安全隐患观察卡范本

COMPANY: ________________
POSITION:_______________________
DATE : __________________
TIME:______________________________
LOCATION:_______________________________________________________________
采取的整改措施: _____________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
(Goggles, face shield, glasses) 3) Hearing protection (ear plugs, ear muffs) 4) Respiratory protection (mask, filter) 5) Hand protection (gloves) 6) Fall protection (harness) 7) Coverall 8) Legs and feet protection (safety shoes)
7) 是否知道有工作程序 8) 是否了解工作程序 9) 程序是否完全 10) 是否正确执行程序 11) 是否执行作业许可 12) 是否执行危险/停工
决定
停止
安全隐患观察交流程序
观察
wk.baidu.com
行动/讨论
反馈 报告
安全措施: ____________________________________________________________________ ________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Please check and mark ( ) in BLOCKS
Personal protective equipment Safe At risk N/A Positions of people
Safe At risk N/A
1) Head protection (helmet) 2) Eyes and face protection
1) Know the procedure of the job
2) Understand content of the procedure
3) Procedure is adequate 4) Follow the procedure
correctly 5) Comply with permits 6) Comply with
2) Working in area of potential fall
3) Safety from electric current
4) Free from hazardous substances
5) Working under load
Procedures
Safe At risk N/A
Safe At risk N/A Safe At risk N/A
Reactions of people during observation 1) Is he adjusting personal
protective equipment 2) Is he changing position
suddenly? 3) Is he rearranging job? 4) Is he changing tools?
Observer’s signature _______________________ Date:______________________________
Part 2 : Supervisor/ Site safety Action to prevent reoccurrence for supervisor: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
PPE
安全 不安全 N/A 工作区域
9) 头部保护（安全帽） 10) 脸部面部保护（安全眼 镜、面罩）
11) 耳朵保护（耳塞） 12) 呼吸保护（呼吸器、过滤 器）
13) 手部保护 (手套) 14) 坠落保护 (安全带) 15) 工作服 16) 腿脚保护 (安全鞋)
6) 是否不易受打击 7) 是否有有坠落隐患 8) 是否会触电 9) 是否远离危险物 10）是否是重负荷
Safety Observation and communication
Report No: (No.Year/Site) ___________
Part 1: planned observers.(All SMOE and PTTEP employees and contractors)
OBSERVED BY:_______________________________
观察到的不安全行为描述: ______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Tools and equipment
1) Right for the job 2) In safe condition and
ready to use 3) Used correctly 4) Removing machine safety
guards
1) Free from striking against/being struck by objects
观察者签名 _______________________
日期:______________________________
2 : 监督或主管/ 现场安全 采取的防范措施: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
lockout/tagout
Decide Safety Observation and communication Feedback
Stop Observation
Act/discuss
Report
Safe practices: ____________________________________________________________________ ________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Super visor’s signature ______________________
Date:______________________________
Note: Please return to HSE department for keep records and statistics.
Corrective action taken: _____________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
XXX 项目安全隐患观察卡
Report No: (No.Year/Site) ___________
1: 计划观察人员（SMOE，PTTEPI 及 CSE 方）
观察者:_______________________________
公司: ________________
职位:_______________________
日期 : __________________
时间:______________________________
地点:_______________________________________________________________
Please check and mark ( ) in BLOCKS
Unsafe acts observed: ______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
安全 不安全 N/A
观察中人们的反应
5) 是否调整了 PPE 6) 是否突然移动了位置 7) 是否重新安排了工作 8) 是否有更换工具
工具设备
5) 适合用于工作 6) 设备工具条件状况 7) 是否正确使用 8) 是否移除了机器安全保护装 置
程序
安全 不安全 N/A
安全 不安全 N/A 安全 不安全 N/A