2015.08 - DH - 01.0. Safety Management Plan
2015.08 - DH - 01.0. Safety Management Plan
2015.08 - DH - 01.0. Safety Management Plan
August 2015
Revision Record
Revision Revision
Description Revised By Approved By
No. Date
00 01.03.2012 First issue Nguyen Tan Tho Le Viet Hai
01 01.09.2012 Second issue Nguyen Tan Tho Le Viet Hai
02 01.05.2013 Third issue Nguyen Tan Tho Le Viet Hai
03 01.12.2013 Fourth issue Nguyen Tan Tho Le Viet Hai
CONTENTS
1 SAFETY POLICY 09
1.1 Safety Organization and Allocation of Responsibility 13
1.2 Project Safety Committee 15
1.3 Sub – Contractors Responsibility 16
1.4 Supporting Staff for Safety 17
1.5 Project Safety Committee Chart 20
3 SAFETY TRAINING 22
3.1 Objective 22
3.2 Trades Training 22
3.3 Sources of Training 22
3.4 Training Requirements 23
3.5 Safety Training for Staffs 24
4 GROUP MEETINGS 25
4.1 Objectives 25
4.2 Purpose 25
4.3 Monthly Safety Committee Meeting 25
4.4 Monthly Safety Talk at Assembly Area 25
4.5 Daily / Weekly Toolbox meeting 25
4.6 Site Coordination Meeting 25
Pre construction meeting with Subcontractor before
4.7 25
commencement of work
CONTENTS
7 SAFETY PROMOTION 37
7.1 Objective 37
Safety Bullet in Boards & Displaying Of Safety Posters And 37
7.2 Slogans
7.3 Safety Campaign 37
7.4 Administration Of Safety Promotion 38
7.5 Promotional Program 38
CONTENTS
CONTENTS
13 Emergency Preparedness 57
13.1 Objective 57
13.2 Identification of Emergency Hazards 57
13.3 Personnel On Emergency Recall List 57
Education and training of employee on Handling of an
13.4 emergency 58
13.5 Emergency Fire Fighting Equipment at work site 58
Establishement and Implementation of emergency action plan
13.6 for specialized Activities 58
13.7 Action Plan in the event of Fire 58
13.8 Emergency drill and exercise 59
CONTENTS
16 LIST OF APPENDIX
Appendix 1_Safety Forms 62
Appendix 2_Regulations References 137
1 Safety Policy
• Enforce on compliance of the TCVN, HSE, OSHA, MOM Act & Regulations on
whichever is reasonably practicable and its subsidiary legislation and the
Safety Management System by subordinates, subcontractors and contractors
or their representatives under their control;
• Ensure that all subordinates and sub-contractors or their representatives under
their control comply with the safety policy;
• Ensure that sub-contractors or their representatives investigate into causes of
every accident and dangerous occurrence & attend meetings convened for the
purpose of accident prevention.
Duties of Site Engineering and Technical SupervisorsI Foreman:
Site supervisors and foremen shall be responsible for assisting the Site Engineer
in implementing and enforcing the safety policy in accident prevention.
They shall:
• Enforce on compliance of the TCVN, HSE, OSHA, MOM Act & Regulations
on whichever is reasonably practicable and its subsidiary legislation and the
Safety Management System by subordinates, subcontractors and contractors
or their representatives under their control;
• Check and ensure that all necessary tools and equipment are safe to use;
• Ensure that all sub-contractors provide and maintain safe access in all places
of work.
• Ensure that all sub-contractors maintain the highest standards of housekeeping
in their work areas;
• Assist in investigating and reporting on accidents and dangerous occurrences
and take prompt remedial action as recommended.
• Ensure that all sub-contractors do not deploy new or transferred worker to
undertake any tasks without appropriate instruction;
• Ensure that the necessary protective clothing and safety equipment is readily
available and that contractors provide workers with the necessary personal
protective equipment;
• Ensure that all sub-contractors strictly enforce on the use of all necessary
protective clothing and safety equipment at all time by workers;
• Attend all safety committee meetings and any other meetings required for the
purpose of accident prevention;
• Set the example for all workers to follow at all times; and observe strictly to the
safety advice of the safety supervisor.
