses routed properly in the site.
Compressed gas cylinders and hoses kept away from
7
hot work and grinding work.
At least 1 meter on both sides of gantry rails are kept
8
clear of material.
9 Floor kept clear of water, oil spillage / accumulation.
Civil Work area
All approach, aisle, ingress / egress to / from site,
1 excavated pits, ramps, walkways kept clear of material
debris tools etc.
Scaffolding material, (H-beam, H-D tower frames,
2 bracing, clamps.) shuttering boards, across pans etc.
are stacked properly at site.
Stacking of bricks, hollow blocks are done in safe
3
manner.
Nails removed from wooden planks / timber and not
4
protruding out.
Saw dust, wood chips and scrap wood cleared from
5
carpentry shop and disposed suitably.
Name of project & Location Reporting Month

Sl. Observation/
Description Remarks
No. Yes / No
Debris from demolition and excavated earth cleared
6
from site and accesses.
Electrical Installations & Booths
1 Approach to DB, Panels, Switches kept clear
Fire extinguishers installed at an easy accessible
2
location.
Welding cables and power cables are routed
3
separately.
Routing of cables is done properly to avoid obstruction
4
& tripping hazards.
5 Floor of electrical booths kept dry.
6 Rubber mats are in place at electrical panels.
Stores
1 Walkways, entry and exits kept clear.
2 Materials placed on racks are safely accessible.
Compressed gas cylinders are segregated as full or
3
empty and type of gas.
Vertically stored cylinders are secured / chained to
4 avoid toppling and horizontal once guarded against
rolling down.
Flammables storage areas are isolated from store,
5
office and work areas.
6 Cement bags are stacked in proper gradient safely.
Corrosive material (e.g. acids, alkalis) are stored away
7 from other material and kept on collection trays to
safeguard against accidental leakage.
Storing area for lifting tools & tackles, ropes, wire ropes
8
& PPE is dry, clean & free of corrosive material
Easy accessibility to installed fire extinguishers
9
ensured in store.
General
1 Separate scrap yard is allocated for the site.
Approaches to workstations, offices, time offices,
2
stores, P&M are well laid and demarcated.
Site roads are kept clear of stacked material for free &
3
safe vehicular movement.
Heavy material stacking is taken care of to prevent
4
slips, collapse and rolling.
For housekeeping at elevated workplaces refer to
5
(Safety While Working at Height Checklist)
EHS In-Charge
REF.: EHS-L&T-52
DIESEL GENERATOR (DG) INSPECTION CHECKLIST
Location Reporting Month
Report No. Date of Inspection
Make Inspected By & Signature
S.No Points Observations Measures

Whether the continuity and tightness of earth conductor are
1 checked?
2 Mention the gauge of the earth conductor used
3 Whether earth resistance is measured?

4 Mention the value of Earth Resistance
5 Is DG provided under shed / cover?
6 Whether entry is restricted into the DG room?
7 Are cable trenches are covered?
8 Is insulation provided on the battery terminals? .
9 Is thermal insulation done for the DG exhaust/

Whether stack height is maintained as per Environment
10 requirements given in procedure manual?
11 Whether DG exhaust is diverted outside the shed?

Are all the rotating parts of DG guarded (coupling,
12 radiator fan)?
13 Whether any leakage of fuel / oil in the DG room?
Whether DG surrounding is free from flammable
14
material?
Whether fire extinguisher / fire buckets with stand are
15 provided?
17 Whether DG is fitted with Acoustics & Silencer insulations?
Verified by:
Site Engineer / Manager. Signature. Date.
CABLE RISER WORK PERMIT REF.: EHS-L&T-F053
Permit Serial No---------------- Date -------------------------
The person taking permit to fill up:
5. Exact location where the work is being carried out _____________________________________
6. Description of work: __________________________________________________________
7. Duration of work. (Time) From :______________ To ______________
8. No of person engaged : ____________________________________________________________
Points to be checked
1. Is the area free from any falling materials?
2. Well Ventilated
3. Scaffolding inspected
4. Is required to be wear safety harness and hook right place
6. Proper barricades provided with sign boards
7. Are the operatives provided with adequate PPE and explained about
hazard during Tool Box Talk.
8. Illumination intensity is acceptable.
9. Emergency light provided.
10. Others if any:
LONE WORKING IS NOT PERMITTED INSIDE CABLE RAISER ROOM- BY ORDER (HSE Dept)
Certified that the above quoted HSE precautions are ensured at the work location.
The work completed safely & Permit
returned by:
Permit Closed by:

Signature with
Designation
date & time
Permit Validity: From: ______ Hrs. To: ________Hrs. Permit Closed / cancelled at: Hrs.
After Work Completion (and before leaving the location) –The openings have been protected and reinstate safely.
By Permit Requester: Name: Designation: Signature with date & time:
Comments:
____________________________________________________________________________________________
(ACCESS CONTROL PERMIT) REF.: EHS-L&T-F054
PERMIT TO WORK for Civil / Electrical / MEP Works after handing over to T&C
Permit Serial No: ____________________ DATE: _______________
To be filled in when required to work in the Substation area

10. Exact location where work is being carried out ____________________________
11. Duration of work. From : Date:______________ Time ______________
To: Date ______________ Time _______________
12. Nature of the Work: ____________________________________________________________
14. Points to be checked:
1. Has the area been fenced/cordoned off?
2. Has the warning sign been displayed?
3. Has proper illumination been arranged?
4. Has the Panels protected from dust?
5. Has No smoking policy explained to crew?
Are the operatives provided with adequate PPE and explained
7.
about electrical hazards and risk?
8. Any other precautions taken (specify)
Permit Applier/Holder:
The above points have been complied with and conditions rendered safe / hazards innocuous to undertake the Civil/ Electrical
/MEP work.
___________________ ______________ _________________

