ACT02 50 MW WIND POWER PLANT

CHECKLIST SUMMARY

S.No Document No Project Name Checklist Name Remarks

1 PKAC-13.1-021-CLVI Liberty Vehicle inspection checklist

PKLB-13.1-021-CLVI
2 PKAC-13.1-021-CLFA Liberty First aid kit inspection checklist
PKLB-13.1-021-CLFA
3 PKAC-13.1-021-CLDG Liberty Diesel generator inspection
checklist PKLB-13.1-021-CLDG
PKLB-13.1-021-CLCI
4 PKAC-13.1-021-CLCI Liberty Crane inspection checklist

5 PKAC-13.1-021-CLOHSCM Liberty Overall hse site condition & PKLB-13.1-021-CLOHSCM

monitoring checklist
PKLB-13.1-021-CLLA
6 PKAC-13.1-021-CLLA Liberty Lifting activity checklist PKLB-13.1-021-CLAI
PKLB-13.1-021-CLSI
7 PKAC-13.1-021-CLAI Liberty Ambulance inspection checklist
PKLB-13.1-021-CLWFC
8 PKAC-13.1-021-CLSI Liberty Scaffolding inspection checklist PKLB-13.1-021-CLFP
PKLB-13.1-021-CLWH
WTG Foundation concrete pouring
9 PKAC-13.1-021-CLWFC Liberty
checklist PKLB-13.1-021-CLEX

10 PKAC-13.1-021-CLFP Liberty Fire preventation checklist PKLB-13.1-021-CLAHH

PKLB-13.1-021-CLWM
11 PKAC-13.1-021-CLWH Liberty Working at height checklist PKLB-13.1-021-CLPTA
PKLB-13.1-021-CLFBH
12 PKAC-13.1-021-CLEX Liberty Excavation checklist PKLB-13.1-021-CLAII
Accommodation, health and PKLB-13.1-021-CLE
13 PKAC-13.1-021-CLAHH Liberty
hygienic checklist PKLB-13.1-021-CLNLM
14 PKAC-13.1-021-CLWM Liberty Waste management checklist PKLB-13.1-021-CLFEI

15 PKAC-13.1-021-CLPTA Liberty Power tools audit checklist PKLB-13.1-021-CLHKI

PKLB-13.1-021-CLLCI
PKLB-13.1-021-BTR
16 PKAC-13.1-021-CLFBH Liberty Full body harness checklist

17 PKAC-13.1-021-CLAII Liberty Accident/incident investigation

report
18 PKAC-13.1-021-CLE Liberty Environmental checklist

19 PKAC-13.1-021-CLNLM Liberty Noise level monitoring form

20 PKAC-13.1-021-CLFEI Liberty Fire extinguisher inspection

checklist
21 PKAC-13.1-021-CLHKI Liberty House keeping inspection checklist

22 PKAC-13.1-021-CLLCI Liberty LPG cylinder inspection checklist

23 PKAC-13.1-021-BTR Liberty BODY TEMPERATURE RECORD

24 PKAC-13.1-021-ICOL Liberty INSPECTION CHECKLIST OF LOADER

25 PKAC-13.1-021-IOEWHGC Liberty INSPECTION OF ELECTRIC WATER

HEATER /GAYSER CHECKLIST

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY POWER TECH LIMITED. ANY UNAUTHORIZED USE, INCLUDING
MODIFICATION AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLVI

REV: 00
VEHICLE INSPECTION Issue Date: June 2020

Page: 01

NUMBER PLATE: DATE:

DRIVER LICENCE NO: MODEL No:

DRIVER NAME: TOTAL KILOMETER:

STATUS: ACCEPTED / REJECTED INSPECTION TYPE:

S.No Visual Check Yes No Remarks

1 Tires are in good condition?

2 Head/Tail Lights are working?

3 AC is in working condition?

4 Seat Belt installed and in working condition?

5 Reverse alarm is in working condition?

6 Power Windows are in working condition?

7 Horn is in working condition?

8 Windshield vipers are in working condition?

9 Brake system is in good condition?

10 Side indicators are in working condition?

11 Any Leakage found (Oil/ Water/ Diesel)?

12 Anti Lock system is working condition?

13 Parking Brake is working condition?

14 Permit certificate available

15 Fitness certificate available

E&P DEPARTMENT PERSON NAME & SIGN:

EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLFA

REV: 00
FIRST AID KIT INSPECTION Issue Date: June 2020

Page: 01

PROJECT:

FIRST AID KIT LOCATION: DATE:

STATUS: ACCEPTED / REJECTED

S.No CONTENTS QTY USES Remarks

1 Saniplast For Minor Cuts
For eyespurpose e.g. Avoid to sun
2 Eye Pads Sterile
exposure.
3 Triangular Bandage For fingur cuts & injury

4 Pyodine Cleaning wound and cuts

5 Antiseptic Skin Cream (Polyfax) For burn, minor cut

6 Gauze Bandage 2'' For Bandage to cuts

7 Alcohol Swabs For Cleaning purpose

8 Adhesive Tape For Dressing purpose

9 Disposable Gloves Pairs (Latex) For Handling injury, cuts

10 Normal Saline 100 ml For Cleaning wounds, cuts

INSPECTED BY:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLDG

REV: 00
DIESEL GENERATOR INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT: SHIFT OPERATOR’s NAME:

MAKE: MODEL/PLATE#

STATUS: ACCEPTED / REJECTED DATE:

S.No DESCRIPTION CONDITION Remarks

1 Oil leaks (engine)

2 Radiator (water leaks, water sufficient)

3 Cooling Water Hoses

4 Exhaust System/spark arrestor

5 Electrical Control Panel

6 Electrical distribution boardconnections

7 Earth Bonding Connections

8 Machine Lifting Eye

9 Fire Extinguisher

10 Fuel lines (leaks)

11 Fuel Tank and Filler Cap

12 Battery condition

13 Secondary containment (spill tray)

14 Emergency stop

COMMENTS:

E&P DEPARTMENT PERSON NAME

& SIGN
EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLCI

REV: 00
CRANE INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT: MACHINERY OPERATOR’s

NAME:
LOCATION: DATE:

STATUS: ACCEPTED / REJECTED SUBCONTRACTOR:

S.No DESCRIPTION YES NO REMARKS

1 Tires are in good condition

2 Driver Belt Condition

3 Head/Tail Lights are working

4 Hydraulic System ( Leak Operability)

5 Electric System lights, Indicators, Horn, and Wipers etc.

6 Speed Meter, Oil Temp/Pressure, Water Temp etc.

7 Radiator Condition

8 Fire Extinguisher

9 Windshield vipers are in working condition

10 Brake system is in good condition?

11 Side indicators are in working condition?

12 Any Leakage found (Oil/ Water/ Diesel)?

13 Crane and Operator Certificate (Available)

14 Parking Brake is working condition?

15 Guard (Rotating & Moving Parts)

16 Mirrors

COMMENTS:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
INSPECTOR NAME & SIGN:

EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

OVERALL HSE SITE CONDITION & MONITORING C

PROJECT: INSPECTED BY:

LOCATION: DATE:

S.No DESCRIPTION YES

1 EXCAVATIONS
a Excavations 1.2 M or greater shored sloped or benched
b Solid physical barricade around excavation, safe access and egress provided
c Cross over bridges equipped with handrails, planked and cleated

2 SCAFFOLDS AND LADDERS

Safe access & egress provided, ladder extends 1m above landing, drop bar installed, rigidand
a stable footing, planks crack free and secured and used only to support workers not as a pipe
support or other uses

b All guard rails installed - top rail, mid rail and toe boards installed if required
c Personnel engaged in scaffold work trained in Scaffold Erection and Fall Protection
d Scaffolds 12m and above approved & inspected by a competent Scaffold Engineer
Metal ladder not used around electrical services. Job made ladders only for Below Grade Work.
e
Ladders not painted
Ladders stored on racks and not left unsecured in the standing position. No materials stored on
f
ladders.
Two persons not allowed to work on the same ladder unless specifically designed for that
g
purpose.
3 VEHICLES AND MOBILE EQUIPMENT
a Lights, brakes, horns, back-up alarms working properly
b Seat belts provided and used
c Daily equipment inspection checklist completed by Operator
d Equipment used properly and as per the purpose it was designed
e Licenses or certifications as required

