Item Description Score Remarks

2 General Work Permit or written instructions.

HES-OS.03-09/10, WP-II.7 (CPI initiated)
1

- Work Permit or authorization issued &

current
3 Job Safety Plan SH -0S.34, WP-II.8,
1
-Contractor JSAs and /or Safe Work Practices
or procedures on-site or available

4 Daily Tailgate Meeting HES-OS.03-20.6, WP-

I.11
1
- covers specifics from JSAs/SWP & recorded

- any worker concerns noted & addressed

5 Emergency Response / Communication /

First Aid HES-OS.03-13, WP-II.03. TF 000
1
653 8110

- ERP or Emergency communication plan

- qualified first-aider & first aid kit available

onsite or nearby
6 Appropriate PPE: WP-III, HES-OS.03-14
1
-head/eye/foot/ gloves/body/hearing

- respiratory: BA/respirator/dust mask if

required

7 Hand tool condition: WP-II-04

1
- fit for purpose- no major defects

- no site made tools

8 Power tool condition: WP-II. TF. 000 653 815
& 000 653 8109
N/A

- Electric / pneumatic/ hydraulic

- extension cords, air hoses, color code tagging

in place

9 Safe Access to work area: SD-01-04.

1

-walkways/ladders fit for purpose/ secured

-Extension ladders have 1.0m above landing

10 Welding & cutting: WP-II-03, TF

N/A

- flashback arrestors/reverse flow check valves

- fire watch, fire extinguisher, welding hood

11 Gas Celynder Handling: WP-II-03, TF-4.4.I.I
N/A

- Gas bottles secured/stored with cap on

- Safe gas celynder handling.

12 Site organization: WP-II.01, HES-OS.03-15

0 Sampah bekas sisa makanan
berserakan disekitar tempat
istirahat dan tidak adanya
tempat sampah

-equipment/materials organized/ housekeeping

- facilities -shade / water / toilet / wash supplies

- refer to Waste Management Inspection Report

Section Total 8 Total Possible- 12 8 N/A =

4
Attachment Action item pic
Item Description Score Remarks

A. GENERAL
1 Access Control. CPI FSWP
- All access control applied as per CPI FSWP guideline
1

2 General Work Permit or written instructions. HES-

OS.03-09/10, WP-II.7 (CPI initiated)
1

- Work Permit or authorization issued & current

3 Job Safety Plan SH -0S.34, WP-II.8,

1

-Contractor JSAs and /or Safe Work Practices or

procedures on-site or available

4 Daily Tailgate Meeting HES-OS.03-20.6, WP-I.11

1
 - covers specifics from JSAs/SWP & recorded

- any worker concerns noted & addressed

5 Emergency Response / Communication / First Aid

HES-OS.03-13, WP-II.03. TF 000 653 8110
1

- ERP or Emergency communication plan

- qualified first-aider & first aid kit available onsite or

nearby

6 Appropriate PPE: WP-III, HES-OS.03-14

1

-head/eye/foot/ gloves/body/hearing

- respiratory: BA/respirator/dust mask if required

7 Hand tool condition: WP-II-04
1

- fit for purpose- no major defects

- no site made tools

8 Power tool condition: WP-II. TF. 000 653 815 & 000
653 8109
N/A

- Electric / pneumatic/ hydraulic

- extension cords, air hoses, color code tagging in place

9 Safe Access to work area: SD-01-04.

1

-walkways/ladders fit for purpose/ secured

-Extension ladders have 1.0m above landing

10 Welding & cutting: WP-II-03, TF

N/A
10
N/A

- flashback arrestors/reverse flow check valves

- fire watch, fire extinguisher, welding hood

11 Gas Celynder Handling: WP-II-03, TF-4.4.I.I

N/A

- Gas bottles secured/stored with cap on

- Safe gas celynder handling.

12 Site organization: WP-II.01, HES-OS.03-15

0 Sampah bekas sisa makanan
berserakan disekitar tempat
istirahat dan tidak adanya
tempat sampah

-equipment/materials organized/ housekeeping

- facilities -shade / water / toilet / wash supplies

- refer to Waste Management Inspection Report

Section Total 8 Total Possible- 12 8 N/A = 4

B. Traffic Control / Equipment Score Remarks
1 Heavy trucks & equipment: WP-II.04, HES- OS.03.6 /
OS.29, TF 000 653 8108
N/A

- no deep cracks, cuts or gouges in tires

- no oil/fuel leaks
-operators following safe work practices

2 Signalman in place: HES-OS.29

N/A
- congested areas, reversing, OH lines

- maintains visual contact with driver at all times

3 Access to site: HES-OS.24

N/A
- overhead power lines Pipeline crossings etc.

- dust control in place for roads

4 Warning signs/ barriers: OS.24,TF. 000 653 8134, CPI
SOP - CONSTRUCTION TRAFFIC
N/A

- OH lines, speed, yield, special instruction

- Road resurfacing, excavations etc.

5 Stationary equipment condition: SD-05-06, HES-

OS.03(17.9)
N/A
-mixers / generators / power plants / storage containers

-fuel tanks 110% secondary containment/ storage etc.

Section Total 0 Total Possible- 5 0 N/A =

5
attachment