Ship Name: Ship Type: Date:
A. Ship Main Entry.
SL. No Check Point Status Remarks
1 Yard to ship bridge (Must have water level during high tide)
2 Ladder/Bridge Inspection (Visible LOTO card)
3 Ladder using rules (3 points rule visible on signage)
4 Lifesaving Appliance (LSA), Such as lifebuoy, Life jacket and rope.
5 Safe for ship entry (Signage)
6 POB/Live man score or head count
7 Walk-way and emergency exit arrow marking by paint
8 Signage (No smoking,
9 Bottom block hole and pipe head sealed by plate welding
10 Ship safety briefing by onboard HSE person.
A. Ship (Deck)
SL. No Check Point Status Remarks
1 All open hole, Confined space precautionary measures by visible precautionary
signage and barricading by caution tape.
2 All cutting edge around covered by railing.
3 Visible work related permits, signage and precautionary measure.
4 Tank or cargos holds ventilation by open hole and blower.
Deck has to clean from oil symptoms and oil shin.
5 Oily pipe head seal by poly.
6 Oil spillage kit box. (Must have kit as per list)
7 Dust Bin
B. Master Station (Emergency Assembly Point)
SL. No Check Point Status Remarks
1 Tool Box Talk meeting topic signage.
2 Emergency Alarm/Bell.
3 First aid box (Must have first aid items as per first aid item list with medical
officer seal and sign).
4 Emergency eye wash.
F. Accommodation & Engine Room
SL. No Check Point Status Remarks
1 Escape routes Emergency exit arrow marking by paint.
2 Walk-way has to be clean from oil spillage, oil shin, sludge and any obstacle.
3 Light and ventilation by open hole and blower.
4 Glass wool and other flying materials packed by ploy beg.
5 Engine room emergency door cutting and keep doorway spill barrier.
6 LSA and gang ladder keep on beside emergency door at engine room.
7 Oil spill kit.
8 Fire pump and Firefighting equipment (FFE), Rescue and Lifesaving Appliance
(LSA) put on designated area at engine room.
Ship Name: Ship Type: Date:
G. Lifting Gear.
SL. No Ancillary Items Physical
Condition
Visible
Calibration Tag
Calibration
Certificate
Remarks
1 Wire ropes and slings.
2 D-Shekels.
3 Bow shekels.
4 Hooks.
5 Chain blocks and lever hoists.
6 Sheaves and pulley.
7 Eyebolts and lifting eye.
8 Hydraulic Jacks.
9 Deck crane
10 Turnbuckles.
11 Lifting beams and spreader bars.
_____________ __________________
Checked By HSE Manager
Maintenance Engr.
Special Note:
All lifting gear must be thoroughly inspected prior to use and as per the scheduled maintenance
intervals.
1. Ensure all lifting gear is free from damage, deformation, or excessive wear.
2. Verify certification tags and ensure they are up to date and legible.
3. Check for any signs of corrosion, cracks, or unauthorized modifications.
4. Confirm that all load ratings are clearly marked and comply with operational requirements.
5. Lubricate moving parts if applicable, and ensure proper functionality of hooks, safety latches,
and locking mechanisms.
Action Required:
Any defect or non-compliance must be reported immediately. Defective lifting gear should be tagged
as “Out of Service” and removed from the operational area.
C. Fire Fighting Equipment (FFE)& Rescue Item.
SL. No Check Point Status Remarks
1 Fire pump.
2 Fire Extinguisher.
3 Fire Blanket.
4 Fire-fighter suits (heat-resistant).
5 Emergency Escape Breathing Device (EEBD).
6 Self-contain breathing apparatus (SCBA).
7 Rescue Tripod.
8 Stretcher.
9 Fire axes.
10 Communication devices (Walkie-Talkie)
D. Life Saving Appliance (LSA)
SL. No Check Point Status Remarks
1 Lifebuoy.
2 Life jacket.
3 Rope.
E. Fall Protection Equipment (FPE)
SL. No Check Point Status Remarks
1 Full body harness.
2 Fall arrestor device.
_____________ __________________
Checked By HSE Manager
Basic Safety Briefing
SL. No Discussion Topic Discussed Remarks
Yes No
Working Time: Total work hour- 8 Hours with lunch hours.
TBT Meeting: 8:00AM-8:30AM-30 Minutes.
Work Start Time: 8:30 AM.
Work End Time: 5:00 PM.
1 PPE: Helmet, Hard hat, Boiler Suit, Safety shoes, Gloves, Respirator Mask and as
per PPE matrix.
Work Permits:
2 Emergency Siren: Sounded 2Min long siren, 30 Second off, again Sounded 2Min
long siren.
3 Assembly Point: Assemblies point a designated safe area where all personnel
must gather in the event of an emergency such as a fire, gas leak, or sounded
emergency siren.
4 Fall Protection: Working at heights of 6 feet (1.8 meters)
Full Body Harness: Body harness + Lanyard + Anchor point.
5 Respirator Mask: Respirator masks are critical personal protective equipment
(PPE) used to protect workers from inhaling hazardous substances; Their
importance cannot be overstated, particularly when dealing with dust, fumes,
toxic gases, and biological hazards.
Fire Extinguisher:
6 Watch Your Head: Sign is a safety warning that alerts people to the presence of
a low overhead clearance or obstruction above them. It means you should be
cautious to void hitting your head.
7 Watch Your Step: Sign is a safety warning that alerts people to a potential
tripping or slipping hazard on the walking surface. It means you should pay
attention to where you're stepping to avoid falls or injury.
8 No unauthorized access to ship restricted areas: This safety sign indicates that
entry is prohibited to unauthorized personnel in specific restricted zones aboard
a ship. These areas may involve security risks, sensitive operations, or hazardous
conditions.
9
10
11
_____________ __________________
Briefed By HSE Manager