Document No:- RSIPL/EHS/REPORT/HO/01

MONTHLY ENVIRONMENTAL HEALTH AND Revision No:- 0

SAFETY REPORT
Date of Issue:- 08.11.2022

PROJECT SITE -
Month Ref:

NAME OF SITE NAME OF SITE MANAGER

Phone No & Alternate phone No
NAME OF PROJECT MANAGER
E-mail Address
Average
EHS Aggreement Name of Engineer nominated Workmen Manhours
Name
signed (Yes/NO) for EHS including Worked
Sl. No Staff Total Manhours Worked
Total No. of Contractor 1 NO
2 NO
3 NO
4 0
(KPI) This Month Cumulative Records Verified Sl. No Topic discussed
1
2
Total No. Pep talks conducted Yes
3
4
Monthly Safety Meeting Date of meeting
conducted yes
Weekly Safety Inspection Date Conducted
conducted
Motivational Program conducted Total paricipants
(Prize Distribution) (Target Audience)

No. of Near Miss Identified 0 Uploaded in Sheet 2

YES No
Date Activity
Total Risk Assessment Conducted

No. of Loss time Accident 0

No. of First-Aid Accident 0 Uploaded in Sheet 2 YES No

Future activities needs Shut-Down /LOTO or High Risk Activity etc
Remarks: (Difficulties/Gaps identified in implementing EHS guidelines )
Site Manager
 Document No:- RSIPL/EHS/CHECKLIST/HO/02
JSA Revision No:-
Date of Issue:-
00
08.11.2022

JOB SAFETY ANALYSIS

Working Location: - DATE PREPARED: DATE
DIVISION:
ISSUED:
Rev. No: -

DESCRIPTION OF JOB/TASK: EQUIPMENT/TOOLS USED:

PREPARED BY: PREPARED BY: REVIEWED BY:

APPROVED BY: APPROVED BY: APPROVED BY:

SEQUENCE OF BASIC JOB STEPS POTENTIAL HAZARDS RECOMMENDED ACTION OR

PROCEDURE
 Document No:- RSIPL/EHS/REPORT/HO/O3
Minutes of Meeting Revision No:- 00
Date of Issue:- 08.11.2022

MOM No. Date Time to

Project Name
Topic
Chairperson

Participants of the Meeting

1.
2.
3.
4.

Topics discussed

Target
No Discussion Action to be Taken Responsibility Status
date
1
2
3
4
5
6
7
8
9

10

11
Insert cells above this (if there are more decisions taken)
Attach Meeting photos for evidence:

Next Meeting Will be held on Signature of Chairperson (PM)

Name (PM/Manager):- Name (EHS Manager/Engg./Supervisor):

Signature with date: Signature with date:
 Incident Reporting Template Doc Number: RSIPL/EHS/REPORT/HO/04

Where Who PM/PH

(Project/Unit) (Victim name, age,
Location of Event Employee or CIRCLE
contractor) HEAD

Event Type When: EHSO

(LTI/Fatality) (Event Date & Time) VP
What Happened (event description): Why: Root cause (*To be investigated further)

Event Picture (on the next slide) & Immediate Action Corrective and Preventive Action
Picture
 Document No:- RSIPL/EHS/REPORT/HO/05
Contractor EHS Performance Revision No:- 00
Evaluation Date of Issue:- 08.11.2022

Check list No: Location No: Date Of Evaluation:

Name Of customer/Client: Project Code & Name:
Name of Subcontractor: Name of Site Engineer/Supervisor/Foremen:

Name of PM/Site Manager: EHS Person:

Statistics Last month Cumulative (till last month / end of contract)

1 Average manpower
2 Average man-hours worked
3 First aid accident
4 Medical aid accident
5 Lost time injury accident
6 Fatal accident
7 Near miss incident
8 Environmental damage
9 Property damage
10 Vehicle accident
11 No. of appreciations given
12 No. of warnings / penalties given

This evaluation must be completed by the concerned site engineer and safety
officer/engineer (both together) on a quarterly basis and report to be submitted
to Project / Site Manager and HO EHS head.