1.3 Subcontractor’s
All sub-contractor and nominated sub-contractor who employs more than 20
workers shall either himself be trained and qualified in .construction safety
supervision or appoint a qualified safety supervisor to coordinate, advise promote
and enforce on all matters pertaining to safety and health in the area of their
responsibilities.
The main safety and health responsibilities of all sub-contractors are listed below;
Project Name: Deutsches Haus
Document No: HBC / HSE / 01
Date: 01.12.2013
Page 16 of 154
Produced By: Tran Mong Lien
Current Revision No: 03
Last Revised date: 01.12.2013
HOA BINH CONSTRUCTION AND REAL ESTATE CORPORATION
Pax Sky Building
123 Nguyen Dinh Chieu Str., Ward 6, District 3,
Ho Chi Minh City
General Line : +84-8 3 932 5030
Email: info@hoabinhcorporation.com
Note:
All our subcontractor will have their own safety officer/department who will report to our
safety manager.
2.0 Safe Work Procedure
2.1 Description
The safe work procedure applied at all workplace to eliminate or minimize the risk
of injury to people, damage to property and harm to the environment.
All works shall be carried out by appropriate trained, competent, approved,
qualified or licensed persons in accordance with the applicable Code of Practice
and Regulations as laid down by MOC, MOLISA, HSE, OSHA, MOM and other
relevant Authority. These procedure should be documented as work procedure or
instruction in case where is statutory requirement to do so or in other cases where
it is deemed necessary.
2.2 Scope
The following are the Safe work procedures are required in compliance with the
statutory requirement; MOLISA, HSE, OSHA, MOM and the best Code of
Practices and Standards for the scope of work shall apply. However the following
safe work procedure serves only as guide.
• Working at heights.
• Hot works.
• Electrical works.
• Excavation.
• Hand Tools.
• Tower Scaffold.
2.3 Procedure
All contractors must set a safe work procedure for their work on site and the
contractors are to follow all work instruction required by and the highest and
inclusive of Where Reasonably Practicable shall be in conformance to the below
Safety ACT, Regulations, Approved Code Of Practice and guidelines and shall be
accompanied with the proper documentations and relevant drawings with
endorsements from a Certified and licensed Professional Engineer;
• TCVN
• HSE
• OSHA
• MOM
• OSHAS 18001
• ISO 14001
Safety officer or site safety supervisor who observes the performance of unsafe
act or work practice by any person at the worksite shall stop such performance
immediately by either giving direct instruction to the offender or through the
superior of the offender.
2.5 Permit – To – Work System
Permit-to-work is required to perform the works as stated below:
• Working at Height.
• Hot Works & Work.
• Lifting Permit.
• Excavation Permit.
• Confined Space Entry Permit
• Scaffold Erection / Dismantling
• Electrical Permit
• General Permit
• Safety Officers.
• Scaffold Supervisor.
• Crane Operator.
• First-Aider.
• Electrical Worker.
Record of fitness?
Equipment / Machinery Faulty devices?
Maintenance?
Properly labelled?
Properly stacked I
Materials
arranged?
Falling hazards?
Lighting?
Environment Ventilation?
Noise?
Project Name: Deutsches Haus
Document No: HBC / HSE / 01
Date: 01.12.2013
Page 29 of 154
Produced By: Tran Mong Lien
Current Revision No: 03
Last Revised date: 01.12.2013
HOA BINH CONSTRUCTION AND REAL ESTATE CORPORATION
Pax Sky Building
123 Nguyen Dinh Chieu Str., Ward 6, District 3,
Ho Chi Minh City
General Line : +84-8 3 932 5030
Email: info@hoabinhcorporation.com
Making Recommendations
Once the investigator analysed the facts, he will look at the possible underlying
root causes for the cause of accident. His recommendations will cover preventive
measures such as :
• Education and training &Safety Promotion
• Enforcement of rules & regulations I penalty fine
• Redeployment of workers & Periodical inspections
• Functional System I Subsystem I Procedures modifications.