4 TOOLS AND EQUIPMENT

a The right tool is being used and used correctly for the task
b All protective safety guards and torque handles secured and used.
c Electrical power tools are double insulated, connected to a grounded
d Tools are maintained in a safe condition, inspected and color coded for the month.
Electrical cords in good condition (no taped splices) & color coded, Elevated 2m high,flagged for
e
visibility, routed away from walkways & water

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
f When required all material is secured and work benches utilized

5 SAFE WORK PERMITS

a Daily equipment inspection checklist completed by Operator
b Pre-talk-safety reviews (Toolbox Talks) available for review

c Evidence of safety plan being followed e.g., tie off, barricading, shoring/sloping, signage etc.

6 PERSONAL PROTECTIVE EQUIPMENT

a Approved hard hats, safety glasses, hearing protection, face shields, safety foot wear.
b Clear safety glasses worn inside buildings and poorly illuminated work area

c Arc shield worn during welding, burning, grinding,

chipping
d Proper foot protection ,gloves worn for job performed for concrete or other activity.

7 CANTEEN & KITCHEN

a Sufficient seating provided & cleaned .
b Cutting boards & working desk cleaned.
c Waste bin available & cleaned.
d Water dispenser / Water Cooler available
e Kitchen crew health record maintained.
f Cook & Service personal wear caps & apron.
g Sufficient hand washing & dry facilities provide.

8 TOILETS

a Wash basins clean taps / shower working

b Toilets are cleaned & flushing syetem working.

c Floors are cleaned

d Lighting adequate

e Toilet papers /muslim showers /lota provided.

COMMENTS:

EHS MANAGER NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLOHSCM

REV: 00
CONDITION & MONITORING CHECKLIST Issue Date: June 2020

Page: 03

INSPECTED BY:

NO N/A REMARKS

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

LIFTING ACTIVITY CHECKLIST

PROJECT: OPERATOR’s NAME

LOCATION: DATE:

STATUS OF ACTIVITY: COMPLETED / NOT COMPLETED SUBCONTRACTOR

S.No DESCRIPTION YES

1 TBT is delivered prior to start of activity

2 Third party test certificate of cranes display inside the cabin

3 Load chart display inside the operato cabin

4 Crane riggers have sufficient experience to perform the job

5 Check position of Crane

6 Crane counterweight have been installed according to crane manufacture's specs

7 Crane steel wire have been installed according to the crane manufacture's specs

8 Outriggers of crane are extended, if required

9 Ambulance / First aid box is availble at site during the activity

10 Working area is barricated

11 Rigging gears, shackles and slings have been checked

12 Current wind speed at site _________ m/s

13 Crane work is under the supervission of lifting supervissor

14 Fire-extinguishers are available on working site

15 Any leakage found like diesel, Engine oil

16 Lifting work is under the transmission line

17 PPE's requirement is followed according to the activity

18 Any person found the under the suspended load / weight

19 Effective communication between the crane operator and rigger is established

20 According the visual inspection of slings, shackles are satisfactory

21 Make sure the chain is marked with the safe working load (S.W.L)

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
Ensure the visibility level is sufficient while installing the WTG Mid tower , Top tower and
22
nacelle, Crane operators and riggers can see everything clear.

