Contract
REF : | ||||||
JABATAN KERJA RAYA, KEMENTERIAN PEMBANGUNAN, NEGARA BRUNEI DARUSSALAM PUBLIC WORKS DEPARTMENT, MINISTRY OF DEVELOPMENT, NEGARA BRUNEI DARUSSALAM BORANG PENILAIAN KESELAMATAN KERJA-KERJA JALAN RAYA ROADWORKS’ SAFETY ASSESSMENT FORM | ||||||
TAJUK PROJEK PROJECT TITLE | ||||||
NO. KONTRAK CONTRACT NO. | PEGAWAI PENGUASA SUPERVISING OFFICER | |||||
PEMBORONG UTAMA MAIN CONTRACTOR | KONSULTAN CONSULTANT | |||||
JUMLAH KONTRAK CONTRACT AMOUNT | $ | JUMLAH BAGI KESELAMATAN AMOUNT FOR SAFETY | $ | |||
TEMPOH KONTRAK CONTRACT PERIOD | TARIKH MULA DATE COMMENCE | HINGGA TO | ||||
KEMAJUAN PROGRESS | % | |||||
1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.7
ALAT-ALAT KESELAMATAN
%
SAFETY GEARS
Jaket keselamatan pantul cahaya
Reflective safety jacket........................................................................................................
Topi keselamatan
Safety helmets ......................................................................................................................
Kasut keselamatan
Safety boots...........................................................................................................................
Pelindung pendengaran
Earing protection...................................................................................................................
Sarung tangan
Protective gloves ..................................................................................................................
Pelindung muka/pernafasan
Face masks/respirator protection .....................................................................................
Pakaian yang bersesuaian
Appropriate working clothes...............................................................................................
2.0
2.1
2.2
2.3
2.4
2.5
LAMPU AMARAN/ISYARAT BERKELIP
%
WARNING LIGHT/BEACONS OR BLINKERS
Lampu amaran dan isyarat dipasang semasa kerja waktu gelap/ malam
Warning light/blinkers install during dark/night................................................................
Lampu amaran/isyarat jelas dilihat dan tidak terlindung
Warning lights/blinkers usually clear and unobstructed...............................................
Lampu pencahayaan kawasan kerja terang dan mencukupi
Flood light for work area adequately and clear..............................................................
Pengawal/isyarat bendera digunakan
Flagman control signal used..............................................................................................
Pengawal/isyarat tanda “BERHENTI/JALAN” digunakan
“STOP/GO” signal board used during work operation ................................................
3.0
3.1
3.2
3.3
3.4
PERATUS PURATA
AVERAGE PERCENTAGE
%
PAPAN TANDA/ISYARAT DAN ALAT AMARAN
SIGNAGES, SIGNALS AND WARNING SIGNS
Alat amaran dan papan tanda dipasang mengikut panduan
Signages and warning signs installed accordingly and systematically ....................
Tidak terlindung dari sebarang benda yang diletakkan
Not obstructed by any item on site...................................................................................
Kon keselamatan tambahan disusun secara teratur dan mencukupi
Additional safety cones installed properly and adequate ............................................
Penghadang kawasan kerja dipasang dengan lengkap dan sempurna
Work area barricaded adequately and properly............................................................
4.0
4.1
4.2
4.3
4.4
PERATUS PURATA
AVERAGE PERCENTAGE
%
LALUAN MASUK JENTERA BERAT/KENDERAAN KE TAPAK BINA
SITE ACCESS FOR HEAVY MACHINERY/VEHICLES
Laluan masuk jentera berat kenderaan pengangkutan
Adequate access for heavy equipment, transport vehicles........................................
Laluan ke tempat kerja tidak terhalang
Access to workplaces unobstructed ................................................................................
Laluan yang dibina, dipelihara dengan sempurna
Access properly constructed and maintained................................................................
Jalan raya awam sedia ada bersih dan dipelihara dengan sempurna
Existing public road clean and properly maintained .....................................................
5.0
5.1
5.2
5.3
PERATUS PURATA
AVERAGE PERCENTAGE
%
KEBERSIHAN TAPAKBINA DAN PENYUSUNAN BARANG BINAAN
HOUSKEEPING & SITE TIDINESS
Kawasan kerja dan sekitarnya bersih
Worksite & surround area clean and tidy........................................................................
Barang binaan, perkakas dan kelengkapan disimpan/disusun dengan sempurna
Materials, tools and equipment properly stored.............................................................
Bersih dari sebarang tekungan air/tumpahan minyak dan sebagainya
No standing water/oil spills, etc..........................................................................................