Category Good Satisf. Avg. Poor

Adherence to EHS Requirements
1 Adherence to induction of new workman (safety pass)
2 Compliance to work permit.
3 Compliance to Material Safety Data Sheets (MSDS) requirements.
4 Compliance with site EHS instructions.
Participation:
5 Attendance for EHS meetings.
6 Attendance for EHS trainings.
7 Participation in accident investigations.
Housekeeping
8 Existence of weekly housekeeping program.
9 Overall site housekeeping practices.
10 Chemical hazard control.

Name (PM/Manager/Engg./Supervisor:- Name (EHS Manager/Engg./Supervisor):

Signature with date: Signature with date:
 Document No:- RSIPL/EHS/REPORT/HO/05
Contractor EHS Performance Revision No:- 00
Evaluation Date of Issue:- 08.11.2022

11 Fire control measures.

12 Flammable and explosive materials control.
13 General waste – trash collection and storage.
Contractor Safety Program:
14 On site safety officer / safety representative.
All workman employed by the Contractor have been managed effectively
15 with reference to EHS and Quality (meets company standards, practices
and/or procedures).
16 Internal EHS training for their team.
17 Internal EHS meeting.
18 Updates to written safety programs.
Tools and Plants and Equipment:
19 Availability of required tools / plants and equipment.
20 Condition / maintenance of contractor’s tools / plants and equipment.
21 Contractor’s knowledge and proper use of tools / plants and equipment.
22 Contractor’s tools / plants and equipment certification readily available.
23 Contractor’s materials inspection/acceptance program followed.
Execution of Work:
24 Cooperation in implementing EHS procedures.
25 Attitude / behaviors at site.
26 Contractor’s planning of work.
27 Timely closure of reported deviations.
Key Field Personnel:
28 Competence of main office staff and management.
29 Quality of first and second line supervision.
Project Management/Supervision:
30 Control on own team.
31 Control of subcontractors if any.
32 Contractor’s ability to obtain qualified personnel.
33 Contractor’s ability / willingness to procure required PPE.
34 Contractor’s ability / willingness to procure safety signage / posters.
Issues and Concerns:
35 Readiness to accept responsibility.
36 Hazard / signage warning / Safety devices / equipment in place.

TOTAL

Name (PM/Manager/Engg./Supervisor:- Name (EHS Manager/Engg./Supervisor):

Signature with date: Signature with date:
 Document No:- RSIPL/EHS/REPORT/HO/05
Contractor EHS Performance Revision No:- 00
Evaluation Date of Issue:- 08.11.2022

OVERALL PERFORMANCE:

Any specific issues or concerns with the contractor:

Would you hire this contractor again to do similar work:

How can this contractor improve on its past performance:

Evaluation by (Name & Sig.):

Good: 91% - 100% compliance Satisfactory: 75% - 90% compliance
Average: 50% - 75% compliance Poor: Less than 50% compliance
In case of non-applicability of a particular point, put a dash in all the boxes / cells.

Name (PM/Manager/Engg./Supervisor:- Name (EHS Manager/Engg./Supervisor):

Signature with date: Signature with date:
 Document No:- RSIPL/EHS/REPORT/HO/06
EHS VIOLATION MEMO Revision No:-
Date of Issue:-
00
08.11.2022

EHS VIOLATION MEMO

Applicable for Both RSIPL employee(s) and Sub-contractor(s)
Business Unit : TL, Substation, Railways Date:
Site/Project Details : Company Employee
Memo no : Contractor
Violation by : Contractor Worker

Issued by : Others

Brief Description:

Action plan:
Level 1 Level 2 Level 3
Counseling Counseling Suspension
Coaching & Training Coaching & Training Termination
Written warning Written warning

