HSE

MANAGEMENT VISIT FORM

Country : KSA

Date : Aug, 14 , 2015

Project : Utilities (Package 8)

Name: Muhammad Naeem

Site : RAK

Function / Position :Safety Supervisor

Tour Summary :
HSE / Safety Observations (07)

Management Visit
Participation in :
Safety Meetings
General toolbox talk
Safety Training
Other :

SBM Cards: :
Other :

Overall impression
Poor
1

Excellent
2

HSE

Positive Findings

Daily toolbox meeting conducted

Good Housekeeping and cable management was observed inside tank# 7
PCMC have provided proper singes for waste skip.
PCMC have provided life line for roof work.

Opportunities for Improvement

Damaged welding cable was being used in tank # 8

GSW Welding machines were placed on the walkway near tank # 8
PCMC made excavation deeper than 2 meter without proper access and egress, and there is no
confined space permit to work.

Main Actions Taken

Welding foreman was asked to replace such cables immediately.

Relevant foreman was asked to address the issue on immediate basis.
Informed to HSE office the importance of the situation.

Page 1 of 10

HSE
MANAGEMENT VISIT FORM
WHAT TO DO?

WHAT NOT TO DO?

Lead by example, show your expertise

Do not interrupt abruptly someone who is

performing an hazardous activity

Wear proper PPE as per site requirements

Do not just focus on the negative observations;

emphasize the positives

Do demonstrate active caring for people

Do not fail to stand back and watch, ask

questions and provide opportunity for real time
communications

Take a constructive approach to negative observation

Do not appear expert in area in which you are not

Reward positive observation (using incentive

program, take the name or id number of the person for
later reward)

Always remember that a polite treatment will be

better received than rude manners

Note 1: The purpose of this checklist is to provide management with main guidance to perform a
Management HSE visit on site.
Note 2: The following list is not a comprehensive list.

HSE Observations
Items

PPE
Lifting
Equipment
Power & Hand
tools
Access and
egress
Electrical
Work
Hot Work
Confined
Spaces
Work at
Height

Housekeeping
/ Slips
Chemicals &
Waste
Barriers,

Examples of observations
Availability, good condition, suitability for the task,
used by workers
Equipment in good condition, color coded, safe
lifting and slinging practices, marking of equipment
with SWL
Condition of electrical appliances and cables,
vehicles and forklifts, guarding of rotating
machinery
Adequate access, card or tag system to monitor
people, signage for escape routes,
Permit to Work displayed, portable electric tools,
condition of tools/equipment, cables and cable
runs ,
Permit to work displayed, firefighting equipment
available, fire watchers, adequate protective
equipment
Entrance clearly indicated, Permit to work
displayed, atmosphere testing procedure, warning
signs, standby person
Scaffolds tagged, use of full body harness when
necessary, wearing of life vest when working over
water, openings protected with barricades, rescue
facilities,
General tidiness of work areas, walkways and
escape routes clear of obstructions,
material/equipment stored out of the way, no fire
risk,
Storage, secondary containment, label on
containers, containers closed, MSDS available,
free of spills,
Sufficient warning signs and barriers, clearly

Page 2 of 10

Comments

OK

OK

OK
OK
OK

OK

OK

OK

OK

OK
OK

Immediate Action
taken /
Discussion /
Intervention

HSE
MANAGEMENT VISIT FORM
signs and
notices

displayed, TASKS banners, pictorial signs, safety

alerts,

Other

Toolbox Topic:

Work Permit #:

Al-Shahrani
GSW
PCMC

HEAT STREE

Total Attendees
197
Time

Hazardous WP, Confined Space

Work permit

Sub-contractor involved:

Total Workforce:

06:00am to 11:30am

AL-SHAHRANI,GSW,PCMC
5-HSE Officer
1-HSE manager
13-Forman
4-Supervisor
6-Operator
168-Labor & helper

197

Equipment Inspected:
SOC (Safety Observation Card ):

Page 3 of 10

26
144
27

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND
DETAILS/ ACTION TO
BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

REVISED
BY

DATE TO
BE
CLOSED

AREA:
Package #8
TASK OBSERVED

Daily toolbox
meeting conducted
on Heat Stress

1.

14.08.15
05:50 AM

Page 4 of 10

ACTION TO BE
TACKEN:

GSW

INFO

HSE
MANAGEMENT VISIT FORM
Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND
DETAILS/ ACTION TO
BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

REVISED
BY

DATE TO BE
CLOSED

AREA:
Package #8
TASK OBSERVED

GSW Welding
machines were
placed on the
walkway near tank
#8
14.08.15
06:10 AM

ACTION TO BE
TACKEN:

2.

Relevant foreman
was asked to
address the issue
on immediate basis

Page 5 of 10

GSW

Immediately

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND
DETAILS/ ACTION TO
BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

AREA:
Package #8
TASK OBSERVED

Good
Housekeeping and
cable management
was observed
inside tank# 7
14.08.15
07:50 AM
3.

Page 6 of 10

ACTION TO BE
TACKEN:

GSW

REVISED
BY

DATE TO
BE
CLOSED

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND DETAILS/

ACTION TO BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

AREA:
Package #8
TASK OBSERVED

PCMC made excavation

deeper than 2 meter
without proper access and
egress, and there is no
confined space permit to
work.
14.08.15
08:50 AM

ACTION TO BE TACKEN:

4.

PCMC

Informed to HSE office the

importance of the situation.

Page 7 of 10

REVISED
BY

DATE TO
BE
CLOSED

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

LOCATION AND DETAILS/

ACTION TO BE TAKEN

PHOTO EVIDENCE

SUBCONTRACTOR
RESPONSIBLE

AREA:
Package #8
TASK OBSERVED

PCMC have provided life

line for roof work.

14.08.15
08:50 AM

ACTION TO BE
TACKEN:

5.

PCMC

Page 8 of 10

REVISED
BY

DATE TO
BE
CLOSED

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND DETAILS/

ACTION TO BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

AREA:
Package #8
TASK OBSERVED

PCMC have provided

proper singes for waste
skip.

14.08.15
09:00 AM

ACTION TO BE TACKEN:

6.

PCMC

Page 9 of 10

REVISED
BY

DATE TO
BE
CLOSED

HSE
MANAGEMENT VISIT FORM

Unsafe
Act N

DATE

PHOTO EVIDENCE

LOCATION AND DETAILS/

ACTION TO BE TAKEN

SUBCONTRACTOR
RESPONSIBLE

REVIS
ED BY

DATE TO BE
CLOSED

AREA:
Package #8
TASK OBSERVED

Damaged welding cable

was being used in tank # 8

ACTION TO BE TACKEN:

7.

21.06.15
10:50 AM

GSW

Welding foreman was

asked to replace such
cables immediately

Page 10 of 10

OPEN