• All materials shall be placed under the charge of appointed material controller
who should be responsible for the receiving, storage and issuing of the
materials.
• Proper facility shall be provided for the safe storage of materials & Proper
facility shall be provided for the safe holding of waste materials & for disposal
by licensed waste contractor.
6.6 Reporting of hazards and incidents
• Any person who discovers any hazards or incidents should immediately
report such matters to his superior.
• Any person who suffers any injury arising from his course of employment
should notify his superior within the shortest period of time and in no case
should be more than 3 days from the date he suffered the injury
6.7 Housekeeping
• Debris should be placed in waste bins of suitable size while waiting for disposal
by licensed waste collector. Debris should not be indiscriminately dumped
around the worksite as it might cause environmental pollution and breeding of
pest.
• Food waste should be bagged and tied and placed in designated refuse bins
and removed from the worksite daily by licensed waste collector.
• All employees shall make use of waste bins and sanitary facilities provided at
the worksite to maintain the housekeep ing of the worksite in a generally
acceptable condition.
6.8 Removal of Fire Hazards
• All flammable substances such as diesel, kerosene, thinner, paint, etc. shall be
stored in well ventilated designated storage area with authorized access.
• Flammable solid waste such as paper, cardboard, plastic sheets, etc. shall be
removed daily from construction area and placed in designated waste bins for
disposal by licensed waste collector.
6.9 Enforcement of In-House Safety Rules and Regulations
• All trade person-in -charges shall have the responsibility to enforce the relevant
in-house safety rules and regulations to ensure that all employees under their
charge comply with such rules and regulations and works are being carried out
in accordance with the appropriate manner and code of practice.
If work is carried out near public roads, all signage shall comply with the
recommendations of the Temporary Road Signage or as gazetted by the local
government.
6.10.2 Policy concerning repeat offenders
The following procedures shall be set up for repeated offenders on violating
safety:
Verbal Warning: The offenders will first be given a verbal warning for any unsafe
act by the PM /SS.
• Fine: If the offender repeats the offence again, he will be fined by the PM / SS
• Removal from site: If the offender still persists with the unsafe act, he will
be removed from the site.
6.11 Safety Rules and Regulation for all Site Staff & Workers
• Workers must fully use their safety personal protective equipment (PPE).
• Always check with your supervisor if you are doubtful.
• Report injuries sustained to your immediate supervisor at once.
• Safety Harness must be worn when working above 2 meters and must be
properly anchored.
• No throwing of objects or debris from height.
• Strictly observe all safety/ warning signs posted & speed limit of Client site ( 10
KM/H)
• No littering - keep workplace clean Practice good housekeeping.
• Report immediately of any unsafe act / condition to your supervisor.
• Barricade all the opening at work area to prevent fall of person .
• Never operate machines / equipment / explosive powered tools if you are not
authorized.
• Do not use defective tools / equipment. Keep them properly after using.
• Do not take short cuts - use proper access.
• Never hitch a ride on suspended load or moving dumpers, excavators etc.
• Any worker who violates safety rules and regulations will be severely dealt with.
• Attend toolbox meetings and Participate actively in Safety Promotion.
• Observe all safety measures and work safely at all times.
• No discharge of waste water in to public drain /Sea.
• Regular removal of construction waste & food waste.
• Apply necessary permit prior to start works.
• There shall be mandatory no smoking site wide.
8.5 Control
• Safety rules and regulations in force at the worksite shall be conveyed to sub-
contractor's top person-in-charge to ensure close & effective communication
and observance.
• Sub-contractor's safety supervisor shall possess pro-active attitude in safety
supervision work and shall attend as far as possible all safety committee
meetings and safety inspections and participate in all safety promotional
activities being organized at the worksite.