Financial penalties Financial penalties

Fines & penalties: cc to finance, State CC: Circle head Financial penalty of Rupees only to
head, Plant Head/ Circle Head EHS head sub-contractor ( not for any
HR/Admin individual)
Others for info or high light the ............................................
process ............................................
Imposed to (Name of agency with
brief)........................................
Repetition of Violation Suspension period

In case of Denial reason: Escalation to Top management

Remarks & Comments for further improvements:

Name (PM/Manager) Name (EHS Manager/Engg./Supervisor):

Signature with date: Signature with date:
 Document No. RSIPL/EHS/REPORT/HO/07
Revision No 00
EHS AGREEMENT Date of Issue 08.11.2022

R.S INFRAPROJECTS PVT LTD

ENVIRONMENT,
HEALTH and SAFETY
(EHS)

EHS
AGREEMENT

FOR
SUB-CONTRACTOR,
SUPPLIER,
TRANSPORTER &
SERVICE PROVIDER.

This will be a mandatory attachment for any contract documents as an annexure or

supplement.
This document has three parts:

1. General Safety requirements for all contractors and service providers (of any type)
2. Annexure A: Guidelines for PPEs
3. Details Terms & Conditions that apply if PPEs are provided by the company
(RS Infraprojects Pvt. Ltd.).

Prepared By Reviewed By Approved By

Debasish Das-EHS Manager Management Management
01-08-2022 10.09.2022 10.09.2022

The Contractor Signature:………………...

Introduction:

The objective of this guideline is to brief RSIPL’s EHS requirements to its contractors. To be
in-line with the company’s EHS policy, each person is responsible for continual EHS culture
improvement and therefore has accountability to ensure compliance of EHS parameters during
work execution. In this regards, there is a minimum level of safety responsibility and
subsequent safety implementation at site, expected from all RSIPL’s contractor/suppliers.

To achieve the expected safety goals, all contractors must have a commitment to apply and
follow all safety rules and procedures stated in this EHS Agreement.

Definitions:
The Company: First Party – RS INFRAPROJECTS PVT. LTD. and its authorized
representative e.g. site team / EHS team / Customer, Client etc.
The Contractor: Second Party – Service provider (transportation vendors, passenger or logistic
vehicle supplier) company, contractor / sub-contractor (Foundation, mechanical and electrical
contractors at site / units / offices or manpower suppliers etc).

The Contractor shall follow all safety instructions given by the Company. No idle charge or
extra payment shall be considered for Safety Training, Safety meeting, Safety Induction and
Pre-Medical Examination or any mentioned safety requirements in this EHS agreement that are
required to be met by the Contractor. Any materials / equipment / examinations that had to be
bought / done to meet the Company’s safety requirements, will be made by the contractor at
their own cost.

The Contractor shall have no right to decide the applicability of certain EHS requirements in
case of a conflict. If it is found that the Contractor is doing any activity which is against the
EHS requirements of RSIPL, then the Company reserves the right to penalize the contractor or
terminate the contract. Further The Company reserves the right to reject any or the complete
EHS requirements of the Contractor.

It is the Contractor’s responsibility to visit the work site and to satisfy the Company as to the
extent of the work and all conditions under which the work will be carried out. No claims based
on the lack of any such knowledge shall be entertained. The Company will recover (from the
Contractor) the cost (if any involved) for any consequential effect (due to non-compliance to
the Company’s EHS requirements) on the Company’s facilities / properties inside or outside
the work location.

