Instrument, Installation & Maintenance Co.

Job Safety Observation Report No: IMCO_JSO_11

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: 27, August’ 07 Time of JSO: 03:30 pm
Person Involved: Mhd. Ayoub Gul Company Name: Qatar Al Atiyah
Nationality: Pakistani Badge Number: Sub Contractor
Location of Incident: sub station 905 at DSSA IMCO Worksite Supervisor: Eddie Mendoza

Brief Description of incident:

At about 3:30 pm, QAIG sub contractor of IMCO in s/s 905 at DSSA unloading the chain excavator. Due to the
narrow space road the low-bed trailer (when chain excavator load) does not get proper position to unload the
excavator, they are decided to position near to the sidewalk gutter and unload the excavator. But unfortunately
the interlocking tiles and curved store has suddenly damage.

Attach separate sheets if insufficient space; NOTE IMCO_FO_JSO_019a

Action Taken:
Immediately stop the operator to unload the chain excavator and assist them to provide a piece of wood for
travel of chain excavator up to the portion of rough road which is not to damage the gutter..

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) Worksite supervisor should check the area and study before transferring any heavy equipment especially in narrow
space road.
2) Assign a signal man to assist the driver for maneuvers of the trailer.
3) Avoid unnecessary discussion that causing of delay of work and causing of traffic.
4) If the surface of area is not level and unsafe for unloading of chain excavator, ensure that area will backfill and
leveled the ground.

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: Joel R. Vestal Date open: Date closed:

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

Name: Joel R. Vestal Name: Francis E. Tan

Signature: Date: 27, Aug.’07 Signature: Date:

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