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HSE Observation Form

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

S/N:
HSE OBSERVATION REPORT
ACF-MRA-069

To TOYO Location GPK, AGRU Zone GPP2


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 X Advise
Procedure Not Know /
Rearrange Jobs Hands & Arm Vibration / Noise Used Incorrectly X Action
Understood
Stopping Job Respiratory System Contacting Electric Current X In Unsafe Condition X Procedures Not Followed
Attaching Grounds Trunk Contacting Temperature Extremes Housekeeping
Inhaling, Absorbing or Swallowing
Legs & Feet
(Hazardous substance)

Observation Remarks : SA SC UA UC X Corrective Action

One of the scaffolding teams from ABT maintenance (Profitrise – Immediate action by ACF Scaffold Inspector to remove the GREEN TAG
Scaffolding company) remove ACF metal deck without inform ACF teams and barricade that area to ensure no worker working on that area.
(Qimako – Scaffold or PMT) and left the opening area without install back
the metal deck. There also erected the scaffolding on that area. To request HSE ABT highlighted this SERIOUS ISSUE to Maintenance
Potentially workers fall down. teams.

Best practice, ABT maintenance should inform the ACF teams with
proper channel to ensure working area safe for everybody.

Issuer’s
Name
MOHD RADZI ABDULLAH Company TSD, PGB Date 22.11.15 Time 1645HRS 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 X 07. Inadequate Supervision CLASS B
damage. E.g. Oil observed on main walkway
03. Inadequate Maintenance 08. Physical Incapacity
04. Inadequate Purchasing X 09. Lack of Knowledge A condition or practice likely to cause minor injury or non-disruptive property
CLASS C
X 05. Inadequate Work Standard X 10. Improper Motivation damage. E.g. Workers handling metal pieces without gloves
TYPE X “S” for Safety “H” for Housekeeping Immediate action is to be taken for Class “A” Hazards

HSE OBSERVATION PHOTO REFERENCE

REMARKS

Discipline Piping

Person In charge Yusli


RA / RAR / WL Ahmad Wizran
PTW Related No.
CONTROL OF HIERARCY
Elimination X
Substitution
Isolation
Engineering Control
Administrative Control X
Personal Protective Equipment
Profitrise STATUS

Notified Contractor Yes X No


Pendi
Follow Up Complete
ng
1

2
3

Completion Date

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

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