QA/QC  › Scaffolding & Safety  › Safety Management Plan
Form · QC-SCF-FRM-002
Safety Management Plan
13 checkpoints across 6 sections. Before project commencement; communicated to all stakeholders
13 Checkpoints
6 Sections
Once per project; updated if changes occur
Safety Manager, Site Manager

Checklist Preview

S.No.CheckpointIS RequirementStatus
A. 1. SAFETY POLICY & OBJECTIVES
A1Safety policy statement: Commitment to zero-accident culture; all activities prioritize worker safety
Acceptance: Policy documented; Signed by site management; Communicated to all workers
Clause 1.1 — Policy
OK
NC
NA
HOLD
A2Safety objectives: Targets for incident reduction, near-miss reporting, inspection compliance
Acceptance: SMART objectives set; Monitored monthly; Reported to management
Clause 1.2 — Objectives
OK
NC
NA
HOLD
B. 2. HAZARD IDENTIFICATION & RISK ASSESSMENT
B1Hazard register prepared: Fall from height, struck by object, electrocution, collapse, etc. identified
Acceptance: Comprehensive list; Severity & likelihood rated; Control measures identified
Clause 2.1 — Hazard list
OK
NC
NA
HOLD
B2Risk assessment matrix: Each hazard rated High/Medium/Low; control hierarchy applied
Acceptance: Risk matrix completed; Elimination/substitution considered first; PPE last
Clause 2.2 — Risk matrix
OK
NC
NA
HOLD
C. 3. CONTROL MEASURES & SAFE WORK PRACTICES
C1Engineering controls: Scaffold design, guardrails, safety nets per IS 3696
Acceptance: Controls specified per risk; Standards met; Design approved by engineer
Clause 3.1 — Engineering
OK
NC
NA
HOLD
C2Administrative controls: Work permits, JSA, supervision, inspection frequency documented
Acceptance: Procedures documented; Training schedule included; Responsibility assigned
Clause 3.2 — Administrative
OK
NC
NA
HOLD
C3PPE requirements: Helmets, harnesses, footwear specified; inspection & maintenance plan
Acceptance: PPE types listed; Fit-testing planned; Maintenance schedule noted
Clause 3.3 — PPE
OK
NC
NA
HOLD
Showing 7 of 13 checkpoints ·
A. 1. SAFETY POLICY & OBJECTIVES
A1Safety policy statement: Commitment to zero-accident culture; all activities prioritize worker safety
Clause 1.1 — Policy (IS 3696)
Policy documented; Signed by site management; Communicated to all workers
OKNCNAHOLD
A2Safety objectives: Targets for incident reduction, near-miss reporting, inspection compliance
Clause 1.2 — Objectives (IS 3696)
SMART objectives set; Monitored monthly; Reported to management
OKNCNAHOLD
B. 2. HAZARD IDENTIFICATION & RISK ASSESSMENT
B1Hazard register prepared: Fall from height, struck by object, electrocution, collapse, etc. identified
Clause 2.1 — Hazard list (IS 3696)
Comprehensive list; Severity & likelihood rated; Control measures identified
OKNCNAHOLD
B2Risk assessment matrix: Each hazard rated High/Medium/Low; control hierarchy applied
Clause 2.2 — Risk matrix (IS 3696)
Risk matrix completed; Elimination/substitution considered first; PPE last
OKNCNAHOLD
C. 3. CONTROL MEASURES & SAFE WORK PRACTICES
C1Engineering controls: Scaffold design, guardrails, safety nets per IS 3696
Clause 3.1 — Engineering (IS 3696)
Controls specified per risk; Standards met; Design approved by engineer
OKNCNAHOLD
C2Administrative controls: Work permits, JSA, supervision, inspection frequency documented
Clause 3.2 — Administrative (IS 3696)
Procedures documented; Training schedule included; Responsibility assigned
OKNCNAHOLD
C3PPE requirements: Helmets, harnesses, footwear specified; inspection & maintenance plan
Clause 3.3 — PPE (IS 3696)
PPE types listed; Fit-testing planned; Maintenance schedule noted
OKNCNAHOLD
Showing 7 of 13 ·
Inspection Sign-Off
APPROVED
APPROVED WITH CONDITIONS
REJECTED — REVISE
Remarks
Name / Sign / Date
Prepared By
Name / Sign / Date
Approved By
Name / Sign / Date