• Stern action shall be taken by the Management against sub-contractor who
fails to observe safety rules or regulations.
• Monthly in-house safety audit shall be carried out by appointed safety auditor
from other project site to assess the general safety condition of a worksite.
• A monthly summary audit report shall be prepared by the head office safety
committee and circulated to all worksites.
• A copy of the record shall be submitted to the site safety personnel shall be
kept by the safety personnel in the relevant file at the worksite for the
purposes of necessary reference and inspection by an inspector
10.4 Procedure for breakdown and repair.
• The procedure for breakdown and repair shall include safe work practices to
prevent incident during repairing.
• As far as practicable, repair shall be carried out off-site in properly established
facility such as mechanical workshop where proper water pollution control facility
is available.
10.5 Competency of Maintenance Personnel
Maintenance personnel shall be trained and competent. Repairs and maintenance
carried out by external agents shall conform to the manufacturer’s recommendations
and specifications and worksite's in-house rules and regulations.
10.6 DefectsISubstandard Reports
All unsafe conditions, defects and substandard conditions must be rectified and
certified safe before it can be allowed to be used on the site.
10.7 Definition
Approved Person
Approved Person means any person (whether an officer of the Government or not)
who is approved by the Chief Inspector by a certificate in writing for the purposes of
carrying out examinations and tests of hoists and lifts, lifting gears, or lifting
appliances and lifting machines.
Competent Person
Competent Person means any person who have undergone a course of training
(related to the nature of the work) conducted by the relevant government I approved
institution
The Project team carrying out the Risk assessment shall ensure that the following
basic steps are systematically carried out. This is to ensure that all potential
hazards can identify, and subsequently safety I control measures are implemented
to reduce I eliminate the hazards identified.
The contractor shall submit a risk assessment in addition to the method statement,
before any hazardous operation is launched on site. This is to demonstrate that he
has considered what could foreseeable result in an incident I accident and has
identified the control measures necessary to reduce the residual risk to an
acceptable level. This procedure is a legal requirement under the regulation.
It is essential that teams of appropriately experienced and competent people carry
out these risk assessments.
Revision Record
Revision
Revision Date Description Revised By Approved By
No
00 01.03.2012 First issue Nguyen Tan Tho Le Viet Hai
01 01.09.2012 Second issue Nguyen Tan Tho Le Viet Hai
02 01.05.2013 Third issue Nguyen Tan Tho Le Viet Hai
03 01.12.2013 Fourth issue Nguyen Tan Tho Le Viet Hai
1. PURPOSE
To establish systematic procedures for identification of health and safety hazards, risk
evaluation and risk control on site for risk management purposes (in compliance with the
WSH Act and its subsidiary legislations) and to take appropriate action to eliminate the
hazards or reduce the risks associated with the hazards. Also, to provide a means to
identify significant environmental impacts and manage them in a way that eliminates or
reduces them to an acceptable level.
2. SCOPE
3. REFERENCES
4. PROCEDURE
4.1 Site Risk Assessment Team
4.1.1 The Risk Management Facilitator should ensure that a Risk Assessment (RA) Team
is formed and consisting of persons who have a thorough knowledge of the work to
be assessed to conduct the risk assessments. Risk Management Facilitator shall be
a RA Team Leader.
4.1.2 RA Team members should include Site Management Staffs, Technical Personnel,
Site Engineers, Workplace Safety Health Officers (WSHO) / Supervisors, Site
Supervisors, Sub-contractors, Maintenance Personnel, Workers Leader and Supplier
Personnel applicable to the work activities being analyzed.
b. Provide the necessary support and resources to the RA Team to enable them
to effectively perform the analysis activities modified activities and new
developments.
a. Prepare risk assessments for their work activities with their RA Team
c. Participate in the risk assessment review of their work activities by the Main
Contractor’s RA Team.
f. Inform all persons working at the site of the risks as well as the control
measures.
g. Ensure that all new employees are aware of the risk assessment for the work
activity that they carry out; and
e. Inform all persons working at the site of the risks, and the means to minimize,
or where possible, eliminate the risks;
f. Ensure that all employees are aware of the risk assessment for the work
activity that they carry out; and
g. Review or revise the risk assessment at least once every 3 years, and also to
review in the event of:
(ii) A significant change in work processes that could affect the Safety and Health
of the workers.
