Transcription of 表格格格格 表表 3A FORM 3A - Labour
1 [ 17(2) ] [reg. 17(2)] 3A FORM 3A FACTORIES AND INDUSTRIAL UNDERTAKINGS (SAFETY OFFICERS AND SAFETY SUPERVISORS) REGULATIONS WEEKLY REPORT TO BE PREPARED BY SAFETY SUPERVISOR EMPLOYED ON CONSTRUCTION SITES ( ) 17(2) Form approved by the Commissioner for Labour for the purposes of regulation 17(2) of the Factories and Industrial Undertakings (Safety Officers and Safety Supervisors) Regulations ( ) Name of Safety Supervisor ( ) Name of Safety Officer * ( ) Name of *Proprietor ( ) Name of Company Address of Construction Site ( ) ( ) Number of Workers For the week between and ( ) General Safety Check (G=Good; S=Satisfactory.)
2 P=Poor) ( ) Sunday Monday Tuesday Wednesday Thursday ( ) Friday ( ) Saturday Access and Egress ( ) Gangways Ladders Passageways Others Working at Height Scaffolds Working Platforms Floor Edges/Openings Lift Shafts/Openings Others SOSS-F3A-1 (Rev. 2002) ( ) General Safety Check (G=Good; S=Satisfactory; P=Poor) ( ) Sunday Monday Tuesday Wednesday Thursday ( ) Friday ( ) Saturday ( ) Earthwork Excavations Trenches Caissons Tunnels Slopes Others Lifting Appliances and Lifting Gear ( ) Cranes ( Tower Cranes, Gantry Cranes, Mobile Cranes, etc.) Winches Pulley Blocks Passenger Hoists Material or Skip Hoists, including Hoistway Suspended Working Platforms Chains, Ropes, Hooks, Slings Others Electricity Switches Wiring Fixed Installations Portable Lighting Portable Tools Welding Machines Others SOSS-F3A-2 (Rev.
3 2002) ( ) General Safety Check (G=Good; S=Satisfactory; P=Poor) ( ) Sunday Monday Tuesday Wednesday Thursday ( ) Friday ( ) Saturday ( ) Fire Prevention Fire Fighting Appliances ( ) Means of Escape Dangerous Goods Stores Gas Welding Cylinders Others Health Asbestos Control Dust Control noise Control Protection from Dangerous Substances First Aid Equipment Washing Facilities Latrine Others Machinery ( ) woodworking Machines Loadshifting Machines Abrasive Wheels Power Presses Others General Housekeeping Safety Nets and Fans Stacking of Materials Passageways Lighting Ventilation( ) (( ) ( )) Notice of Employment of Safety Officer/Safety Supervisor (YES/NO) Others SOSS-F3A-3 (Rev. 2002) ( ) General Safety Check (G=Good; S=Satisfactory; P=Poor) ( ) Sunday Monday Tuesday Wednesday Thursday ( ) Friday ( ) Saturday Personal Protective Equipment Helmets Eye Protectors Ear Protectors( ) Respirators Safety Belts Gloves Safety Shoes Reflective Jackets Others Recommendations Signature Safety Supervisor( ) Date ( ) ( ) I discussed this repo rt with the safety supervisor on.
4 Signature * / *Proprietor / Safety Officer Note: (1) * ( ) Proprietor includes the person for the time being having the management or control of the business carried on in the industrial undertaking or notifiable workplace and includes a body corporate and a firm and also the occupier of any industrial undertaking or notifiable workplace and the agent of such occupier. (2) Delete if inapplicable. SOSS-F3A-4 (Rev. 2002)