6.0
6.1
6.2
6.3
6.4
PERATUS PURATA
AVERAGE PERCENTAGE
%
JENTERA BERAT DAN KENDERAAN PENGANGKUTAN
HEAVY MACHINERY AND TRANSPORT VEHICLES
Bersih dan dipelihara
Clean and maintained properly.........................................................................................
Alat pelindung di bahagian bergerak dipasang
Guards on moving parts .....................................................................................................
Didukung di atas tanah yang kukuh dan stabil
Stable, firm base & properly supported ...........................................................................
Dilindungi dari cuaca buruk dan semasa operasi
Protected against adverse weather and work in progress..........................................
PERATUS PURATA
AVERAGE PERCENTAGE
PERATUS PURATA
AVERAGE PERCENTAGE
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7.0 | KERJA-KERJA PENGGALIAN/PEPARIT EXCAVATION WORKS | % | 8.0 | ALAT PERKAKAS TANGAN/ELEKTRIK KUASA ANGIN DAN MESIN MANUAL HAND TOOLS/ELECTRICAL, PNEUMATIC POWERED TOOL AND MACHINE | % | |
7.1 | Dinding penyangga atau penahan peparit yang mencukupi dan sempurna Adequate of proper shoring and side supports ............................................................. | 8.1 8.2 | Alat perkakas tangan dan elektrikal berkeadaan baik Hand and electrical tools in good condition..................................................................... | |||
Mesin gerudi/pemecah jalan digunakan dengan betul dan selamat Pneumatic drill/road breaker correctly and safely used................................................ Perkakas kimpalan gas/arka, tong gas dan mesin digunakan dengan betul dan selamat Gas/arc welding tool, gas cylinder and machine correctly and safely used............. Disimpan dan dipelihara dengan sempurna Maintained and stored properly......................................................................................... Dikendalikan oleh pekerja mahir dan berpengalaman Operated by skilled and experience workers ................................................................. | ||||||
7.2 | Laluan yang selesa dan mencukupi bagi pekerja Adequate access for workers............................................................................................ | |||||
7.3 | Tanda rintangan dan halangan jelas dilihat Barriers and conspicuous signs........................................................................................ | 8.3 | ||||
7.4 | Xxxxxx dan bebas dari air dan segala sisa sampah Free from debris and water................................................................................................ | 8.4 | ||||
7.5 | Dihadang pada jarak yang selamat daripada barang binaan dan kelengkapan jentera/mesin Barricaded at safe clearance from materials, heavy equipments and machinery. | 8.5 | ||||
PERATUS PURATA AVERAGE PERCENTAGE | PERATUS PURATA AVERAGE PERCENTAGE | |||||
9.0 | TIANG ELEKTRIK, KABEL ATAS DAN LAIN-LAIN KABEL BAWAH TANAH ELECTRICAL PYLONS, OVERHEAD CABLES AND OTHER UNDERGROUND CABLE | % | 10.0 | KEBAJIKAN PEKERJA DAN KEMUDAHAN LAIN WORKERS WELFARE AND OTHER FACILITIES | % | |
9.1 9.2 9.3 9.4 | Tidak ada kelengkapan jentera diletakkan di bawah kabel atas berkuasa tinggi No equipment parked under high voltage cables......................................................... Dilindungi dengan lengkap dan sempurna Properly and adequately protected .................................................................................. Tiada operasi dijalankan semasa hujan No operation during raining................................................................................................ Langkah keselamatan/perhatian lebih apabila bekerja di kawasan yang terdapat kabel-kabel perkhidmatan sedia ada Extra precautionary measures/attention taken when working at the vicinity of existing services cables....................................................................................................... | 10.1 10.2 10.3 10.4 10.5 | Tempat tinggal/rehat pekerja mencukupi Adequate accommodation /rest area .............................................................................. | |||
Kemudahan tandas dan tempat mandi Adequate clean sanitary toilets and bathrooms............................................................. Alat pemadam api disediakan Fire extinguisher provided................................................................................................... Peti ubat kecemasan mencukupi disediakan First-aid boxes adequately provided ................................................................................ Pondok pengawal disediakan Guardhouse installed........................................................................................................... | ||||||
PERATUS PURATA AVERAGE PERCENTAGE | PERATUS PURATA AVERAGE PERCENTAGE | |||||
PERATUS KESELURUHAN (%)
OVERALL PERCENTAGE (%)
ULASAN
COMMENTS
PAGE FROM
ULASAN COMMENTS | ||||
LAPORAN OLEH REPORTED BY | ||||
NAMA / NAME | JAWATAN / POSITION | TANDATANGAN / SIGNATURE | TARIKH / DATE | |
DISEMAK OLEH REVIEW BY | ||||
NAMA / NAME | JAWATAN / POSITION | TANDATANGAN / SIGNATURE | TARIKH / DATE | |