Name of Site In-charge Signature Designation
Date: ____________Time ________________
Permit issuer: (T&C)

The above precautions are compiled and the Civil /Electrical /MEP work can be carried out in the above area.
___________________________ ______________________ ______________________
Name & Signature (T&C) Signature Designation
Date: ___________Time ________________
Permit Checked: (EHS)

___________________________ ______________________ ______________________
Name & Signature (EHS) Signature Designation

Date: ___________Time ________________
Permit Closeout:
Work area and adjacent area were inspected and were found safe.
_______________________________ ______________________ ______________________

Permit Applier / holder L&T - T&C Dept. L&T EHS Engineer
Date: __________ Time ________________
List of workmen’s involved in the above works
S.no Name of workmen Designation Company Signature Remarks

Supervisor in charge:-
Name Sign Date_________

Camp Inspection

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LARSEN & TOUBRO LIMITED

Power Transmission & Distribution (UAE)

28 STAR CARD EHS-L&T-F028 40

Inspection Date _______________ # of person using:______________ Job #:______________

Kit In-charge: ______________________________ Signature: ___________________

Inspected By: _______________________________ Signature: ___________________

Inspection Date _______________ # of person using:______________ Job #:______________

Kit In-charge: ______________________________ Signature: ___________________

Inspected By: _______________________________ Signature: ___________________

Inspection Date _______________ # of person using:______________ Job #:______________

Kit In-charge: ______________________________ Signature: ___________________

Inspected By: _______________________________ Signature: ___________________

Unit Name: __________________ Plate number: _____________________ Job #:_____________

Operator / In-charge: ______________________________ Signature: ________________

Inspected by: __________________________________Signature: ________________

Date of Inspection: ___________________ Next Date of Inspection: _______________

Operator / In-charge: ______________________________ Signature: ________________

Inspection Date: ________________ Month Colour Code: ________________ Job #: _______________

Inspected by: ____________________ Designation: __________________ Signature: _______________

Area In-charge: ___________________ Designation: __________________ Signature: _______________

Next Date of Inspection: ______________________________

Crane Capacity:__________________ Inspection date:________________

Operator / In-charge: ______________________________ Signature: ________________

Inspected by: __________________________________Signature: ________________

Colour Code: ______________________________

25 Warning back lights & Horn

Site EHS Inspection REF.: EHS-L&T-F006

Area responsible: ________________ Location: ________________ Job #: _______________

Date of Inspection: __________________________________ Time: _______________

SI. SATISFACTORY CORRECTED ACTION

2 Full Time Supervision & Competency

3 Signs & Barricade

5 House Keeping / Hygiene

8 Monthly Inspections of M/c, tools &Equip’t

9 Floor Opening Protections

10 Physical Safety Power Tools/Electrical Equip't

11 Fire Fighting Equipment

12 Physical condition of Hand Tools

13 Ladder & Working Platform Safety

SI. SATISFACTORY CORRECTED ACTION

17 Scaffolding Requirements compliance

18 Crane Requirements / Operators Competency

19 MEWP Requirements / Operators Competency

20 Forklift Requirements / Operators Competency

21 Testing & Commissioning compliance

22 Lock-out / Tag -out Procedure

21 Lifting Gears Requirements

22 Personal Protective Equipment (PPE)

23 Transport and Road Safety

24 Working at Heights Requirements

Inspected By: _____________________ Signature:________________ Date of Inspection :___________________________

Power tools inspection checklist

Inspected By: ______________________Signature:________________ In-charge: __________________________ Signature:________________

SI. Cable Physical

Inspection Date _ # of person using: Job #:__

Kit In-charge: ____________ Signature: _

Inspected By: _____________ Signature: _

Inspection Date _ # of person using: Job #:__

Kit In-charge: ____________ Signature: _

Inspected By: _____________ Signature: _

Inspection Date _ # of person using: Job #:__

Kit In-charge: ____________ Signature: _

Inspected By: _____________ Signature: _

Unit Name: ________ Plate number: _ Job #:___

Operator / In-charge: ______________ Signature:

Inspected by: __________________Signature:

Date of Inspection: _____ Next Date of Inspection: _

Operator / In-charge: ______________ Signature:

Inspection Date: __ Month Colour Code: Job #: _

Inspected by: ____ Designation: Signature: _

Area In-charge: ___ Designation: Signature: _

Crane Capacity:__ Inspection date:

Operator / In-charge: ______________ Signature:

Inspected by: __________________Signature:

Area responsible: __ Location: Job #: _

Date of Inspection: ____________________ Time: _

Inspected By: _ Signature: Date of Inspection :_______

Inspected By: ____Signature: In-charge: Signature:

Inspected by: ___________ Signature: _ In-charge: _Signature:____

Inspection Date: __ Monthly Colour Code: Job #: _

Inspected by: _______________ Signature: _ Site In-charge: _Signature:

Inspected by: ______ Signature: _ In-charge: Signature:______

Date of Inspection: ____________________ Job: _

Inspected by: ______ Signature: _ In-charge: Signature:______

Inspected by: ______ Signature: _ In-charge: Signature:__________

Inspected By: ______ Signature:

Location: ________ Job #: _Date of Inspection: _______

Inspected By: ______ Signature:

In Charge: ____________________ Signature: _