[Link] EHS requirements / conditions:

1. Safety and cleanliness of the work area is the Contractor’s responsibility.

2. Every contractor workman must be aware of the risks resulting from the work that he
performs and the safe work procedure.
The Contractor Signature:………………...
3. All activities falling in the scope of the Contractor is to be assessed for risk by the
Contractor in consultation with the Company and risk mitigation techniques to be followed
as suggested (by the Company) thereafter.
4. Each workman shall be responsible for maintaining his personal safety during work
execution. In the event of unsafe circumstances for which safety precautions have not been
taken, he shall referto his supervisor / engineer (of the Company or the Contractor) in order
to take the precautionsand arrangements to perform the work in a safe manner.
5. Loose clothing (of any type) is not allowed at work sites or restricted working area.
6. No activity shall start or continue in the absence of the supervisor / engineer (Full time
supervisor). The Contractor shall not assign a workman as a supervisor or vice versa.
7. The Contractor is responsible to maintain Good Housekeeping and regular cleaning of The
Company’s working area / those areas (of The Company) occupied by The Contractor and
to maintain proper hygienic condition.
8. Provide temporary shelter for breaks and eating at the work site. There should be sufficient
rest shelters as to accommodate all the workmen.
9. The Contractor shall at its own expenses shall arrange (as applicable) for….
a. Accident Prevention Tools (APT) / Welfare Tools such as revere alarm / back horn and
seat belt (for their vehicle), Fire Fighting Equipment (for their office, vehicle, crane, DG
Set and required places), First Aid Boxes (for their team)
b. Personal Protective Equipment (e.g. safety helmet with chin strap, safety shoes, hand
gloves, dust mask, goggles, full body safety harness with double lanyard and shock
absorber etc.) as required for the work. It may change subjected to work nature and
Client requirement.
c. Collective Protective Equipment (e.g. scaffolding / barricades - soft and hard, safety
cones, fire extinguishers, fire buckets)
d. Safety Training (The Contractor has to send their workmen for The Company’s Safety
Induction Program at their cost and for such other training as may be required).
e. Medical checkup of his team, additional Pre-Employment Medical Examination (for
some specified work) in his operation / activities and when required at their cost.
10. The Contractor shall arrange all PPE (personal protective equipment) well in advance and
maintain a record of distribution with signature of receivers. PPE shall be confirming to
relevant ISI / BIS / CE specifications (at least any one) and shall be of right fit to
employees.
The type and quality of PPE that the Contractor wishes to use at the site has to be
approved by the Company’s safety personnel.
11. Non-compliance with the provisions of this EHS agreement or those EHS instructions that
are given from time to time by the Company either verbally / written (via e-mail, other
documents) shall be deemed as a violation of the Company’s requirements, and shall
exempt the Company from the liability for any damages resulting from noncompliance with
the EHS instruction of the Company regardless of the type and volume thereof. Further,
such acts (violation of the Company’s regulations) can also lead to penalizing the
Contractor by the Company.

The Contractor Signature:………………...

 Duties and responsibilities of The Contractor supervisor / engineer:

1. The duty of familiarizing a workman with the safety requirements and the possible and
existing risks at the workplace shall fall upon his immediate supervisor / engineer of The
Contractor.
2. The supervisor / engineer shall carry out frequent periodical inspections on the work site,
equipment, tools, operation and surrounding circumstances as a part of their duties and shall
work on duly correcting the notes and unsafe conditions. Until corrected, the supervisor /
engineer shall not ask his workmen to work.
3. The supervisor / engineer shall attend the entire safety meeting organized by the Company.
4. Supervisor / engineer shall ensure that all workmen under their supervision comply with all
rules applicable to their job.
5. Supervisor to ensure that all works are started only after getting work permit from the
Company.
Smoking prevention:

1. Smoking is prohibited at all the work premises controlled by the Company. Smoking could
be allowed only in designated smoking area (if any identified by The Company).
2. Providing a designated smoking area is at the discretion of The Company.
3. In the places where smoking is allowed, matchsticks and cigarettes must be disposed of in
the container specified for this purpose after making sure of extinguishing the same.
Environment preservation:

1. The Contractor is fully responsible to follow all environmental norms including controlling
of oil spillages, waste management, handling of hazardous waste, control of noise etc. as
statutorily required or directed by the Company from time to time if anything. Collection,
storage and sorting of waste must be in compliance with the law and with the Company site
procedures.
2. The Contractor is responsible for segregating wastes (like hazardous / flammable /
chemical) and managing all type of waste materials / products generated by his work and its
safe disposal (as required by local statutory requirements)if applicable.
3. All measures are to be adopted and implemented to ensure that air / soil / water are not
polluted.

