Author: SAFETY UNIT

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

ALAT-ALAT KESELAMATAN
SAFETY GEARS

%

2.0

LAMPU AMARAN/ISYARAT BERKELIP
WARNING LIGHT/BEACONS OR BLINKERS

%

1.1
1.2
1.3
1.4
1.5
1.6
1.7

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

2.1
2.2
2.3
2.4
2.5

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

PERATUS PURATA
AVERAGE PERCENTAGE

PERATUS PURATA
AVERAGE PERCENTAGE

3.0

PAPAN TANDA/ISYARAT DAN ALAT AMARAN
SIGNAGES, SIGNALS AND WARNING SIGNS

%

4.0

LALUAN MASUK JENTERA BERAT/KENDERAAN KE TAPAK BINA
SITE ACCESS FOR HEAVY MACHINERY/VEHICLES

%

3.1
3.2
3.3
3.4

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

4.1
4.2
4.3
4.4

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

PERATUS PURATA
AVERAGE PERCENTAGE

PERATUS PURATA
AVERAGE PERCENTAGE

5.0

KEBERSIHAN TAPAKBINA DAN PENYUSUNAN BARANG BINAAN
HOUSKEEPING & SITE TIDINESS

%

6.0

JENTERA BERAT DAN KENDERAAN PENGANGKUTAN
HEAVY MACHINERY AND TRANSPORT VEHICLES

%

5.1
5.2
5.3

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

6.1
6.2
6.3
6.4

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

MUKA DARI
PAGE ________ FROM ________

3

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
7.2
7.3
7.4
7.5

Dinding penyangga atau penahan peparit yang mencukupi dan sempurna
Adequate of proper shoring and side supports
Laluan yang selesa dan mencukupi bagi pekerja
Adequate access for workers
Tanda rintangan dan halangan jelas dilihat
Barriers and conspicuous signs
Bersih dan bebas dari air dan segala sisa sampah
Free from debris and water
Dihadang pada jarak yang selamat daripada barang binaan dan kelengkapan jentera/mesin
Barricaded at safe clearance from materials, heavy equipments and machinery

8.1
8.2
8.3
8.4
8.5

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

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

MUKA DARI
PAGE ________ FROM ________

3

ULASAN
COMMENTS

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REPORTED BY

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JAWATAN / POSITION

TANDATANGAN / SIGNATURE

TARIKH / DATE

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REVIEW BY

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