HSE & BBS AUDIT FORM Reports P. No. Name Unit Administration Ammonia Unit Asset Integrity Bagging & Shipping Unit Clinic Club CSR MM GCF Electrical Engineering Department Equipment Maint. Fab. Shop Finance Horticulture Human Resource Info Tech Unit Inspection Unit Instrument Laboratory LLA Machine Shop Machinery Material Unit Medical Centre Planning & Development Plant Management Process Unit Production Project Unit Protocol Section Public Relat Dep Quality Asur Off Resident Manager HSEQ Security Section Civil Works Transport TTC Urea Unit Utilities Unit Vehicle Shop Date Time Area Administration Air Cond System Amm Storage Sys Amm Syn And Ref Ammonia Unit ARIM Bagging & Shipping Unit CCR Clinic Club CO2 Remo & Methan Cont-Out Ser Sec Cooling Tower Coolng Water Sys Desulphur & Refor DSP Gas Compression Electrical Engineering Department Envir Protection Equipment Maint. Fab. Shop Finance Fire Fightng FAC Fix Aset& St Acc Gas Compression Gas Sup Station GCF Unit Gen Management Horticulture Human Resource Inert Gas Gen Info Tech Unit Inspection Unit Inst & Plant Air Instrument Laboratory Liner Plant LLA FFC MM Machine Shop Machinery Mat Acc Unit Material Unit MIS Sup & Mnt Un Motor Pool Offsite FAC Planning & Scheduling Plant Management Power Generation Process Unit Production Project Unit Protocol Section Public Relat Dep Quality Asur Off Resident Manager Safety Unit Schools Security Section Special Projects (Maint) Staff Canteen Staff Club Steam Gen System Technical Services Township Township FAC Transport TTC Urea Unit Utilities Unit Vehicle Shop Vendor Servicmen Waste Water Disp Water Treatment Group or Single Group Single Auditor P. No. 1 Auditor Name 1 Auditor Info 1 Auditor P. No. 2 Auditor Name 2 Auditor Info 2 Auditor P. No. 3 Auditor Name 3 Auditor Info 3 Auditor P. No. 4 Auditor Name 4 Auditor Info 4 Job Audited Reactive Behavior Adjusting PPE Changing position Rearranging job Stopping job Attaching grounds/lockouts. Safe Work Practices Lock out/Tagout Confined space entry Communication of hazards Pre/post job inspection Excavation Radiation PPEs Head Gear Eye protection / face shielding Respiratory protection Arm & Hand covering Foot & Leg protection . Housekeeping Trash & Debris Cords/wires control Trip Hazards Excessive Barricading Warning Sign Tools & Equipment Wrong for the job Used incorrectly Tools in good condition Anti fall tool lanyard . . Ergonomics Forceful exertions Awkward postures Long duration w/o rest. . . . Body Position Pinch points Eyes on path Eyes on task/hands . . . Specific Job Risks Strike against or caught Line of fire Fall Slip hazard Contact hot, chemical / electric Inhale or swallow Positve Observation Opportunity for Improvement FFC Employee Name FFC Employee Designation Contractor's Employee Name Contractor's Company Name Toolbox Talk Conducted & Hazards Communicated? --- Select --- Yes No Not Applicable SUBMIT