COMMENTS:

SITE SUPERVISOR NAME & SIGN:

EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLLA

REV: 00
G ACTIVITY CHECKLIST Issue Date: June 2020

Page: 01

OPERATOR’s NAME:

SUBCONTRACTOR:

NO REMARKS

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLAI

REV: 00
AMBULANCE INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT: DRIVER's NAME:

LOCATION: DATE:

STATUS: ACCEPTED / REJECTED SUBCONTRACTOR:

S.No DESCRIPTION YES NO REMARKS

1 Tires are in good condition

2 Seat Belt Condition
3 Head/Tail Lights are working
4 Mega phone
5 Radiator Condition
6 Hooter is working condition
7 Fuel level
8 Fire Extinguisher
9 Windshield vipers are in working condition
10 Brake system is in good condition
11 Side indicators are in working condition
12 Any Leakage found (Oil/ Water/ Diesel)
13 Parking Brake is working condition
14 Mirrors
15 Oxygen Cylinder
16 Emergency light / siren lights
17 Front and central AC is working
18 Medical Equipments
19 Stretcher
20 Spare tyre
21 Doctor Chair

COMMENTS:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
INSPECTOR NAME & SIGN:

EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLSI

REV: 00
SCAFFOLDING INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:

STATUS: ACCEPTED / REJECTED HC/SUBCONTRACTO

R:

S.No DESCRIPTION YES NO REMARKS

1 Wooden planks have been provided in the structure

2 Verticality of standards has been checked and found ok

3 Ladders are properly fixed

4 Brasses have been provided for strength of structure

5 Planks are properly fixed and secured

6 Toe boards have been provided with all the platforms

7 Mid rail has been connected with the structure

8 Hand rail has been attached more than 1 meter high

9 Scaffolding has been leveled properly

10 Angle of ladders is 75 degree and location acceptable

11 Ladder is fixed from both end I.e. top and bottom

The scaffolding has been provided with green tag and the valid
12
date and authorized signatures.

COMMENTS:

INSPECTOR NAME & SIGN:

EHS PERSON NAME & SIGN:

INDUS WIND ENERGY LIMITED (50MW)
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLWFC

WTG FOUNDATION CONCRETE POURING REV: 00

CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:
SITE SUPERVISOR NAME & EHS PERSON NAME &
SIGN: SIGN:

STATUS
S.No DESCRIPTION (√ or X) REMARKS

1 TBT is delivered prior to start concrete pouring □

2 All workers working inside the pouring area is following HSE rules □
3 PPE's are worn by all workers working inside the concret pouring □
4 Trafic flow is planned properly □
5 Electrical wiring found good condition □
6 Fire extinguisher found in place prior to main concrete pouring □
7 Availibility of ambulance ensured prior to main concrete pouring □
Barricade found properly supported prior to main concrete
8
pouring □
9 High visible PPE's are used when required □
10 Water showering found prior to main concrete pouring if required □
11 Provision of long shoes during main concrete pouring □
Housekeeping of site found effective ? Prior to main concrete
12
pouring □
Proper lighting arrangement during night time main concrete
13
pouring □

COMMENTS:

EXECUTIVE MANAGER NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
EHS MANAGER NAME & SIGN:
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLFP

REV: 00
FIRE PREVENTATION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:

EHS PERSON NAME: INSPECTED BY:

STATUS
S.No DESCRIPTION (√ or X) REMARKS

1 Is the designated smoking area notified □

No smoking signs and posters displayed in the hazardous area of
2
project site □
All the combustible material has been removed from the work
3
site □
4 All the electrical devices are provided with protection systems □
5 Circuit breakers have been provided. □
Hot work (welding, grinding and cutting) is allowed only after
6
obtaining the hot work permit from concerned authorities □
All the requirement of work permit alongwith fire watcher or fire
7
extinguisher are being fulfilled □
All the HSE rules being observed for fuel storage and refueling the
8
vehicles at the project site. □
9 Adequate fire extinguishers provided & people trained □
10 Smoke detectors provided in offices & stores □

COMMENTS:

EHS MANAGER NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLWH

REV: 00
WORKING AT HEIGHT CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:

EHS PERSON NAME: AREA SUPERVISOR

NAME:

STATUS
S.No DESCRIPTION (√ or X) REMARKS

1 All the workers have been explained safe work procedures. □

2 Work area inspected before starting of the job □
3 All workplatform ensured to be of adequate strength □
4 Walkways provided with hand rail, mid rail and toe guard. □
5 Flameable material, if any are cleared □
6 Ladders placed at right slope □
7 Ladders, staircases bolted properly □
Fabricated made shift arrangements and checked for quality and
8
type of material welding, anchoring etc. □
9 Are ladders properly secured to prevent slipping, sliding or falling □
Platforms and walkways free of oil / grease or other slippery
10
spillage □
11 All PPE's should be followed as per requirements □
12 Flammable material, if any, are cleared □
13 Proper Housekeeping □

COMMENTS:

EHS MANAGER NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLEX

REV: 00
EXCAVATION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

EXACT LOCATION: DATE:

EXCAVATION FOR: EHS PERSON NAME:

AREA SUPERVISOR
INSPECTED BY: NAME:

STATUS
S.No DESCRIPTION (√ or X) REMARKS

Excavated machinery are inspected and its emission certificate

1
posted inside the cabin □
2 Is the method of excavation shored, sloped? □
3 Is there a water seepage or stagnating water? □
4 Has the plan been made to use de-watering system? □
Are all the excess materials stacked at least 1 meter away from the
5
edge of the excavation? □
6 Has adequate safety signs and barricades been placed? □
In the case of road crossing has all the necessary traffic diversion
7
and safety rules and regulations been taken care of? □
Has toolbox meeting been conducted to explain the hazards
8
involved in this work? □
9 Are required PPE's used during the excavation □
10 Are ladders properly secured to prevent slipping, sliding or falling □
11 Proper sloped when excavation depth is 2 meter or above □
12 Proper Housekeeping when completed th job □

COMMENTS:

EHS MANAGER NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLAHH

ACCOMMODATION, HEALTH AND REV: 00

HYGIENIC CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

EXACT LOCATION: DATE:

INSPECTED BY: EHS PERSON

NAME:

S.No DESCRIPTION STATUS REMARKS

(√ or X)
Is drinking water facility connected through a water filter and filter
1
gets replaced regularly? □
2 Is sufficient showering water available in showering area? □
3 Cloth washing facilities and sufficient water available. □
4 Are Floors are free from any damage and kept neat and clean? □
5 Are Air conditioner are in good condition? □
6 Light are in good condition □
Is Good House keeping including surrounding of accommodation
7
free from the waste.? □
8 Are sufficient fire extinguisher and first aid medicine are available.? □
"No Smoking" sign posted where it is not allowed i.e flammable and
9
any oils. □
10 Are the bath rooms, toilets and wash basins kept cleaned regularly. □
11 Are sufficient toilets available for the personnel accommodation.? □
Are wash basin available for the personnel accommodation near
12
toilets facility? □
13 Are bath room available for the personnel accommodation. □

COMMENTS:

ADMIN MANAGER NAME & SIGN:

EHS MANAGER NAME & SIGN:

INDUS WIND ENERGY LIMITED (50MW)
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLWM

REV: 00
WASTE MANAGEMENT CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:

INSPECTED BY: EHS PERSON

NAME:

S.No DESCRIPTION STATUS STATUS REMARKS

YES NO
1 Is Certified waste disposal contractor?

All waste bins, waste containers and hand trolleys are in good
2
condition.

3 All septic tanks are properly covered and no outflow is present

around septic tanks.

4 All wastewater is diverted to septic tank sewer line and no spread

of wastewater in open environments.

5 Fume pipes are in good condition on septic tanks.

6 Any damage to septic tanks.

7 All employees and sanitary workers have been hired according to

their past experience in relevant fields and projects.

8 Necessary PPEs and uniforms for sanitary workers are in place.

No waste is present at un-authorized locations other than main

9
waste collection area.

