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compan y logo

Doc. No.

company name
FIRST AID BOX CHECKING Items as per Factories Act, 1948 Small sterilized dressings Medium- size sterilized dressings Large- size sterilized dressings Large-size sterilized burn dressings (15 gms) Packets sterilized cotton wool A bottle containing a two per cent alcoholic solution of iodine Salvolatile Solution Bottle (Savlon) Roll of adhesive plaster A snake-bite lancet Packet of potassium permanganate crystals Scissor First Aid Booklet Aspirin Tablets Ointment for burns (Burnol) A bottle of a suitable surgical anti-septic solution (Dettol) Location Expiry Date

Rev. No. Issue/Rev. Date

00 12.11.2010

Month:
Item No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Remark

Monthly Checking Done

Name

Sign

Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Fire Extinguihser - Master list


Extinguisher No. Location Type Capacilty Remarks

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 31 32 33 34 35 36 37 38 39 40 41

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Fire Extinguihser - Master list


Extinguisher No. Location Type Capacilty Remarks

42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Fire Extinguihser - Master list


Extinguisher No. Location Type Capacilty Remarks

83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No. Quarterly Checks Condition of Location Capacilty Safety Pin & Discharge Seal Horn, Handle Discharge Tube

CO2 EXTINGUISHER CHECKING


Yearly Checks Weight of CO2 Extinguisher Condition of Gross / Full Actual As on Diffrence in Valve Weight Weight Weight Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No. Quarterly Checks Condition of Location Capacilty Safety Pin & Discharge Seal Horn, Handle Discharge Tube

CO2 EXTINGUISHER CHECKING


Yearly Checks Weight of CO2 Extinguisher Condition of Gross / Full Actual As on Diffrence in Valve Weight Weight Weight Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA

Quarterly Checking Done

Yearly Checking Done

Name

Name

Sign

Sign

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

DCP EXTINGUISHER CHECKING


Quarterly Checks Yearly Check Condition of CO2 Cartridge DCP Safety Discharge Inner Gross / Full Actual As Diffrence in Powder Pin & Tube Container Weight on Weight Weight Seal

Location

Capacity

Squeeze Nozzle

Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

DCP EXTINGUISHER CHECKING


Quarterly Checks Yearly Check Condition of CO2 Cartridge DCP Safety Discharge Inner Gross / Full Actual As Diffrence in Powder Pin & Tube Container Weight on Weight Weight Seal

Location

Capacity

Squeeze Nozzle

Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

DCP EXTINGUISHER CHECKING


Quarterly Checks Yearly Check Condition of CO2 Cartridge DCP Safety Discharge Inner Gross / Full Actual As Diffrence in Powder Pin & Tube Container Weight on Weight Weight Seal

Location

Capacity

Squeeze Nozzle

Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

DCP EXTINGUISHER CHECKING


Quarterly Checks Yearly Check Condition of CO2 Cartridge DCP Safety Discharge Inner Gross / Full Actual As Diffrence in Powder Pin & Tube Container Weight on Weight Weight Seal

Location

Capacity

Squeeze Nozzle

Remarks

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA

NA NA NA NA NA NA NA NA NA NA NA

Quarterly Checking Done

Yearly Checking Done

Name

Name

Sign

Sign

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Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

MECHANICAL FOAM EXTINGUISHER CHECKING


Quarterly Checks Condition of Location Capacity Safety Pin & Seal Discharge Tube Foam Solution Yearly Checks Weight of CO2 Cartridge Movement Gross / Full Actual As Diffrence in of wheels Weight on Weight Weight Remarks

Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok

Ok Ok Ok Ok Ok Ok Ok

NA NA NA NA NA NA NA

NA NA NA NA NA NA NA

NA NA NA NA NA NA NA

Quarterly Checking Done

Yearly Checking Done

Name

Name

Sign

Sign

Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

Month:
Extinguisher No.

ABC EXTINGUIHSER CHECKING


Quarterly Checks Location Capacity (Kg) Nozzle Condition of Remarks Safety Pin & Seal Discharge Tube Nitrogen Pressure

Quarterly Checking Done

Name

Sign

logo

Doc. No.

company name
Month:
Condition of Hand Eye wash operated Showers valve

Rev. No. Issue/Rev. Date

SAFETY EYE WASHER CHECKING


Monthly checking

Sr. No.

Location Body wash Shower

Foot operated Valve

Remarks Any leakage Drain Pipe

1 2

Near Bay 05 Entrance Near DM Plant

Ok Ok

Ok Ok

No No

Ok Ok

Monthly Checking Done

Name

Sign

00 12.11.2010

Remarks

logo

company name
Month:
Monthly checking Sr. No. Location Condition of

SELF CONTAINED BREATHING AP

1 2

Near Bay 05 Entrance Near DM Plant

Ok Ok

Ok Ok

Monthly Checking Done

Name

Sign

Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

TAINED BREATHING APPARATUS CHECKING

checking Remarks

No No

Ok Ok

logo

company name
Month:
Condition of Monthly checking Sr. No. Location

AIR LINE CABINET CH

1 2

Monthly Checking Done

Name

Sign

Doc. No. Rev. No. Issue/Rev. Date 00 12.11.2010

AIR LINE CABINET CHECKING

checking Remarks

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