Power & Water Utility Company for Jubail and Yanbu (MARAFIQ) Document ID No : MSSM-1-SF-002

Page 1 of 1
OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT MANUAL Rev. No.: 0
Date of issue: 2 Oct 2011

FORM NO. 107

SAFETY OBSERVATION REPORT
Report No. From To
Dept Dept
Date Time Contractor
Area Location System
Job Description:
ITEM OBSERVATION CORRECTIVE / PREVENTIVE ACTION STATUS ON ACTION(S) TAKEN ETC
REQUIRED

Comments:

Reported by:
Note: Please return this form to Safety Section after taking actions on above-mentioned Safety observations

PROPRIETARY NOTICE IMPORTANT

THIS DOCUMENT CONTAINS INFORMATION PROPRIETARY TO MARAFIQ. ANY DISCLOSURE OR USE IS EXPRESSLY PROHIBITED Only document with stamps are considered official.
EXCEPT UPON WRITTEN PERMISSION BY MARAFIQ.