HSE Observation Form

Activated Carbon Filter (ACF) Systems at GPP2, GPP3 and GPP4

S/N:
HSE OBSERVATION REPORT
ACF-MRA-062

To TTSB Location COMPRESSOR HOUSE GPP4 Zone N/A

1. Workers Reaction 2. Personal Protective 3. Position of People 4. Tools & Equipment’s 5. Procedure & Orderliness 6. Positive
Equipment Behavior
Correcting PPE Head, Face, Eye, Ear Fall / Caught in between Wrong for the job Procedure Inadequate Advise
Procedure Not Know /
Rearrange Jobs Hands & Arm Vibration / Noise Used Incorrectly X Action
Understood
Stopping Job Respiratory System Contacting Electric Current In Unsafe Condition Procedures Not Followed
Attaching Grounds Trunk Contacting Temperature Extremes
Inhaling, Absorbing or Swallowing
Legs & Feet
(Hazardous substance)

Observation Remarks : SA SC X UA UC Corrective Action

All workers working at height follow the 100% tie-off harness observed to Good Practices during working at height.
prevent from falling down especially during raining activity.

Issuer’s
Name
MOHD RADZI ABDULLAH Company TSD, PGB Date 20.11.15 Time 1710HRS Signature
Legend :
A condition likely can cause loss of life or body part of permanent disability or
Basic Course CLASS A extension loss of structure or equipment. E.g. Compressor operated without a
flywheel cover
01. Inadequate Engineering 06. Abuse & Misuse
A condition or practice likely to cause serious injury or disruptive property
02. Normal Wear & Tear 07. Inadequate Supervision CLASS B
damage. E.g. Oil observed on main walkway
03. Inadequate Maintenance 08. Physical Incapacity
04. Inadequate Purchasing 09. Lack of Knowledge A condition or practice likely to cause minor injury or non-disruptive property
CLASS C
05. Inadequate Work Standard 10. Improper Motivation damage. E.g. Workers handling metal pieces without gloves
TYPE “S” for Safety “H” for Housekeeping Immediate action is to be taken for Class “A” Hazards

HSE OBSERVATION PHOTO REFERENCE

REMARKS

Discipline Piping / Mechanical

Person In charge Yusli

RA / RAR / WL A Wizran / Zainuddin
PTW Related No. H0067807/08/09
CONTROL OF HIERARCY
Elimination
Substitution
Isolation
Engineering Control
Administrative Control X
Personal Protective Equipment
STATUS

Notified Contractor Yes No

Pendi
Follow Up Complete
ng
1

2
3

20.11.2015 @
Completion Date
1730hrs

Activated Carbon Filter (ACF) Systems at GPP2, GPP3 and GPP4