4.2.4 It shall be the responsibility of the Workplace Safety & Health Officers. to:
a. Ensure that the risk control measures are implemented without undue delay
after the completion of risk assessment;
b. Implement safe work procedures developed by the RA Team for work which
poses safety or health risks to workers.
c. Inform any changes in the work process to the RA Team Leader in charge.
b. Adhere to the safe work procedures established to reduce any safety and
health risks at the work site; and
4.2.7 It shall be the suppliers’ duty to work with the RA Team to identify any other hazards,
evaluate and control the risks that machinery, equipment or hazardous substances
may cause.
4.3.1 The essential steps involved in evaluating the magnitude of safety and health
hazards and risks are as follows:
Step 1: Preparation
c. Possible types of accident or incident and ill health include: person falling from
height; object falling from height; slips or falls on the level; electrocution;
Asphyxiation
a. Control hazards and reduce risks by the following the hierarchy of Control
measures: Elimination; Substitution, Engineering Controls; Administrative
Control; Personal Protective Equipment.
Step 5: Risk Communication
a. The Workplace Safety & Health Officers must keep a written description of the
risk assessment for at least 3 years.
a. RA Team Leader / Workplace Safety & Health Officers shall review the risk
assessment plans:
- Once every 3 years;
- Whenever new information on safety and health risks surfaces;
- There are changes to the area of work and/or
- After any accident or serious incident.
4.3.2.1 The essential steps involved in evaluating the magnitude of WSH aspects and
impacts are as follows:
Step 2 - Identifying potential WSH aspects / impacts, and the likely outcome or
consequence.
4.3.4 It is the responsibility of the Main Contractor RA Team to review theirs and Sub
Contractors risk assessments before being approved by the Main Contractor, Senior
Site Engineers / Sub contractor’s management personnel.
4.3.5 It is the responsibility of the Main Contractor or Sub contractors RA Team leader to
disseminate the control measures recommended by the approved risk assessment to
all relevant work groups including workers concerned.
4.3.7 It is the responsibility of the Workplace Safety & Health Officers / RA Team Leader to
ensure that the previous analysis be reviewed and revised accordingly.
Appendix B Severity
• Adverse weather and flooding & any other incident resulting in mass loss.
13.3 Personnel on Emergency Recall List
A "Personnel on Emergency Recall List" which contains the names and contact
telephone numbers of the project manager, site manager, site safety supervisor
and other responsible person -in-charge shall be prepared and displayed in
conspicuous positions in the site office and the security guardhouse at all times.
Any vacancy created on the emergency recall list due to reason such as
responsible person on overseas trip, etc. shall be filled up temporarily by suitable
person which shall be decided by the management.
• Chemical Gloves.
• If the fire is too big, attempt to prevent spreading of fire if possible close all
doors, windows and Separating I wetting combustibles (tables, chairs and other
flammable).
• Evacuate to the assembly area and report to safety personnel on the location,
nature and extent of fire.
Fire Preventive Measures
To prevent the possibilities of an outbreak of fire within the work site the
following precautions shall be strictly complied with by all the staff at work site:
• Smoking is strictly prohibited & Cooking on site.
• No storage of flammable liquids or other highly combustible materials near hot
work area.
• All electrical appliances are to be checked for its serviceability.
• Any worn-out wiring or fittings are to be replaced with minimum IP65
• All workers are to ensure that electrical appliances not in use are switched off &
all electrical plugs are to be removed from the sockets after use.
• A safety check is to be conducted to ensure that there is no smell I sight of
flame, or smoke before leaving the room.
13.8 Emergency Drills and Exercises
Emergency drills or exercises shall be conducted at defined intervals to test the
effectiveness of the emergency plans. Records of emergency drills shall be
maintained for evaluation and improvement purpose.