Unsafe act / unsafe condition / accident / near miss reporting / rectification:

1. Workman going to site without safety induction is deemed as an unsafe act.

2. Rectify immediately any unsafe conditions existing in their work area. If it is outside their
scopeof work / power / area / supervision, the same has to be immediately reported to the
Company.
3. All accidents, near miss events to be reported to immediately to the Company.
4. The Contractor has to participate in the accident investigation to find the root cause. The
accident/ near miss investigation team will be formed by the Company. In the event of an
occurrence of an accident affecting one of the Contractor workman in connection with the
activity concerned, the Company will authorize the Contractor’s participation to the

The Contractor Signature:………………...

 investigation.
Employment age :

The Contractor shall ensure that all his workmen have completed the age of 18 years.
Workmen, who have not completed the age of 18 years, shall not be engaged in any activity by
The Contractor.

Training :

1. Before assigning or mobilizing any workman (engineers / supervisors / worker) of the

Contractor to a job, they shall be sent to the Company’s EHS department for safety
induction training program. This is a mandatory requirement. While coming for the training
program, The Contractor Workman shall come with the complete set of personal protective
equipment (PPE) for the work he is assigned to (without which he shall not be trained).
After the training program and on receipt of relevant documents (medical certificates / skill matrix)
2. The supervisor / engineer of the Contractor shall ensure that his workmen have received the
necessary training to qualify them to carry out their work in a safe manner.

Pre-employment medical check-up:

1. All workmen must be medically fit to perform their respective job and should be certified as
medically fit by a doctor. This will be applicable all works performed by all contractors.
Apart from medical fitness certificate, The Contractor shall arrange for medical checkup for
all his workmen before employment and shall ensure that no person with anyof the following
disease is employed by him at any of the Company site / units / business.
(i) Epilepsy (ii) Colour blindness (iii) Deafness
(iv) Unfit to work at height (for applicable contractor)

2. Workman engaged in height work, should have medical certificate saying they are fit for
such works (height work) in additional to general work fitness.
3. The Contractor shall employ only trained, skilled and competent persons and medically fit
workman. Record of such medical checkup shall be maintained and made available by the
Contractor for inspection by the Company at any time.
4. Medical fitness certificate is to be obtained from a MBBS doctor and it is a pre-requisite to
attendthe safety induction program.

Records:

The following record of employment shall be maintained by the Contractor and produce to
the Company as and when asked for the records.
(i) Name of the workman (ii) Age
(iii) Work designation and job scope (iv) Pre-employment medical check-up
(v) Aadhar card copy
(vii) Training records
The Contractor Signature:………………...
 (ix) Length of service with the Contractor and total years of experience
Other documents as required by the Company are to be maintained and produced as and
when demanded by The Company.

First-Aid :
The Contractor shall arrange necessary first aid equipment at the site for their workman. The
kit shall be periodically checked for stock quantity and expiry of medicines. It is the
responsibility of the Contractor to replenish the stock. A first aid registers also to be kept to
ensure that all first-aid accidents are reported.

Driving / Transportation:

1. Drivers of vehicles or machines must have the necessary licenses and qualifications
2. Smoking / talking in cell phone is prohibited while driving the vehicle
3. The Contractor’s workmen and their transporters shall follow the local state / country
government traffic rules and the Company’s road safety rules (speed limit / parking etc.).
4. Ensure drivers or any people do not sleep under parked vehicles; all drivers shall wear
appropriate Personal Protective Equipment at site (as defined by site / unit management).
5. Use vehicles (car / bus / other transportation vehicle for human and material) that are in
excellent roadworthy conditions i.e. brakes / tires / vehicle body, both rear view mirrors in
good condition,good seats, seatbelt neat and in good working condition.
6. The Contractor shall be fully responsible for safe and secure transportation of material with
loadingand unloading done with safe, certified and tested tools and equipment.
Travelling on the bed of the trailer / truck or trunk of the pick up or at any such place which is
outside the cabin of the vehicle meant for passengers to sit, is prohibited.

