HSE Observation Form

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

S/N:
HSE OBSERVATION REPORT
ACF-MRA-065

To TOYO Location GPK, AGRU Zone GPP4

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

Buddy System and working with valid PTW. Good practices.

Issuer’s
Name
MOHD RADZI ABDULLAH Company TSD, PGB Date 22.11.15 Time 1500HRS 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 Insulation

Person In charge Yusli

RA / RAR / WL Zainuddin / Nazman
PTW Related No. C0155498
CONTROL OF HIERARCY
Elimination
Substitution
Isolation
Engineering Control
Administrative Control X
Personal Protective Equipment X
STATUS

Notified Contractor Yes X No

Pendi
Follow Up Complete
ng
1

2
3

22.11.2015 @
Completion Date
1500hrs

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