Emergency ManagementI Communication Methods
The following method shall be followed in the event of an emergency of fire and
explosion.
Emergency action when accident
APPENDIX 1
SAFETY FORMS
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Zone:
1. Inspected Items
Hoarding
Excavation/ Trench
Scaffolds
Temporary Work
Tower Crane
Plant machinery
Material Hoist
Drainage
Floor Openings
Edge Protection
Working Platform
Electricity
Overhead/Underground Services
Material Storage
3. Remarks
_____________________________ ________________________
Contractor’s Site Agent & Construction Manager &
Safety Officer Zone Safety Officer in-charge
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Fire Prevention Foreman Means of escape and hot work 30 mins WHSO Bi-monthly
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Project Name:
Date: Course Name:
Venue:
Time: Course Content:
Speaker:
Company Name Trade Name Position Staff No. Joint Date Signature
Page 3 of 3
Project Name: SaiGon Centre
Document No: HBC-HSE-FORM-03
Date: 01.05.2013
Produced By: Tran Mong Lien
Current Revision No: 02
Last Revised date: 01.05.2013
HOA BINH CONSTRUCTION AND REAL ESTATE CORPORATION
Pax Sky Building
123 Nguyen Dinh Chieu Str., Ward 6, District 3,
Ho Chi Minh City
General Line : +84-8 3 932 5030
Email: info@hoabinhcorporation.com
Certificate of Competency
Document Number: HBC / HSE / FORM / 04
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Certificate of Competency
Certificate No.
, which has achieved industrial occupational standard and is competent to work in any site mentioned above.
The above mentioned worker has accepted the SOC training provided by the company. He is appointed to
work at __________________to perform his duty.
Sub-Contractor:
Sub-Contractor’s Stamp
Name of Representative:
Position of Representative:
Contractor’s Stamp
Signature:
Date:
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The unsafe working practice has ceased and works can now proceed
Distributed to: Cc: Site Manager Cc: Safety Manager Cc: Document Controller
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This checklist should be utilised by Main contractor Management during the Contractor Pre-Mobilisation
Meeting. Should any item contained on this list be answered ‘no’, the reasoning must be minuted during the
pre-mobilisation meeting and time scale for action agreed.
Project Date: Comments
Contractor (Name)
Client Construction Provision N/A Yes No
Up to Date Project Health & Safety Plan
Up to Date Project Fire Safety Plan
Details in Respect to Shared Welfare Facilities
Accident Reporting Procedure
Contractor Provision
Health & Safety Method Statement Delivery Schedule
Health & Safety Method Statement(s)
Health & Safety Risk Assessments
Statutory Certificates & Registers for Plant and
Equipment
Understand Training Standard Requirements
Training Certificates - Skills (CITI, SOC etc.)
