Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_

P. O. Box 22803, Doha, Qatar
Tel no. 0974-466-79-10/23/24 REPORT Project Title: EPIC FOR POWER
SUPPLY TO DSSA & NWDH

Describe in detail the Job Safety Observation: (including scenarios and recommendations)
_________________________________________________________________________________________________
Date of Job Safety Observation: 16 July’ 07 Time of JSO: 10:00 am
Person Involved: Not Applicable Company Name: Qatar Al Ahtiyah
Nationality: Not Applicable Badge Number: Sub Contractor
Location of Incident: 33kV s/s (Zikreet) IMCO Worksite Supervisor: Mhd. Abdul Rahman

Brief Description of incident:

At around 10:00 am, a hired air compressor of Qatar Al Atiyah sub contractor of IMCO, operating by supplying
air to Jack hammer was suddenly blasting caused by improvised hose coupling. We found out also the unsafe
condition of the air compressor machine when the hydraulic oil was leaking, no proper fire arrestor and the
pressure gauge was totally damage.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately stop the air compressor machine and requesting Qatar Al Atiyah for the immediate removal on the
working area.

State actions taken to correct and prevent such occurrence: If closed what evidence have you to verify:
If still OPEN state measures for closure:

Recommendation;
1) The QP safety rules & regulation for contractor should be implemented.
2) Replacement of the air compressor machine and subject for the inspection and approval by the safety of IMCO and
QP.
3) Use proper materials by coupling of any auxiliary parts of the equipment machine to avoid accident to the workers.
4) All guards, whether fixed or automatic, must be constantly maintained and kept in position while machinery is in
Use.
5) Guards must be maintained systematically by competent persons and defects must be repaired immediately.

Confirm if Job Safety Observation is Open or Closed

OPEN CLOSED

If closed sign: Safety Officer: I hereby confirm that the Job Safety Observation has been closed and corrective preventive
methods applied

Signature: Roge P. Drillon Date: 16, July ’07

Reported By: Reviewed and Checked by HSE In-Charge ONLY:

Name: Roger P. Drillon Name: Francis E. Tan

Signature: Date: 16, July ’07 Signature: Date: 17, July ’07
Designation: Safety Officer Confirm closure if applicable
Are their attachments
YES NO Closed: YES NO
Note: Form must be completed in all sections where possible; clear precise legible reporting must be made, ensure that any
attachments are correctly filled out and stabled or adequately clipped

Form Created: 16_January_07 IMCO_FO_JSO_019

Form revision # : 0