EHS rules applicable during the carrying of job by The Contractor:

1. Daily review:
When required by the Company, the Contractor’s supervisor / engineer of the site shall attend
a daily meeting on the site office / work site, prior to the start of the daily job, to ensure that:

 All services of the Contractor remain compliant with the safety plan
 No unforeseen tasks not covered in the safety plan arise
 No new element prevents application of the safety instructions agreed by both parties.

Minutes of meeting shall be provided by the site.

Local / statutory / government laws / rules / regulations – Government regulations:

The Contractor shall understand all the applicable Government regulations pertaining to his
activities and shall apply it all and full and that all people are required to abide by all such
Government regulations. These government regulations may be the existing one or that new
onesthat may come during the course of the Contractor’s on-going work.

The Contractor Signature:………………...

Breach of contractual agreement:

1. Consequences of failure to apply the EHS rules by The

Contractor in case of:
- Non-compliance by the Contractor to the requirements detailed in this EHS agreement, or
- Repetitive violation of EHS requirements, or safety performance being, or becoming
insufficient and if a corrective action plan is not implemented or does not enable to achieve
the required level,

Then, the Contractor is considered as in breach of its material obligations under the
agreement concluded for the execution of the job affected by the above non-compliance.
The Company maytherefore at its sole discretion apply any penalty or liquidated damages as
provided in the said agreement or even suspend or terminate the said agreement for default of
the Contractor without prejudice to any other rights or remedies available to it under the
agreement, for the Company to claim any further liability towards the Contractor.

2. Exclusion of staff members:

If The Contractor’s staff or third party staff acting on its behalf do not-comply with the
Company requirements (such as but not limited to deviation from a communicated EHS
Operational Instruction, deviations from the Safety Plan) The contractor is aware and agrees
that the Company has the right to temporarily, or permanently exclude the breaching
Contractor’s staff or third party’s acting on its behalf.

3. Suspension or termination of contract:

In the event of serious or imminent situation that may jeopardize the safety or security of the
staff working on the site, including the Contractor’s staff or its third party staff acting on its
behalf for the execution of the services at site, or that may jeopardize the environmental
conditions or public at the site or nearby the site, the Company may request at its own
discretion the immediate suspension of the services until the situation is returned to normal
conditions, or depending on the nature of the situation may request the permanent end of the
services. In this case, the Contractor shall bear its own costs resulting from such suspension
or termination. In this case, the Company is only liable to pay the Company for the services
actually executed at site and approved by the Company until the suspension or the
termination of the services. No further indemnity or payment may be requested by The
Contractor.

4. Penalty:
If The Contractor breaches the stipulated agreed terms and conditions on health safety and
environment, then the Contractor shall be liable to pay penalty or damages under this
clause.

Any penalty imposed on The Company (by its customer / Government) due to negligence of
the Contractor, will be recovered by the Company from the Contractor. At any case no
penalty to any individual will be imposed. It will be imposed to The Contractor.

The Contractor Signature:………………...

J. The Company EHS requirements :

The Contractor shall follow all the EHS requirements of The Company, as said in this
EHS Agreement. The Contractor shall also agree to follow all those new EHS
requirements that maybe formed during the course of the work as the result of:
a. New government laws / rules
b. New Client / Customer EHS requirements
c. Action plan developed on the outcome of an Accident Investigation
d. New and safe technology or material available at market
e. Any other EHS requirement The Company as part of continual improvement program.