- First Aider
- Fire Marshall
Details Relating to Sub-Contractor Control
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3. Accident Type
Fatality 3 Day Reportable Serious Near Miss Incident
Specified Major Injury Dangerous Occurrence Non MOLISA Reportable
WSH Department Use Only:
WSH Distribution (BSC / MSC )
WSH Department Archive
Main Contractor Legal (Insurance Purposes)
MOLISA NOTE: All other persons must request access to report via WSH Department
Date Received:
Approved For Distribution: Initials: Date:
Accident Summary
Telephone:
Date of Birth:
Employer’s Details
Employer:
Address:
Telephone:
Company Contact:
Site Supervisor/
Line Manager:
Employer Status: (i.e. Contractor, Sub Contractor, Agency)
Accident/Incident Witnesses
Witnesses Name Employer Statement Attached (/)
Accident Details
Occurrence Events
Investigation Findings
Investigation Conclusions
Investigation Recommendations
STATEMENT OF OCCURRENCE
Document Number: HBC / HSE / FORM / 08
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STATEMENT OF OCCURRENCE
( NEARMISS /ACCIDENT/ DANGEROUS OCCURANCE/OTHERS)
Statement of Account
____________________________ _________________________
Name & Signature of interviewee Name & Signature of interviewer
Date : Date:
____________________________
Name & Signature of Person
Taking the statement
Date:
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YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
BULKY / UNWIELDLY DIFFICULT TO GRIP HOT COLD HEAVY LIGHT SHARP / ABRASIVE UNSTABLE ECCENTRIC SHAPE
CONFINED UNEVEN
HOT COLD HUMID WINDY DUSTY NOISY VIBRATING OBSTRUCTIONS STEPS SLOPES
SPACE SURFACES
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
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Process: Activity:
Location: Personnel at Risk
Risk To Health
Control Measures
Storage Disposal
Spillage Fire
Information
First Aid
Eye Inhalation
Contact
Skin Ingestion
Contact
Other Controls
Monitoring Record Attached Not Applicable
Health Record Attached Not Applicable
Surveillance
Training/Instruction Required
Verbal Instruction Written Instruction
Tool Box Talk Specialist Training
Assessed Received
by: by:
Designation: Designation:
Date: Date:
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PPE Requirements
Head Eye Hearing Foot Hand/Arm Body Resp. Fall Life Jacket High Vis Vest
Restraint (buoyancy
aid)
Make/Type/Model of PPE
Permit to Excavate
Document Number: HBC / HSE / FORM / 12
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Has a method statement been submitted with an attached sketch of the Yes No
area of the Excavate?
Is a cable locating device available on site to survey the area to Yes No
establish the location of any uncharted cables?
Are operatives conversant with safe Excavateging practices? Yes No
Other precautions
I hereby declare that the above precautions have been put into effect prior to the works commencing.
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MC Manager: MC Manager:
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Explosive/Combustible Atmosphere
Air Test
Date/Time
Oxygen %
Explosive Gas
Toxic Gas (H2S)
Other
Special Instructions
The above requirements have been met and shall remain in effect for the duration of the described work:
Name of Person in Charge of
Work (print) Signature:
All personnel and equipment are out of the confined space and it is safe to close up:
Name of Person in Charge of
Work (print) Signature:
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B: I hereby declare that it is safe to work on the following earthed metal enclosures or structures:
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I hereby declare that I ___________________________________ accept responsibility for doing the work
Name: ________________________ Sign: _____________________ Date: _______________ Time: _________
Section 4 Clearance To be completed by supervisor directly responsible for the works to be undertaken.
I hereby declare that all men under my charge have been withdrawn from the Location specified in this Permit and that all gear, tools
and additional equipment be removed.
I hereby declare that this Permit of Work and all copies thereof are cancelled.
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Controls/Precautions
8. Other Precautions
Failure to comply with any of the ticked precautions will result in hot work permit being suspended.
I hereby declare that the above precautions shall be put into effect prior to the commencement of operations.
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3N/A Comment
• Has the ground level area been suitably secured to prevent unauthorised
access to the building/structure
• Other precautions:
I hereby declare that the precautions identified above have been put into effect
I am satisfied that the precautions identified above are satisfactory for the works to be undertaken
I hereby confirm that the work to which this permit relates is now complete. All personnel and materials are now clear. The site of
demolition has ben left in a safe condition.
I am satisfied that the work area has been left in a safe conditions
THIS PERMIT IS HEREBY CANCELLED
Name: ________________________ Sign: ______________________ Date: __________________ Time: _________
Plant Permit
Document Number: HBC / HSE / FORM / 19
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PLANT PERMIT
Owner:
Plant:
Manufacturer
& Model:
Serial No:
Issue Date:
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Date of work(s) to be carried out: _________________(dd/mm/yyyy) ( permit is valid for the shift only )
Time the work(s) is carried out: ___________________(hh:mm); Time finish: _____________(hh:mm)
Location of work(s) to be carried out (attach plan): __________________________________________
Number of workers/operators: __________________________________________________________
Plant, equipment and machinery involved: ________________________________________________
Known hazards : ____________________________________________________________________
I, the undersigned, have full knowledge of the above work(s), safety precautions and requirements. I shall
undertake complete supervision and ensure that all safety precautions and requirements, but not limited to
the attached checklists , are complied with prior to the commencement, during and after work. I shall also be
responsible for any incident should I fail to ensure safety precautions and requirements highlighted by Main-
contractor. I shall inform and accompany the safety supervisor /officer to counter inspect before I commence
work.
