Client: (PMC) : PD Contractor:

SAFETY VIOLATION REPORT

Project Ref: : DATE :

Project Name : TIME :

SAFETY DISCREPANCIES NOTED :

1 Construction Fencing 8 Electrical 15 Site Condition
2 Excavation / Earthwork 9 Protective Apparel 16 Equipment Certification
T E M

3 Demolition 10 Fire Protection / Prevention 17 Safety Equipments

4 Scaffolding / Formworks 11 Compressed Gas / Cylinder 18 Motor Vehicles
5 Access Facilities 12 Hand / Power Tools 19 Unsafe Conditions / Acts
I

6 Lifting / Hoisting / Gears 13 Health / Welf / Sanitation 20 Hot Work / Weld / Burning
7 Equipment / Machinery 14 First Aid / Medical 21 Others

REMARKS :
ITEM LOCATION DISCREPANCIES

ORIGINATORS Project Manager

FROM CONTRACTOR DATE :

TIME :
ACTION TAKEN ON ABOVE DISCREPANCIES :
ITEM ACTION

CONTRACTOR'S SAFETY OFFICER CONTRACTOR'S PROJECT MANAGER

CORRECTIVE ACTION(S) BY CONTRACTOR Distribution : Client

TO BE ACCOMPLISHED WITHIN (24) HOURS, PMC
RETURN COPY TO P.M.'S OFFICE WITH Contractor
ACTION TAKEN.