2. EHS - ANNEXURE A:

1. Personal Protective Equipment:

The Contractor shall ensure that following PPE shall be available in minimum at all time
and shall be used by employees without exception whatsoever at all construction site and
units (excluding office area or area demarked as Non PPE Zone).

Personnel PPE
All employees working at Safety helmet (with HDPE shell and chin strap) and safety
construction sites / Units shoes with steel toe cap and safety reflective jackets.
Workers mixing asphalt material Gum-boots with steel toe.
cement, lime mortar, concrete Safety goggles and safety gloves for all effected site
and using such hazardous personnel and contractor has to be replaced periodically to
materials. ensure clear vision and adequate protection.
Welders Welding screen, safety shoes with rubber sole, leather hand
gloves, apron and hand & leg sleeves.
Jack hammer, DG set and Ear muffs, hand gloves & safety goggles.
compressor etc. operator
Electrician Rubber hand gloves (as per voltage rating) and non-
conductive safety shoes.
Workers engaged in cleaning or Dust mask, hand gloves and goggles.
similar works
Workers working at height Full body Safety Harness with double lanyard, shock
absorber and large hooks.

The Contractor shall arrange all above PPE well in advance and maintain a record of
distribution with signature of receivers. Above PPE table does not state / mention all
required PPE at The Company works. Concerned EHS or other supervisory staff of The
Company can be contacted to understand the complete PPE requirement for a particular job.

The Contractor Signature:………………...

2. Employment of experienced / competent persons - for all activities and operations, The
Contractor shall:
1. Employ only trained skilled, competent and medically fit persons. The persons holding valid
license approved by the relevant law enforcing / regulating agency should only perform
followingjobs:
a) Electrical works on high & low-tension lines
b) LMV and HMV Driving c) Heavy earth moving equipment operations
d) Blasting e) Other (as applicable)
2. Eye sight of the employees in the following category shall be examined every six months.
(i) Crane operators (ii) LMV/HMV drivers
(iii) Heavy earthmoving equipment operators (iv) Other (please Specify)

3. Details Terms & Conditions that apply if PPEs are provided by the
company (RS Infraprojects Pvt. Ltd.).

If, as per the work order, all personal protective equipment falls under the company
scope, the below given guidelines will be followed across the project of the company.

1. The contactor should provide details of PPEs requirements, including quantity and
size of PPEs, to the project in-charge and store in-charge at least 15 days before the
team arrives on site for work.
2. The contractor should ensure the proper utilization of PPE and take necessary care
of all personal protective equipment issued to them by the company.
3. The contractor will be responsible for the loss of issued PPE. Re-issue will be made
by proper certification from the site/project and the cost for the same will be
deducted from their invoice.
4. Once the contractor has completed their work on the project, they must return all
PPEs (returnable only) in good condition. The cost of the PPEs will be subtracted
from the contractor's invoice or retention if they don't comply.
5. Returnable Safety materials:- Safety Helmet, Safety Full body harness/Rope grab,
Gum Boot, Welding shield, Life line, First Aid box, Fire extinguisher, Retractable
Wire Rope Fall Arrester , Hard Road barriers, Safety Cones, Safety
flag(Red,Green)& Electrical Hand gloves etc.
6. Non-Returnable safety materials:- Safety Shoes, Reflective Jackets, Cotton hand
gloves, Barricading/Warning tape etc.
7. All PPEs will be issued to contractors based on the company guidelines and the
frequency will be maintained as given below.

The Contractor Signature:………………...