10 Waste transport vehicles are properly covered.

11 No litter is spread outside and around the bins.

12 All drivers and sanitary workers have received relevant trainings.

COMMENTS:

ADMIN MANAGER NAME & SIGN:

EHS MANAGER NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLPTA

REV: 00
POWER TOOLS AUDIT CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

EXACT LOCATION: DATE:

INSPECTED BY: EHS PERSON

NAME:

S.No DESCRIPTION STATUS REMARKS

(√ or X)
1 Power tools properly insulated and secured. □
2 Connection socket is in safe working condition. □
Power supply cable connected with the tool is in acceptable
3
working condition. □
4 Safe guard has been provided for moving parts. □
5 Cutting / grinding disk has been properly fitted. □
6 The handle of power tool is in reliable working condition. □
7 The attached power distribution boards are properly secured. □
8 The circuit breaker has been provided with the power supply circuit. □
The power distribution box has been connected with earthing
9
device. □

COMMENTS:

E&P INCHARGE NAME & SIGN:

EHS INCHARGE NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLFBH

REV: 00
FULL BODY HARNESS CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

FULL BODY HARNESS NO: INSPECTION DATE:

NEXT INSPECTION
INSPECTED BY: DATE:
CONDITION: GOOD FAIR POOR

STATUS
S.No DESCRIPTION (YES or REMARKS
NO)
1 Check Full body harness by visual inspection. □
2 Damages, cracks, cuts found in harness belt. □
3 Two Lanyrd "Y" with absorber □
4 Tuf tug for fall arrest system available. □

COMMENTS:

EHS INCHARGE NAME & SIGN:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLAII

ACCIDENT/INCIDENT INVESTIGATION REV: 00

REPORT Issue Date: June 2020

Page: 02

PROJECT:

DATE: DAY:

TIME: WEATHER:

LOCATION OF ACCIDENT:

ACCIDENT INVESTIGATION TEAM:

WHAT TASK WAS BEING PERFORMED AT THE TIME OF THE ACCIDENT?

WHAT HAPPENED?

WHAT FACTORS CONTRIBUTED TO THE ACCIDENT?

ENVIRONMENT: EQUIPMENT/MATERIALS:

□ Noise □ Layout / design □ Wrong equipment □ Equipment failure

for the job

□Lighting □ Dust / fume □ Inadequate □ Equipment too heavy

maintenance /awkward than Surface Level

□ Vibration □ Slip / trip hazard □ Inadequate □ Inadequate training provided

guarding

□ Ground Surface having low □ Other □ Other

load bearing capacity
WORK SYSTEMS: PEOPLE:

□ No formal Hazard □ No / inadequate risk assessment □ Drugs / alcohol □ Procedure not followed / no
Identification done conducted procedure exists –No Lifting Plan

□ No / inadequate controls implemented

□ No / inadequate safe work e.g. □ Lack of communication (Use of Sign
procedure TBT not conducted and activity was not □ Fatigue Language between Chinese Rigger and
under HSE Inspection by EPC Contractor Pakistani Crane Operator)

□ Hazard not reported □ Absence of training / supervision □ Change of routine □ Distraction / personal issues / stress

□ Other □ Time / production □ Other

pressures
 INDUS WIND ENERGY LIMITED (50MW)
CORRECTIVE ACTIONS:
What are we going to do to fix
Contributing factor Who? When? Completion date
the problem?

ACCIDENT INVESTIGATION PROCESS REPORT

1, ESTABLISH THE FACTS OF THE ACCIDENT , INCLUDING:

QUESTION: REPLIES

What Happened?

When and Where did it

happen?

What task was being done?

Who was involved?

Were there any witnesses?

2, NECESSARY INFORMATION DURING ACCIDENT INVESTIGATION

Maintenance Records

Safe Work Procedures

Instructions Manuals

Training Records

3, CONSIDER ALL THE POTENTIAL CONTRIBUTING FACTORS:

4, IDENTIFY THE ROOT CAUSE:

REVIEW AND COMMENTS BY SUPERVISOR:

NAME SIGNATURE DATE:

 INDUS WIND ENERGY LIMITED (50MW)
REVIEW AND COMMENTS BY CONTRACTOR PROJECT MANAGER (IF A CONTRACTOR
ACCIDENT)
NAME SIGNATURE DATE:

REVIEW AND COMMENTS BY HDEC HSE MANAGER:

NAME SIGNATURE DATE:

REVIEW AND COMMENTS BY HDEC PROJECT MANAGER:

NAME SIGNATURE DATE:

 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLE

REV: 00
ENVIRONMENTAL CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

LOCATION: DATE:

INSPECTED BY: EHS PERSON

NAME:

DISPOSAL
S.No DESCRIPTION QUANTITY DISPOSAL REMARKS
COMPANY NAME

NON HAZARDUS WASTE:

1 1- General waste
2- Food waste

HAZARDUS WASTE:
1- Medical waste
2 2- Grease waste
3- Oil Filter waste
4- Oily Rags & Grease Rags

3 WATER CONSUMPTION:

LIQUID WASTE:
4 1- Liquid waste
2- Chemical
3- Oil Spillage

AMBIENT AIR QUALITY:

5 1- General Air
2- Diesel Generator Smock analysis
3- Vehicle /Machine smock

NOISE LEVEL:
1- Machineries noise
6 2- Generators
3- Heavy duty vehicles
4- Batching Plants

DUST EMISION:
7 1- Trafic movement
2- Construction

8 DAMAGE OF INFRASTRAUCTURE

9 OPEARTIONAL PHASE IMPACT

COMMENTS:

EHS MANAGER NAME & SIGN:

.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-
CLNLM
REV: 00
NOISE LEVEL MONITORING FORM Issue Date: June 2020

Page: 01

PROJECT:

DATE: INSPECTED BY:

INSPECTOR NAME & SIGN:

S.No LOCATION WORK ACTIVITY NOISE SOURCE NOISE LEVEL REMARKS

(DB)
1

10

NOTE: NOISE ACCEPTANCE LEVEL=85DB

COMMENTS:

EHS MANAGER NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

FIRE EXTINGUISHER INSPECTION CHECKLIST

PROJECT:
NEXT
INSPECTED DATE: INSPECTION INSPECTED BY
DATE:

CAPACITY/ LOCK/ INSPECTION PRESSURE DISCHARGE

S.No Fireextinguisher No: LOCATION: TYPE: SEAL
WEIGHT PIN TAG GAUGE HOSE

COMMENTS:

E&P INCHARGE NAME & SIGN:

EHS INCHARGE NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLFEI

REV: 00
R INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

INSPECTED BY:

DISCHARGE
REMARKS
NOZEL

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-CLHKI

REV: 00
HOUSE KEEPING INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

PROJECT:

EXACT LOCATION: INSPECTION DATE:

INSPECTED BY:

CONDITION: GOOD FAIR POOR

STATUS
S.No DESCRIPTION (YES or NO) REMARKS
1 Necessary sinage /Posters provided and kept clean. □
2 Waste bins placed & emptied regularly. □
3 Seprate bin provided for hazardous & non-hazardous waste □
4 Area free of superflous & redundant materials. □
5 Lights,window glass kept clean. □
Offices and accommodation area kept clean and free of
6
contamination. □
7 Insecure and missing Drainage line/man hole covers. □
8 Toilets clean. □
9 Water available. □
10 Smoking area available/smoking bins available. □
11 Safety signages well placed ,neat and clean. □
12 Emergency phone/cell numbers posted. □
13 Emergency response plan well publicized/implemented □
14 Safety equipment/Fire extinguishers placed and inspected regularly. □
15 Dust suppression /water shawering conducted. □
16 Drinking water point clean and free from water spillage. □
Site roads are kept clear of stacked material for free & safe vehicle
17
movement. □
Heavy material stacking are taken care of to prevent slips, collapse
18
& rolling. □
19 Oil,slippery surface not present. □
Flammable storage areas are isolated from store, office & work
20
areas. □
21 Materials placed on racks are safely accessible

COMMENTS:
 INDUS WIND ENERGY LIMITED (50MW)
EHS INCHARGE NAME & SIGN:
 2x50 MW LIBERTY WIND POWER PROJECT

LPG CYLINDER INSPECTION CHEC

PROJECT:

EXACT LOCATION: INSPECT

INSPECTED BY:

CONDITION: GOOD FAIR POOR

S.No DESCRIPTION 1 2 3 4 5 6 7 8 9 10 11 12 13 14

1 Body：No breakage, no crack, no

serious corrosion.

