Contractor Name - : Check Sheet Concrete Bucket Doc Number:-HSE-CL-28 Project Name

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Check sheet Concrete Bucket Doc Number:-HSE-CL-28

Project Name:
Equipment No. Date of Inspection :
Location: Next Due Date:

7
3

5 1

-Contractor Name Doc No.:


SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEMS PHOTOS Y/N
S
Su
Wah
T
M
F S
Su
Wah
T
M
F
e e
Supporting legs are in good
condition free from any
Shutter are free from
1 crack/bend/dent/corrosion) & 5
leakage
erected in a firm and leveled
ground

Are Any Crack near joint of


Shutter are free and
2 Handle or it is found any 6
easy to operate
corrosion nearby

Secondary Protection is in
good condition and Rope
3
sling and D-shackle is
certified.

Bucket are free from


7
Concert

Inter connecting joints of


4 handle is free from corrosion
and damage DOCUMENTS

8
Concrete Bucket is tested and certified by third party

NAME SIGNATURE DATE


Checked by Engineering Incharge

NAME SIGNATURE DATE


Checked by Safety Dept.

NAME SIGNATURE DATE


Chkd by Operator / Signalman

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