 SR. NO Item Description Unit Life in Months

1
Safety Helmet Nos. 24
2
safety Shoes Pair 12
3
Reflective Jackets Nos. 6
4
Gum boots Pair 12
5
Electrical Gloves Pair 12

6
Welding Shield Nos. 12

7
Safety Goggles Nos. 6
Safety Full Body
8
Harness/Rope grab Nos. 24

Other than the aforementioned safety items, if anything else is issued in accordance with the
nature of the job, the site safety staff or project in charge will decide its duration and
communicate it to the contractor at the time of issuance. This will be done with the approval of
the HO EHS Department.
Declaration:

By signature of this document, The Contractor confirms that it has read and understood all of
the above EHS rules and processes applicable to the site for the execution of the services. All
the above conditions are acceptable to the Contractor and the Contractor undertakes to apply
them and makethem apply to their personnel and to any third party acting on their behalf.
This document prevails over any other document signed upon the parties strictly for its subject
matter, that is to say the EHS rules applicable at the site for the execution of the services by
the Contractor.

Made on _ (date), at _ (location).

Name of the Contractor (Company Name) ….………………………………………………….

Name, function and signature …………..…………………………………..…

of the Contractor’s authorized person
(with Company seal) …………..…………………………………..……

The Contractor Signature:………………...

 Document No:- RSIPL/EHS/REPORT/HO/08

EQUIPMENT TRACKING SHEET Revision No:- 0

Date of Issue:- 08.11.2022

EQUIPMENTS TRACKING SHEET

COMPETENC EQP. 3rd

REG NO / TYPE OF NAME OF DRIVING
DRIVER Y PARTY [Link]
S: NO PLANT SAP EQUIPMENTS DRIVER/OPT LICENSE COMPANY/HIRED
LICENSE NO CERTIFICATE CERTIFICATE ATE NO
CODE NO. /MODEL NO R [Link]
ISSUES [Link]

1
2
3
4
5
6
7
8
9
10

Prepared By: Approved by:

 Document No: RSIPL/EHS/REPORT/HO/11

WORK STOP NOTICE Revision No:

Date of Issue:
00
08.11.2022

Part A - GENERAL (Completed by Originator)

WSN NO. DATE (DD-MM-YY) TIME (HH:MM)
PROJECT PLACE / LOCATION NO.
CLIENT RSIPL REPERSENTATIVE
SUB - CONTRACTOR NO. OF WORKMAN INVOLVED

Part B - DETAILS OF WORK STOP NOTICE (Completed by Originator)

Activity Stage (Level - 1) Civil Mechanical Electrical Process / Sub-Activity (Level - 2)

You are requested to stop the work immediately due to following Violation / deficiencies observed with reference to

Technical Specifications Approved Drawings Relevant Standards Work Methodology / SOP

Work Instructions EHS Manual HIRA Job Safety Analysis (JSA)

DOCUMENT DETAIL / NO. ……………………………………………………………………………………………………………………………

DETAILS OF REQUIREMENT / RECOMMENDATION

DETAILS OF VIOLATION / DISCRIPENCY

Type of Violation Unsafe Act Unsafe Condition

Originator (Name & Designation) WSN agreed by (Name & Designation)

Signature with Date Signature with Date

(Originator) (RSIPL Engineer / Supervisor)

Date (DD-MM-YY) Date (DD-MM-YY)

Part C - CORRECTION / ACTIONS(S) INITIATED (Completed by the RSIPL WSN Receiver / Sub-Contractor)
Correction / Control Measures Initiated:

Originator (Name & Designation) WSN agreed by (Name & Designation)

Signature with Date Signature with Date

(Originator) (RSIPL Engineer / Supervisor)

Date (DD-MM-YY) TIME (HH:MM) Date (DD-MM-YY) TIME (HH:MM)

Part D - VERIFICATION AND CLOSURE (Completed by Originator)

Details are verified and WSN is closed

Originator (Name & Designation) Project Manager (Name & Designation)

Signature with Date Signature with Date

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Date (DD-MM-YY): Date (DD-MM-YY): AGEING OF WSN Hrs. Mins.

Part E - PHOTOGRAPHS
PHOTOGRAPHIC EVIDENCE BEFORE WSN PHOTOGRAPHIC EVIDENCE AFTER WSN

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