Name of Task supervisor (applicant):______________________________________________________
NRIC/FIN:___________________________________________________________________________
Appointment: ______________________________ Signature: _________________________________
Organisation: ______________________________ Date of application: __________________________
Approval (by Main Contractor Permit issue officer )
I hereby confirm that the work to which this permit relates is now complete. All men and materials are now
clear. The site has been left in a safe condition, ie, physical/visible protection, warning notices, securely
fixed marked covers etc.
Name of Task supervisor:_____________________________________________________________
NRIC/FIN:________________________________Signature: _________________________________
I hereby confirm that the work to which this permit relates is now complete. All men and materials are now
clear. The site has been left in a safe condition, ie, physical/visible protection, warning notices, securely
fixed marked covers etc.
Name:_____________________________________________________________
NRIC/FIN:________________________________Signature: _________________________________
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Document:
Work at Height Rescue Plan Issue: Valid :
Location/area _____________________________________
JOB TASK:
Reference No.:_______________
Work at Height Dates: ______________________________
What is task to be done?
_________________________________________________________________________________
_________________________________________________________________________________
Operators:
Names of operators who are involved in the work at height:
1) ___________________________________ 2) ___________________________________
3) ___________________________________ 4) ___________________________________
5) ___________________________________ 6) ___________________________________
The Trained harness Checker is to check all individual suspension trauma straps are in good working
condition prior to proceeding with the work at height task and sign below.
RESCUE:
Communication:
What communication systems will be used between the suspended worker and supervisor / rescue
team? (Tick as appropriate)
1) Direct voice communication
2) Whistle
2) Mobile Phone
3) Two-way Radios / Headsets �
If the site rescue team is unable to affect a rescue within 5 minutes the Fire Department to be called on
Telephone Number - 114
In all instances inform the Site Safety Manager and safety Officer of the situation, ℡ -
_________________________________________________________________________________
N.B. Once the rescue team is in attendance and if required, a nominated person is to go to the
site entrance to meet, and direct the emergency services, and provide the following
information:
Which Floor / how high the casualty is: ___________________________________________
Safety of Rescuers: (Tick as appropriate)
Are there a sufficient number of rescuers available? Yes � No �
Is rescue equipment selected appropriate for nature of work? Yes � No �
What obstructions are in the way of reaching the suspended Operator?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Have assessments been made of anchor points, & are they in date for test? Yes � No �
Has consideration been made to method of attaching casualty? Yes � No �
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What equipment is needed to ensure rescue within 5 minutes in order to minimize suspension
trauma? (� as appropriate)
� Rescue ladder..…………………………………….. �
� Aerial ladder truck…………….………….…..…….…. �
� Rollgliss R250 Remote Rescue Kit………………. �
� Suspended access equipment ………………….... �
� Toxic shock strap…….…………………………….. �
� Climbing / rope rescue system………………….……. �
� Safety Ropes……………………………….………. �
� Crane man basket………….……………….…………. �
� Tower Crane.………………………..…….. �
� Stretcher……………………….………………….……. �
� First Aid Kit…………………..……………..….…...
� Resuscitator..…….…………….………….... �
If Operative is injured (� as appropriate)
Can casualty still be rescued within 5 minutes? Yes � No �
Is a qualified first aider who under stands suspension trauma present? Yes � No �
Who and how will the emergency services and hospital be alerted?
� Set up barriers_______________________________
Set up barriers_______________________________________________________
Other Considerations:
Lone working precautions (Detail):______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
APPENDIX 2
REGULATIONS REFERENCES