Valves: no breakage, flexible operation

2
and no leakage.

Bushing: good appearance, no

3 breakage, the next time to change the
label is intact.

Hose: good appearance and no

4
breakage. The next time is well marked.

5 Adequate fire fighting equipments.

Position: the position is correct and

6 there is no sundries around.: the
position is correct and there is no
sundries around.

7 Signature.

COMMENTS:

EHS INCHARGE NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-CLLCI

REV: 00
R INSPECTION CHECKLIST Issue Date: June 2020

Page: 01

INSPECTION DATE:

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

BODY TEMPERATURE RECORD

PROJECT:

EXACT LOCATION:

INSPECTED BY:

Daily Temperature
S.No: Name of Person Signature
Mon Tues Wed Thu
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
Daily Temperature
S.No: Name of Person Signature
Mon Tues Wed Thu
31
32

COMMENTS:

EHS INCHARGE NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-BTR

REV: 00

Issue Date: June 2020

Page: 01

Daily Temperature
Fri Sat Sun

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT
Daily Temperature
Fri Sat Sun

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 INDUS WIND ENERGY LIMITED (50MW)
DOC No: PKIWEL-13.1-021-ICOL

REV: 00
INSPECTION CHECKLIST OF LOADER Issue Date: Sep 2020

Page: 01

MACHINERY
PROJECT: OPERATOR’s
NAME:
LOCATION: DATE:

STATUS: ACCEPTED / REJECTED HC/SUBCONTRAC

TOR:

S.No GENERAL REQUIREMENTS YES NO REMARKS

1 Tires are in good condition
2 Driver Belt condition
3 Head/Tail Lights are working
4 Hydraulic System ( Leak Operability)
5 Electric System lights, Indicators, Horn, and Wipers etc.
6 Speed Meter, Oil Temp/Pressure, Water Temp etc.
7 Radiator Condition
8 Fire Extinguisher
9 Windshield vipers are in working condition
10 Brake system is in good condition?
11 Side indicators are in working condition?
12 Any Leakage found (Oil/ Water/ Diesel)?
13 Loader Frame Cracks
14 Parking Brake is working condition?
15 Floor mat / Headliner
16 Instruments gauges
17 Operator Manuals
18 Inspection / Engine Door
19 Oil Level gauge indication
20 Engine make model No checked
21 Engine cooling condition check?
22 Bucket pins condition check?
23 Doors operation handles
24 Overall Loader visual condtion

COMMENTS:

INSPECTOR NAME & SIGN:

EHS PERSON NAME & SIGN:

 2x50 MW LIBERTY WIND POWER PROJECT
DOC No: PKIWEL-13.1-021-IOEWHGC

INSPECTION OF ELECTRIC WATER HEATER REV: 00

/GAYSER CHECKLIST Issue Date: Sep 2020

Page: 01

PROJECT:

LOCATION: ROOM / CONTAINER DATE:

STATUS: ACCEPTED / REJECTED HC/SUBCONTRACTOR:

S.No GENERAL POINTS OF GAYSER YES NO REMARKS

Outer condition of electric water heater is in good

1
condition?

2 Is any rust or corrision is found any where?

3 Are wires are properly coverd?

4 Temperature of gayser is in limit?

5 Pressure valve is in installed?

6 Pressure valve is in working condition?

7 Is any water leakage found?

8 Is electric supply is proper?

9 Is gayser cover are fitted properly?

10 Is gayser is repaired / New

11 Is heating element is in good condition?

12 Name plate is visible are not

COMMENTS:

E&P INSPECTOR NAME & SIGN:

EHS PERSON NAME & SIGN:

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.
 2x50 MW LIBERTY WIND POWER PROJECT

THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF LIBERTY WIND POWER. ANY UNAUTHORIZED USE, INCLUDING MODIFICATION
AND REPRODUCTION OF THE CONTENT IS STRICTLY PROHIBITED.